Aged Care in Nursing - Case Study Example

Aged Care in Nursing Name Institution Introduction Proper nursing care is critical for a patient’s recovery. Nursing interventions determine how a patient responds to treatment. I may also determine the patient’s mortality. Nursing care needs to be prioritized. Prioritization ensures that the important nursing interventions necessary for patients recover are done. It ensures that nurse do not overlook any of the patient’s needs. Thus prioritization will be necessary to help Mr. Simon fully recover from his hip replacement surgery as quickly as possible. Nursing assessments are also critical for the understanding of the patient’s entire circumstances and need. Assessment entails comprehensive evaluation of a patient’s situation to provide personalized care, no patient situations are similar. Therefore, assessment of Mr. Simon’s situation is necessary in order to personalize his care. Also, when personalizing nursing interventions, it is necessary to use evidence based strategies and practice. This paper will prioritize Mr. Simons nursing care, provide an assessment procedure and suggest evidence based care intervention for nursing. Nursing Assessment Nursing assessment is critical for nursing care. It entails collecting essential and critical information about the patient. Such information includes psychological information, physiological information, spiritual information and psychological information. Consistent and timely assessment also ensures that nursing interventions are timely (The Royal Children’s Hospital of Melbourne, 2014). Assessments are done during admissions, during change of shifts and specific or focused assessments may be done at any time to determine the status of the patient. Admission nursing assessments have a sturdy association with in-hospital mortality, while post-discharge nursing assessments have a link with post-discharge mortality regardless of the patient’s medical diagnosis and history (Rothman et al, 2012). This evidence clearly illustrates the significance of nursing assessment of patient care. Nursing assessment entails four basic steps. They include data collection, data organization, data validation and data documentation (Ackley, & Ladwig, 2014). The data collection may be subjective or objective. The data collected mainly includes all information about the patient. The information includes spiritual, psychological, socio-cultural, emotional, physical fact the influence the patient heals (Monks, 2003). The patient health history must also be collected. These include past surgeries, chronic disease, allergies and any use of folk healing approaches. The present health challenge experienced by the patient must also be noted down. They may include nausea, pain, sleeping patterns, religious practices, current treatment or medications. The patient subjective data consist of covert data or symptoms collected from patients verbal statements while the objective data is made up of overt data or the signs that can be tested or measured against a universal standard. The data from the patient will be collected through observations, interviews and physical examination. Various technical will also be used to collect that data. Once the data is collected, validation is necessary to establish accuracy. Validation involves double-checking to ensure the data is factual to facilitate proper decision-making and limit instances of jumping to conclusions. Organizing that data facilitates systematic presentation of the data for easy assessment (Viljoen, 1988). Recording completes the assessment. Documentation avails all the information collected about a patient. The firs data that the nurse will collect during the assessment is the patient’s vital signs. Vital signs are critical for understanding the immediate patient’s health (Curtis et al., 2011). They include the patient’s blood pressure, pulse rate, temperature, oxygen saturation, respiratory rate, pain score and glucose levels. As Rose & Clarke (2010) note the vital signs results give the patient's baseline for identification of any deteriorations in future. It is easier to identify the patient’s situation through the use of the patient’s vital signs. As Rose & Clark (2010) further observe, abnormal vital signs in a patient are the primary indicators that the patient’s body has compensatory reactions against an infection or injury. The revelation given by the likely compensatory reaction guides the execution of further investigations, assessment and choice and implementation of interventions. In Mr. Simon’s scenario, most is his vital signs are okay. His condition is table and his pupils have equal reactivity. His body temperature is also within normal range. However, the only digression is that of his blood pressure 137/78 mmHg, and pulse 87 bpm which are above the normal range. He is also confused and unable to comprehend anything. He does not remember alto of thing and also fails to stick by what he is told. Next, assessment priority is the patient’s environment and health. A head to toe assessment must be done to determine the patient’s physical health and suitability of the environment (Rose & Clark, 2010). This assessment takes into account the patient’s nutrition status, ability for mobility and self-care, cognitions, orientation, visions mood, memory, among other factions (Rose & Clark, 2010). It also checks the neck, chest, and the abdomen and the associated organs and their functioning. Others are skin, nails, hair, genitalia and extremities. The Physical assessment of Mr. Simon reveals head injury and swelling, injury and healing surgery wood on the femur which limits movement, dehydration, memory loss and poor cognitive ability (Rose & Clark, 2010). The rest of the physical organs and function are okay. The patient’s memory loss and poor cognitive ability could be a product of the anesthesia used during surgery or the injury he sustained on the head during a transfer in the theater (Rose & Clark, 2010). An examination of the mental state and assessment of the state of confusion will be done. Since the patient is elderly, as Sendelbach & Guthrie (2009) observe, the two assessments are essential to establish whether the patient any mental issues such as delirium, amnesia, or dementia. The test can help put the patient repeated asking of his dead wife to take him home and the forgetfulness of what happened prior to his accident (Yap & Joyner, 2014). However, the patient consistent request for his wife is an indicative of the patient need for care. Alongside with his consistent dropping of the PCA button and attempts to rise up despite instruction not rise up indicates restlessness which is a sign of discomfort in the ward environment. Psychiatric assessment is also necessary to rule out or confirm depression (Yap & Joyner, 2014). Neurovascular examination is also essential since the patient’s mobility is limited. Neurovascular injuries are common in hip replacement patients and thus it is essential to assess the neurovascular state of the patient (Barrack & Butler, 2003). The neurovascular injuries commonly mainly involve the peripheral nerves or the central nervous system. The evaluation will focus on assessing the vascular and neural integrity of the limb (Judge, 2007). Integumentary system is the last priority for the assessment is the last on the priority list of assessments. As people age the skin loses its elasticity, became fragile, dry and weak,which predisposes the skin of the elderly people to a high risk of damage (Hunter 2012). Mr. Simon’s operation and healing needs require him to stay in a fixed position for long hour and this would predispose his skin to injury through bed sores, or pressure ulcers. A proper assessment of his skin and skin sore risks will develop early interventions. The assessment of the skin around the point of incision during surgery and the skin around the head bruise and swelling is also necessary to monitor the healing process. Based on Hess (2008) other observations to conduct for the skin are rashes, discolorations, hematoma, liaisons and bruises. Prioritization, and rationale for planned client centred care of Mr Simons Nurses play a critical role in ensnaring patients receives personalized care. Mr. Simon will require personalized care the targets his unique situations. Patient postoperative pain management Clinical care evidence from suggests that postoperative pain is normally sub optional. Unless pain management is made consistent with guidelines developed from the best available scientific evidence, poor pain management is likely to persist (Botti et al., 2014). The best pain management for Mr. Simon is multimodal analgesia (Botti et al., 2014). This is a multimodal pharmacological pain management approach in which patient gets a combination of strong and weak analgesics through systemically and local administration. Administration of a single analgesic, which may either be non-steroidal anti-inflammatory drug (NSAID) or opioid is not effective and has a number of undesirable side effects (White &Kehlet, 2010). Combination of drugs that have different mechanisms, on the other hand, results in synergistic analgesia characterized by reduced dosage of individual analgesic and minimal side effects (Dolin &Cashman, 2005). The timing of the administration also has an influence on the dosage requirements (Husain, Gurha&Tiwari, 2009). The administration should be preemptive and aggressive. Lowering high blood pressure The patient has a high blood pressure. Due to his old age, if the blood pressure is not managed appropriately, there is likelihood that he might develop hypertension. Reducing blood pressure is very critical. Although the patient’s blood pressure is high, it is not a life threatening levels and therefore will not necessitate aggressive drug therapy. Nursing care will seek to gradually reduce the blood pressure to normal level using alternative means (James et al 2013) His surgery wound, head bruise and swelling care Before it heals, the incision wood will require proper care to prevent bacterial infection as well as reduce pain and improve the quality of life during the healing process. First, wood dressing is critical. Modern dressing using Aquacel Surgical is more effective than traditional adhesive dressing (Mepore) (Hopper et al 2012). Mepore has a shorter were time and require more frequent change. Aquacel Surgical has far less blistering. On the outer layer, it uses viscoelastic hydrocolloid layer which accommodates hip movements. In the inside, it uses a highly absorbent hydro fiber material that can accommodate enormous quantities of exudates. Dressing is very critical and dressing complication can increase the recovery period as well as increase costs (Ibrahim et al. 2013). Compression bandage in the first eight hours following the surgery lead to reduced pain as compared to non-compression bandage (Hopper et al 2012). Studies have also shown that wound draining is critical. Draining the wound helps to prevent collection of excessive fluids in the wound and thus facilitate quick recovery (Jaberi et al 2008). Draining will be done using Belovac equipment.Belovic drain excess fluids from the wound and will require periodic emptying when they fill up. Proper handling of the drains is also necessary to maintain the suction presses Tackling the confusion and memory loss It is important to help the patient get comfortable and tackle his amnesia. Since the patient’s memory may take time to recover, yet he does not live with anyone, it will be the Registered Nurse role to help the patient. Counselling will play a critical role (Yap & Joyner, 2014). The nurse will tell the patient what happened and how he come to be where he is. The nurse will feed him with details to help him recollect his lost memory. It will also be necessary to monitor to determine how long the patient takes to regain his consciousness following the trauma on the head. Prevention of Neurovascular injury Due to the reduced mobility consistent observation will be necessary to ensure the patient does not suffer neurovascular injuries (Judge, 2007). The observation should be recorded and action should be taken immediately negative change is noticed. Proper intervention such as massage, reducing constriction by the bandages and physiotherapy will be done to alleviate the symptoms Handling of pressure ulcers Pressure ulcers are better handled through prevention. To prevent the patient from developing pressure ulcers, they will keep changing the patient’s position to ensure that no part of the body is under pressure consistently for extended periods of time (Lyder & Ayello, 2013). In addition, the nurse will ensure that the patient’s bed is as comfortable as possible so that no surface is hard enough to cause sores (Cooper, 2013). IDC care IDC care is necessary to ensure the patient does not develop renal complications and other problem due to longer use of indwelling catheters (Herter &Kazer, 2010). The use of catheters will last till the patient regains his normal hip movements. Closed drainage should be maintain and any leaked or disconnections occur, cleaning and disinfection should be done and a new sterile equipment installed using the aseptic technique (Willson et al, 2009). It is important to ensure the flow of urine is unobstructed and a new bag replaced frequently. Conclusion The prioritizing nursing care intervention for Mr. Simon is critical. The client has multiple issues that need to be handled and his age has the probability of aggravating the illness. Prioritization of nursing care initiatives ensures proper understanding of the patient’s situation. The status can only be put into perspective through proper assessment. Therefore the nurse will prioritize and conduct nursing assessments to ensure there is a clear perspective of the entire physiological, psychological, and physical status of the patient. The assessment results inform the nurse of what is needed to help the patient recover. In the care of patients, the use of evidence based care is important since it ensures that only interventions with proven efficiency and success are adopted and used for managing the patient situation. In intervening in Mr. Simon nursing care needs, the nurses will use evidence based interventions to ensure he gets the best care possible. References Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care. Maryland Heights, Missouri : Mosby Elsevier Barrack, R. L. & Butler, R. A. (2003). Avoidance and Management of neurovascular injuries in total hip arthroplasty. Intr Course Lect. 52. 267-74. Botti, M. et al. (2014). 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