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Nursing Case study for Public Health Act

Question:

Discuss about the Nursing Case study for Public Health Act.

Answer:

1.

Nursingdiagnosis

(patient's need)

 

Planning (Nursing intervention Required)

Expected Outcome

 

Pains assessment and identify risk of impaired tissue perfusion

Oxygen supply, educate patient regarding adequate tissue perfusion, use of incentive spirometer, promote the use of cpm,

Adequate tissue perfusion

social functioning

Assist in ADLs, patient centered care to minimize anxiety and depression, improve self esteem, motivation and counseling.

Improved social functioning

Risk of infection due to severe pain, decreased mobility

Assessment of skin (colour, temperaure), assessment of pain, encourage fluid intake, administer antibiotics.

Wound healing, patient may be afebrile and prevent erythema,

Decreased Physical mobility

Assessment and management of pain, mobilization, help patient with mobility aids, assist with ROM exercises to unaffected joints, proper positioning in bed

Maintain position of function. Increase in strength of knee and joint function, Participation in ADLs

Ref- Cooke, M., Walker, R., Aitken, L.M., Freeman, A., Pavey, S. and Cantrill, R., 2016. Pre‐operative self‐efficacy education vs. usual care for patients undergoing joint replacement surgery: a pilot randomised controlled trial.Scandinavian journal of caring sciences, 30(1), pp.74-82.

2.

Middle aged (45-60) women undergo menopause and the ovaries do not produce estrogen. It results in vaginal dryness, lack of sexual desire and increase in irritation. It is the same case with Mrs. Green. Women having high body mass index are also dissatisfied with weight gain and is evident in case of Mrs. Green.  In addition, when patient undergo chronic illness face permanent lifestyle changes, increased dependency, decreased self-esteem; their normal life transition is disrupted and low social connectedness. Consequently, this causes irritation, psychological and physiological changes therefore Mrs. Green is finding difficult to adjust with her body image.

Ref-Alexander, J.L., Dennerstein, L., Woods, N.F., McEwen, B.S., Halbreich, U., Kotz, K. and Richardson, G., 2014. Role of stressful life events and menopausal stage in wellbeing and health. Expert review of neurotherapeutics.

3.

As a nurse I will keep three factors in mind to make Mrs. Green feel comfortable. It includes “comfort, safety and dignity”. I would initiate any new task taking Mrs. Green’s permission and communicate with her in a soothing and soft voice. I will assess her level of dependency and maintain her autonomy as much possible, while bathing and dressing. I would take care of her personal preferences regarding her personal hygiene as I would love to be treated. I would provide health education which would assist in maintaing patient’s sense of control and minimize embarrassment.

Ref- Cox, J., Cormack, C., Prendergast, M., Celestino, H., Willis, S. and Witteveen, M., 2016. Patient and provider experience with a new model of care for primary hip and knee arthroplasties. International journal of orthopaedic and trauma nursing, 20, pp.13-27.

4.

The two priority needs to be considered when in planning for Mrs. Green’s discharge include

  • Ensure observations are within normal limits and pain controlled on oral analgesia
  • Degree of mobility and fall prevention measures – use of walkers and crutches freely and no sign of wound infection

Ref- Cooke, M., Walker, R., Aitken, L.M., Freeman, A., Pavey, S. and Cantrill, R., 2016. Pre‐operative self‐efficacy education vs. usual care for patients undergoing joint replacement surgery: a pilot randomised controlled trial.Scandinavian journal of caring sciences, 30(1), pp.74-82.

5.

At the age of 50 Mrs. Green is experiencing menopause and associated physiological changes. She has lost protection of estrogen and consequently she experiences shrinkage of genital organs. Women lose sexual desire and incontinence occurs. She is highly susceptible to chronic illnesses. She is also experiencing weight gain and is dissatisfied. At this age the metabolic rate is decreased and muscle tone is not well maintained. Women after menopause undergo emotional troubles such as depression, anxiety, low self esteem, moodiness. Mrs. Green has poor self image due to aging and declining physical activity and increasing dependency for ADLs.  

Ref- Alexander, J.L., Dennerstein, L., Woods, N.F., McEwen, B.S., Halbreich, U., Kotz, K. and Richardson, G., 2014. Role of stressful life events and menopausal stage in wellbeing and health. Expert review of neurotherapeutics.

6.

The community resource/support service that Mrs Green may need after discharge is –“The Victorian Rehabilitation centre”. This community services are important aspect of patients after knee arthroplasty. This community services provides focused therapy that enhances faster recovery in patients. It includes sessions of occupational therapy, shower and dressing, breakfast and physical therapy and range of physical activity.

Ref- O'Brien, L. and Bethavas, E., 2013. The Victorian Charter of Human Rights and its impact on the nursing profession. Australian Nursing and Midwifery Journal, 20(7), p.25.

7.

ADMISSION NOTES

DATE:

12/6/14

NAME:

Mr George Grandin

AGE ON ADMISSION:

87 year

GENDER:

male

RELIGION:

           Christian

CULTURE:

George attends bowling, and church weekly, George has strong faith in God and practice Catholics.

LIFESTYLE PATTERNS:

George maintains healthy lifestyle. He takes nutritious food, multivitamin, and fish oil supplements. He is physically active.

George has strong support network at home and at church. He has high social connectedness.

 

 

COPING MECHANISMS:

 

He is coping up with ageing process with the help of his family support. He maintains his diet and medication and seeks physiotherapist for gait and balance.

SOCIAL:

 

George lives with his wife in their daughter’s flat. He identifies with strong Spanish ties in Australia.

CURRENT HEALTH PRACTICE/NEEDS:

 

Currently George is maintaining good health practices. He takes nutritious food, multivitamins and fish oil supplements. Cognitively, George is alert and orientated.

He had been ambulating independently prior to the fall, but is to be assessed by a physiotherapist for balance and gait and the need for a walking stick or frame. He needs Metamucil daily for constipation.

ADL ASSESSMENT:

·         DIET

·         OUTPUT

·         MOBILISATION

·         HYGIENE

DIET:  can feed own meals

OUTPUT: constipation but no urinary issues

MOBILISATION:  with the help of walking stick and frame

HYGIENE: Independently perform own hygiene

FAMILY CONCERNS AND NEEDS RE: CLIENT

 

George’s daughter is worried about health care needed for George at home.

ADMISSION OBSERVATIONS:

·         T

·         P

·         R

·         BP

·         HEIGHT

·         WEIGHT

·         BMI

T= 36.1

P= 64

R= 18

BP= 105/68

Height= 181cm

BMI= 18 (weight 65 Kg)

NURSING NOTES:

(sign off with name, signature and delegation at the end of the notes)

Name

Signature

Delegation

8.

Nursing diagnosis

(patient's need)

Planning

(Nursing intervention Required)

Expected Outcome

 

Severe pain

Referral  pain clinic, stop usage of NSAIDs, administer paracetamol or any  strong analgesia

Pain relief

Risk of altered mental state

Administer depressants, maintain electrolyte balance. Monitor mood changes  

Prevent confusion, anxiety and depression. Improves mental well being

 

 

Risk of fall in future

Assessment of factors contributing fall (higher position of bed, slippery floor), elimination of the factors, keep bed in low position, provision of gait belt, strengthening exercises for patient  for transfers and ambulance and provision of health education  

Prevents fall

 

Risk of developing pressure areas on these bony prominences

Protection from exogenous contamination, timely dressing and cleaning of wound with the sterile water and use of saline or a topical antiseptic. Monitor skin impairment and maintain fluid balance

Prevention of pressure ulcer and maintains tissue integrity  

 

Ref- Anderson, C., Dolansky, M., Damato, E.G. and Jones, K.R., 2015. Predictors of serious fall injury in hospitalized patients. Clinical nursing research, 24(3), pp.269-283.

9.

Relaxation and meditation is the stress management technique that I would recommend for Mr Grandin’s Nursing Care Plan. Literature review provides an evidence of stress relieve in patients with pain and injury with the help of meditation and exercise.

10.

Patient’s personal health record can be generated and utilized in electronic health record (EHR) is the appropriate method used to collect health related data, as a part of the admission process for Mr Grandin.

Ref- Rashvand, F., Ebadi, A., Vaismoradi, M., Salsali, M., Yekaninejad, M.S., Griffiths, P. and Sieloff, C., 2016. The assessment of safe nursing care: development and psychometric evaluation. Journal of Nursing Management.

11.

Assessment needed by George includes measurement of bone mineral density, multifactorial risk assessment, evaluation of gait and balance and home environment. The nursing care plan will include provision of diet charts and exercise for balance strength, and gait training. Medication chart will consist of antidepressants and antipsychotics, NSAIDs, sedatives and hypnotics.

Ref- Howlin, F., Halligan, P. and O'Toole, S., 2014. Development and implementation of a clinical needs assessment to support nursing and midwifery students with a disability in clinical practice: Part 1. Nurse education in practice, 14(5), pp.557-564.

12.

The two risk factors for older people in hospital are:

  • Risk of chronic pain and heart disease
  • Risk of comorbidities

Ref- Howlin, F., Halligan, P. and O'Toole, S., 2014. Development and implementation of a clinical needs assessment to support nursing and midwifery students with a disability in clinical practice: Part 1. Nurse education in practice, 14(5), pp.557-564.

13

The community support services needed by George include

  • Falls talk and Fallscape - includes behavioral intervention methodology and documentation of screenings and fall history and multimedia training
  • 8 Week program – group interventions to teach practical strategies to reduce fear of falling, exercise to increase strength and balance and set realistic goals to increase activity

Ref- Anderson, C., Dolansky, M., Damato, E.G. and Jones, K.R., 2015. Predictors of serious fall injury in hospitalized patients. Clinical nursing research, 24(3), pp.269-283

14.

The ANMC code of conduct relevant to the case study is “Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care”. Active engagement of George in decision-making will give him a sense of control. It helps patients to believe that their dignity and self-respect is maintained.

Ref-Nursingmidwiferyboard.gov.au. (2016). Nursing and Midwifery Board of Australia - Professional standards. [online] Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 1 Sep. 2016].

15.

The ANMC code of ethics relevant to the case study is “Nurses value a culture of safety in nursing and health care”. The rationale for using this code in George’s case to support the development of shared knowledge and understanding safety as well as development of risk management processes. It helps to prevent adverse events. Nurses recognize the factors in health care setting promoting the adverse events and create a culture of safety by working with their colleagues.

Nursingmidwiferyboard.gov.au. (2016). Nursing and Midwifery Board of Australia - Professional standards. [online] Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 1 Sep. 2016].

16.

The NMBA Enrolled nurse standards for practice relevant to the case study is- “Provides skilled and timely care to people whilst promoting their independence and involvement in care decision–making”. Patients like George are unable to take care of their own physical and mental health needs. As nurse these standards in the practice is to ensure active participation and independence of the admitted patient. Nurses need to recognize when patients physical and mental health is deteriorating and provide appropriate assistance.

Ref- Waugh, A., Smith, D., Horsburgh, D. and Gray, M., 2014. Towards a values-based person specification for recruitment of compassionate nursing and midwifery candidates: A study of registered and student nurses' and midwives' perceptions of prerequisite attributes and key skills. Nurse education today, 34(9), pp.1190-1195.

17.

The relevant act as per case study is –“Public Health Act 2010”. It relates to maintenance of public health standards for the public and other.

Ref- Waugh, A., Smith, D., Horsburgh, D. and Gray, M., 2014. Towards a values-based person specification for recruitment of compassionate nursing and midwifery candidates: A study of registered and student nurses' and midwives' perceptions of prerequisite attributes and key skills. Nurse education today, 34(9), pp.1190-1195.

 

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