Implement and Monitor Nursing Care for Clients with Acute Health Problems - Case Study Example

Humerus Fracture Course Professor University City Date Reason For Admission John is my client who suffered broken humerus (this is the condition where an upper bone of the bone fractures). The client was lucky not to have broken both arms. In simple terms john (not the real name) bone extending from the elbow to the shoulder got a fracture after an accident when he was riding a motorbike. This was as a result of an impact generated after falling with the motorbike moving at a speed of 100 km/h. since this was a high impact fall, there muscle contradiction resulting into a curve of the humerus. This article analyses the situation John is faced with after suffering a humerus fracture in the right arm coupled with various injuries to his hands and other body parts. The analysis will include the signs and symptoms, the reasons for admission, anatomy and physiology relevant to humerus surgery, hospital care and the outcomes of client hospitalization. Signs And Symptoms When john arrived at the hospital with humerus fracture the following symptom were recorded. As a result of various measures taken to reduce pain, I was able to contain some of the symptoms within one hour before taking the patient for surgery to repair the bones. The client was in great pain; the hand was swelling and bruising in the upper arm. As a result the hand and the shoulder could not move and this meant deformity in the broken arm. I noticed that the arm was a bit shorter compared to the other arm due to the curve of the bone and bones were partially separated. Looking keenly at the place where there was a fracture there was an open would in the skin and the broken bones were visible through the skin. Intervention To Relieve Pain Ahmad (2012) explains that, pain after a fracture is normal because the body must respond biologically to the break and injuries suffered. Body tissues near the fracture are the reducing the pain due to swellings and the redness of the skin. Majority of the bone fractures experienced by patients are treated without requiring any surgery. For john’s case the hand could not have healed after immobilization in the cast. Surgery was urgently required because the fracture was severe due to an open would and exposed bone in the elbow joint (Marder 2012). According to Hatzidakis (2015) in order to avoid any kind of infection antibiotics were directly injected in the arm and then the next mission was to reduce the pain. To relief the client pain the first step was to administer strong pain killers expected to reduce pain for a moment but the next procedure to permanently relieve the pain was to perform a quick surgery and restore the strength of the arm, the motion of the joint and normal functions. Also the interventions were aimed at resting the patient normal activities. Health Problem On Client And Family There are problem likely to occur to both the client and the family. First the client will require caregiving by the family which sometime can be stressful and likely to exert some burden to the caregivers who are likely to be family members. Patients with severe humerus fracture require specialized treatments and sometime the care givers are not specialized to offer quality services as required. Therefore the likely scenario on the patient sides includes high possibility of client re-hospitalization, long time to recovery and possible deterioration of the situation. Factors That May Impact On Client Care Discharging the clients with fractured humerus especially the elderly requires extensive plan by experienced professionals. This is because the patients will continue to recuperate at home. The discharge plan for the client must include a rigorous assessment of the client situation and the needs required at the home setting (Vrahas 2013). Seybold (2012) argues that, there is a consensus among scholars that physical environment in the hospital can have a widespread effect on the client care and recovery. These factors include high level of noise that defines health care systems, the smell and the colours. For instance nurses are accustomed to high noise in the hospital while patients may be affected by this if they are not accustomed. Noise disturb the patient brain, their sleeping patterns thus affect how they are recovering. On the other hand the hospital environment has the effect on the nurses and doctors themselves. For instance when staff is not motivated this affects their productivity and the outcome of their job (Seybold 2012). Other factors affecting nurses include the outlook of the hospital, layout and communication between healthcare workers and team in the workplace. Many hospitals, they have started recognizing the importance of the working environment in the provision of care to patients/clients (Feeley 2011). Other factors impacting on the patient health care is changes that have taken place in clinical setting. The changes have placed many demands affecting the level of client care. Still, care received from family members is associated with the risk of re-hospitalization (Seybold 2012). Physical And Psychological Impacts On ADL There are psychological and physical impacts which affect the client with health problem in relation to activities in the daily living. Clients with humerus surgery can be affected by stress and this slows the speed of healing wounds. For instance a client with stress takes long time than normal to recover their health. In addition, stress can also prompt behaviors that are damaging to patients activities on daily living. Poor healing for clients is likely to increase the level of risk exposed to clients resulting to complications and infections which lengthens the period to normal activities of daily living (Keeling 2013). Thus it appears that physiological stress has an impact on the period clients take to return to activities of the daily living. Connected to this is stress and distress among client both of which affects negatively the time taken to heal. Other than psychological factor there are physical factors which have an impact on client activities of the daily living. If the client was a parent their ability to provide to the family and have time with family is affected because they cannot normally function. For instance when clients are taking bath they are likely to experience difficulties and therefore they require help from friends and family members (Doebele 2014). The same applies when they want to take bathroom. For example, clients undergoing humerus surgery have experienced long time before fully returning to their activities of the daily living and spent more time in hospital. For some clients they are return to hospital due to psychological stress. Discharge Plan And Rationale Behind It According to Doebele (2014) before discharging the client with humerus fracture there must be a well thought plan which encompasses varieties of factors such as where the patient will go to fully recover away from hospital. The question is where the client will go after discharge. Is it at home or in another facility? If the client will go home, then there must be a visiting nurse to evaluate the seed and the level of recovery. If not a nurse then a friend must be present as present to take care for the present. Those arrangements must be taken care off. If the client was introduced into new form of medications, their side effect need to be acknowledged, the right dose and the main reasons as to why the patients are receiving them. If there is other medication required when the client is at home, they must be told where to buy and what kind to buy and for what reasons. For the clients with humerus case, they have to be told the activities they will do (Doebele 2014). For example the clients cannot bathe comfortably, drive or use the staircases comfortably or handle other activities. After discharge clients should be informed the professionals they will visit for full recovery. Keeling (2013) adds that, Patient with humerus fracture may need therapy. Such services undertaken outside must be accompanied by a conclusive summary report detailing everything including the response to medication, the pace of recovery and other recommendation. Make sure these appointments are made for you, and ensure that the providers of these services get a report summarizing your hospital stay. Anatomy, Physiology And Pathophysiology Of Humerus Surgery The following is anatomy of the client who suffered a humerus fracture. The named bone commonly known as humerus is a bone located in the forelimb and runs from the elbow to the shoulder. The bone is long and plays essential roles in the movement of the arm and supporting the arm from the shudders. The humerus is found on both arms and articulates with the bone known as scapula located right at the shoulder. The upper portion of the bone is subdivided into three parts. The parts include the rounded head, tubercles and finally the narrow neck (Keeling 2013). Care Of The Humerus Client In Hospital Ahmad (2012) writes that, after the client reported to the hospital and explain their symptom the first test was to take an x ray to ascertain the exalt position where the fracture has happened and the necessary measure/intervention possible. The test ascertained that the joint ball was not in the same exalt position it is supposed to be. The immediate measure was to perform a surgery to replace the broken ball head with a plastic surface. Naturally the shoulder ball is supposed to rests on the socket. Medication for the client included the pain killers and antibiotics to prevent any infections through open in the elbow joint. When providing care for the clients, they should be resected with outmost dignity. This should be achieved through reducing the embarrassment when dealing with procedures considered undignified. In some cases the attitude of the care giver or the nurse should be used to show dignity to clients (Ahmad 2012). So as to deal with cultural and language variation the approaches to be sued must recognize the views of others irrespective of their religion and their culture. Client is expected to intervene and take part in their own treatment by revealing new symptoms to their care givers. Outcomes Of Hospitalization Of Humerus Surgery Proximal humerus fracture is a condition commonly among young and older people in the society. Restoration of such condition and the functions of the broken humerus take place after a comprehensive understanding of the bone anatomy. The most common humerus complications include shoulder instability, other infections and actually the nerves where the fracture takes place are damaged and bones around the fracture loosens. In most cases the condition can be treated without operation and when actual surgery takes place there must be through investigation. When surgery takes place the locking plate is commonly used to treat the intervention. The most common form of intervention should focus on maximizing the client functional outcomes and reducing pain (Austin 2012). John’s fracture cut through the neck and this resulted into a compromise of humeral head. Proximal humerus fracture evaluation should start by investigating and ascertaining the medical assessment records. Follow up strategies should include an evaluation of the pace of recovery, response to medications and ascertaining whether there are complications after treatment. These should be carried using radiography after intervals of around two (2) to ensure bone stability and replacement. After the client has fully recovered from the fracture there will be support services such as therapy and counseling if necessary among other services as required by patients. References Ahmad, C, S 2012, ‘Hemiarthroplasty for three-and four-part proximal humerus fractures’, Journal of the American Academy of Orthopaedic Surgeons, 20(1), 17-27. Austin, L, S 2012, ‘Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients’, Orthopedics (Online), 35(5), e703. Dines, J, S 2013, ‘Management of proximal humerus fractures utilizing reverse total shoulder arthroplasty’, Current reviews in musculoskeletal medicine, 6(1), 63-70. Doebele, S 2014, ‘Dynamic-locking-screw (DLS)–leads to less secondary screw perforations in proximal humerus fractures’, BMC musculoskeletal disorders, 15(1), 194. Feeley, B, T 2011, A systematic review of locking plate fixation of proximal humerus fractures’, Injury, 42(4), 408-413. Hatzidakis, A, M 2015, ‘Intramedullary nail for proximal humerus fractures: an old concept revisited’ In Simple and Complex Fractures of the Humerus (pp. 91-112), Springer Milan. Keeling, J 2013, ‘Circular external fixation for treatment of distal humerus fractures: case report’, The Journal of hand surgery, 38(6), 1155-1160. Marder, R, A 2012, ‘Epidemiology of humerus fractures in the United States: nationwide emergency department sample’, 2008. Arthritis care & research, 64(3), 407-414. Seybold, D 2012, ‘Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures’ A reliable system?, Injury, 43(2), 223-231. Vrahas, M, S 2013, ‘Factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly’, Injury, 44(4), 448-455. Read More