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Nursing Physical Assessment for Patient Safety in General Wards

Introduction to Mr. Porter Case Study

This paper will help in performing a detailed healthcare analysis of a patient named Mr. David Porter. The analysis will help in covering all important aspects of the detailed and comprehensive assessment and will help in providing an insight as to how continuity of care can be provided to the patient. Apart from initial part, the following section will help in highlighting the nursing considerations pertaining to this case scenario and the safest possible way in healthcare solutions can be delivered to the patient. The essay will also help in pondering upon the underlying ethical and legal consideration associated with the case and what specific concerns should be addressed, to avoid any miscommunication between the patient and the healthcare providers (Quill, 2018). The person in the given case study is an 83-year-old male, who met with an accident while working in his farm. He lives alone, all by himself and is succeeded by a son who lives four hours drive away from him. The patient has a detailed history of multiple comorbidities for which he is taking medication with due diligence. Patient has been admitted in a rural hospital setting, where he is managed for his closed transverse fracture to the shaft of the right femur, requiring a surgical correction of intervention of open reduction and internal fixation. The study will also be analysing the patient care and management in the pre-operative and post-operative phases.

A2K Framework for Assessment

Using the method of “A2K” system assessment the nursing professionals can assure that relevant information can be collected and evaluated for the patient (Douglas, 2016). This step also makes sure that no step is missed while taking the assessment details of the patient. The nursing professionals should be given proper training to recognize the signs and symptoms. This can be fruitful for formulating an improved and customized care plan as per the patient’s needs and requirements and thus, attain improved healthcare outcomes. The main components of this assessment including aspects from A-E, should be conducted within minutes, to make sure life-saving measures can be applied aptly (Olgers, 2017).

The patient on admission to the emergency department was having not having any difficulty in maintaining his own airway. The nurse carried out an assessment to evaluate the breathing pattern of the patient. The heart rate of the patient was noted to be 98 beats per minute. The rate was observed to be on higher side and was of irregular rhythm. The respiratory rate of the patient was also noted to be 20 breaths per minute. The blood pressure was also observed to be on a hypertensive side. This can be noted as an abnormal sign for the patient. The circulation parameter was also analysed with the help of peripheral pulses. The readings for capillary filling was also to be evaluated to note for any abnormality. This is very helpful in determining the peripheral circulation as well as noting for the warmth of the extremities and color of the same (Sepahvand, 2019).

The patient can be observed to be physically as well as emotionally disabled. The patient can be observed to be physically impaired due to his fracture. However, the plan to correct the fracture through surgery is in pipeline, but it will lead to a larger recovery phase. The patient is also living alone by himself. This can be related to the patient being emotionally disabled. In his recovery phase the role of family can be very helpful for pacing up the recovery of the patient and will enable positive outcomes as well.

Exposure in the give case scenario is the environment in which the patient is working. The patient works in a farmhouse all by himself. He works in a risky environment and also has multiple comorbidities. This adds to the risk factors for the patient (Ghanbari, 2017). The time when the patient got hurt, he was not wearing any protective gear. The patient only experienced fracture in his lower limb. However, he was exposed to injury at multiple sites. The patient is also quite prone to get injuries such as fracture due to two main underlying reasons. These reasons are, his history of osteoarthritis and due to his progressing age. The patient can also be assessed for any injury of rash which he might have attained from falling down in the barn. The skin should also be clearly and thoroughly inspected for integrity before applying any cannulation in the same. These factors from A2K are to be assessed in the initial hours of patient admission to move on to secondary assessment including F2K.

The patient can further be evaluated for full set of vital signs. This will be helpful in identifying the early warning signs. Patient is having chronic cardiac history and other underlying comorbidities as well. Doing an ECG can also help in detecting for any signs that might not be visible to the naked eyes. The irregular heart rhythm can also be deemed as an indicator for following the same (Greenslade, 2016). The assessment should conclude with informing his son about the incident, after verifying the details from the patient, as no details are mentioned.

This process can include taking a detailed history of the patient, which might not be available in his records. This can include any unknown allergies, surgical history, social history and so on. Social history can include details about smoking or drinking which will be helpful in analysing the associated risk factors.

5-R’s of Nursing Interventions

“5-R” can be deemed as the most globally accepted framework for proper medication administration to the patient (Poltree, 2020). These guidelines are helpful for the nurses to ensure that safe medication administration is carried to the patients. This includes delivering the right medication, delivered at the right time, given as per the anticipated dosage, in accordance with the best suitable route of administration and last but not the least, to the right patient. This is not only helpful for ensuring patient safety, rather helps in reducing the incidences of medication errors by multiple folds.

Before administering the drug, it is vital that the right patient should be identified. This can be done by cross-checking with the name of Mr. Porter, his birth date, his details mentioned in the medication chart. The same details can also be cross checked with the patient’s bracelet (Nance, 2019). The patient is alert but is not oriented at the time of assessment carried out in the orthopaedic ward. The right medication can then be confirmed with the help of medication order prescribed for the patient. The medication should also be checked for generic name, expiry date etc, before being delivered to the patient. Post his surgery the patient is being administered cefazolin through Intravenous route, 2 grams. Heparin 5000 units through subcutaneous route, fentanyl 50 microgram through intravenous route of administration. The patient was withheld on apixaban before being taken for the surgery. Heparin is the most commonly used anticoagulant, that prevents the formation of clots after any major surgical intervention (Asad, 2019). This medication is vital from the point of view of delivering thrombosis prophylaxis to the patient. Fentanyl is also a commonly provided pain medication for post-operative patients (Wilwerth, 2016). This is mostly administered in congruent with morphine for releasing the discomfort of the patient, caused due to surgical intervention. In the give case scenario, the patient has a history of allergic response to morphine and is thus, not given the same. This can also be considered as a safe medication administration process. Cefazolin is also provided to the patient to manage for any underlying infection, that the patient might catch post-surgical intervention (Hussain, 2019).

Nursing Standards

As per the code of ethics for all Australian Nurses and Midwives, 2018, there are four fundamental responsibilities of the nurses (Cowin, 2019). These should be taken into due consideration while managing and delivering care for the patient. These four considerations include, promoting of health, prevention of illness, restoring health and reducing the overall suffering of the patient. The nurses are supposed to carry on deliver their duties, while maintaining respect for patient’s rights, cultural diversity, race, ethnicity, choices he made pertaining to his life (Cusack, 2018).

The one NMBA standards of nursing practice that stands apt for this given case scenario include providing safe, appropriate and responsive quality of nursing practice to the patients. Ensuring patient’s safety makes up for a vital part of the quality of care that is to be delivered to the patient. The patient in the given case study is being constantly monitored by the nurses assigned to his care. The medications are also be being administered as per the prescribed dose and route. The vitals of the patient are observed to be improving. These include the overall score of GCS to be 13/15. This also includes improved quality of pain, despite being managed on only one pan medication.

The patient is also not having any fever post-surgery and is having a normal respiratory pattern. The patient is having a high heart rate and low blood pressure. He can also be observed to be not hemodynamically stable. The patient is obeying command but is also observed to be in a confused state of mind. This should be reported to the senior physicians so that proper steps should be taken with the stipulated time frame (O'Connor, 2018). The patient should also be re-evaluated for the turn of events that took place from the time of his surgery, till his transfer to the orthopaedic ward. The patient is also having multiple comorbidities; therefore, he has to be assessed from the point of view of risk factors. The confused state of patient is also be to comprehended for any underlying cause. This is vital not only from the treatment point of view, but to also safeguard the patient from any impairment it may bring about. The patient is also to be evaluated from the ethical point of view as, due to lack of care delivery to the patient, in a safe manner, he might have developed some underlying condition. The assessment of pain is also to be done from the patient’s point of view, by asking them directly. The nurse also made a mistake of noting the pain barrier observed by the patient, as per her conclusions drawn by observing the patient. There is also a lack in clinical handover of the patient from nurse’s end. Before transferring the patient form post-operative care to the ward, detailed assessment for any danger signs should also be done. This will also ensure patient safety and will make sure of his smooth and speedy recovery.

Conclusion on Mr. Porter Case Study

To conclude the paper was able to explore all of the various aspects of systematic and comprehensive health assessment that should be applied in any given clinical case scenario. This is to make sure that patient care is delivered in its full capacity and till the time the patient may not be able to fully function on an independent basis. It is also necessary to highlight the red signs and catering to the same with efficient and evidence-based clinical practices. The nursing considerations included in the case study highlights the importance of noting down the key aspects pertaining to the case study, so that the patient can be delivered required care in accordance with the same. The paper also highlighted the element of dully following all of the ethical considerations, as it helps in defining the patient outcomes as well. It is the duty of the nurse to make sure safe and secure clinical practices should be rendered to the patient at all times and in bounds of his specific medical needs and requirements. Ethically and professionally governed clinical practices should be delivered by the nurses to make sure to avoid any uncalled-for situation.

References for Mr. Porter Case Study

Asad, Z. U. A., Ijaz, S. H., Chaudhary, A. M. D., Khan, S. U., & Pakala, A. (2019). Hemorrhagic cardiac tamponade associated with Apixaban: a case report and systematic review of literature. Cardiovascular Revascularization Medicine20(11), 15-20.

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review66(3), 320-328.

Cusack, L. (2018). Changes to code of conduct and code of ethics new code of conduct for midwives now in effect for all midwives. Australian Midwifery News18(1), 14.

Douglas, C., Booker, C., Fox, R., Windsor, C., Osborne, S., & Gardner, G. (2016). Nursing physical assessment for patient safety in general wards: reaching consensus on core skills. Journal of Clinical Nursing25(13-14), 1890-1900.

Ghanbari, A., Hasandoost, F., Lyili, E. K., Khomeiran, R. T., & Momeni, M. (2017). Assessing emergency nurses' clinical competency: An exploratory factor analysis study. Iranian Journal of Nursing and Midwifery Research22(4), 280.

Greenslade, J. H., Parsonage, W., Than, M., Scott, A., Aldous, S., Pickering, J. W., ... & Cullen, L. (2016). A clinical decision rule to identify emergency department patients at low risk for acute coronary syndrome who do not need objective coronary artery disease testing: the no objective testing rule. Annals of Emergency Medicine67(4), 478-489.

Hussain, Z., Curtain, C., Mirkazemi, C., Gadd, K., Peterson, G. M., & Zaidi, S. T. R. (2019). Prophylactic cefazolin dosing and surgical site infections: Does the dose matter in obese patients?. Obesity surgery29(1), 159-165.

Nance, E. (2019). Careers in nanomedicine and drug delivery. Advanced Drug Delivery Reviews144, 180-189.

O'Connor, L., Casey, M., Smith, R., Fealy, G. M., Brien, D. O., O'Leary, D., ... & Cashin, A. (2018). The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?.Journal of clinical nursing27(5-6), 882-894.

Olgers, T. J., Dijkstra, R. S., Drost-de Klerck, A. M., & Ter Maaten, J. C. (2017). The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study. Netherland Journal Medicine75(3), 106-11.

Poltree, J., Kuhirunyaratn, P., Jiravuttipong, A., Ruttanaseeha, W., Ritthirod, N., & Wuttisupong, N. (2020). Medication Safety Climate Perception among Registered Nurses in a University Hospital, Thailand. Indian Journal of Public Health Research & Development11(3), 2052-2057.

Quill, T. E., Ganzini, L., Truog, R. D., & Pope, T. M. (2018). Voluntarily stopping eating and drinking among patients with serious advanced illness—clinical, ethical, and legal aspects. JAMA Internal Medicine178(1), 123-127.

Sepahvand, M., Gholami, M., Hosseinabadi, R., & Beiranvand, A. (2019). The use of a nurse-initiated pain protocol in the emergency department for patients with musculoskeletal injury: a pre-post intervention study. Pain Management Nursing20(6), 639-648.

Wilwerth, M., Majcher, J. L., & Van der Linden, P. (2016). Spinal fentanyl vs. sufentanil for post‐operative analgesia after C‐section: a double‐blinded randomised trial. Acta Anaesthesiologica Scandinavica60(9), 1306-1313.

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