The nursing care quality is associated with nurse hard work, nurse practice environment, quality of care adopted, nurse clinical practices and experience (Koy et al, 2015). The critical ill patient requires tremendous approach of nursing care and support. The essay describes the case study of Mrs Deborah Scott who has been admitted to the hospital in emergency department because of her continuous fall activities. The essay describes the critical analysis of the nursing care required for maintaining the health of Mrs Scott. The critical analysis is done based on Levitt-Jones’ clinical reasoning cycle. The essays will also address the care priorities required for Mrs. Scott to recover faster. The treatment approach to be adopted depends on damagecontrol, pain management, fixation selection, and maintaining the quality of life (He, 2019).
Mrs. Scott has admitted in the emergency department few days back. The reason of her admission is that she had fall last night in her room. In the last six months, she had been admitted to hospital three timesandreason for all the admission is the fall activities. She has the medical history of many diseases such as type-II diabetes, hypertension, chronic obstructive disease, and osteoarthritis.
The nursing care practise require for maintaining the health of Mrs. Scott must be clearly defined and discussed with the supervisor before implementing. This is because Mrs. Scott has been repeated injury andsuffersfrom lot of disease. Thus, her care needs to be critically managed. Due to her broken ribs and injuries on chest wall, the first critical care involves the high maintenance of bed rest to provide support to the joints near the fracture sites. This will provide her stability, reduces the disturbing problem, help the muscles to heal faster. Special attention must be given while moving and turning on bed. Preventing the unnecessary movements and disturbance also help in positioning of the ribs and other mall fractures. Check, observe, and evaluate the splinted extremity for edema resolution (Sarah et al., 2013). Coaptationsplint can use for immobilising the fracture. As the patient age is above 60 ears, she may be requiring easy, hand able fracture components. When the edema subsides; fibreglass cast can also be used for proper alignment of the fractures.
Mrs.Scott always complains about the fall activity and was worried about the situation. She was tensed and worried about her health condition. However, Mrs. Scott do a lot to take care of her health. Mrs. Scott has fallen three times from lastsix monthand has developedthe chest problem comprising of broken ribsand many injuries to chest wall. Moreover, she has also been suffering from other disease which can be considered as comorbidities such as type-II diabetes-insulin dependent, cardiac hypertension, chronic obstructive disease, and osteoarthritis.
The rib broken may also lead to the development of other life-threatening disease such as cardiac problem, acidosis, pnemothorax, respiratory problem and many others. The pain arises from the rib fracture may cause some respiratory splinting. So, as the registered nurse, one must ensure that chances of atelectasis and pneumonia does not occur (Ho et al., 2017). Moreover, Mrs. Scott is an elderly patient and suffers from chronic obstructive disease, thus she has the greater chance of developing pneumonia. Therefore, she must require the attentive follow-up care as well. The injuries to chest wall and broken ribs damage may also cause the formation of haemothorax or a pnemothorax condition (Chein, 2017). Thus, these conditions need to be checked on the priority bases to ensure the proper health of Mrs. Scott. Moreover, the mortality and morbidity in patient suffering from rib fracture over 65-year age is higher. The patients can have chance of developingchesttrauma,cardiopulmonary disease, acute respiratory disease syndrome and other ill health condition (Kuo& Kim, 2019).Thus, the critical care and adoption of measureable approach need to be adopted for maintain the health of Mrs. Scott. Moreover, prior diagnosis of chest wall contusion, diaphragmatic injury, sterna function, cardiac contusion, clavicular fracture, pneumomediastinum, flail chest, and scapular fracture must prioritised. Mrs. Scott has the medical history of hypertension and chronic obstructive disease, thus she is at greater risk of developing the above-mentioned disease (Kuo& Kim, 2019).
The practice of incentive spirometer should be encouraged to prevent the pulmonary atelectsis and splinting. The registered nurse must follow the conservative therapy treatment to reduce the pain associated with the rib fractureand must consider the medical history of Mrs. Scott. The conservative therapy includes appropriate analgesia, proper rest, icing application. The registered nurse must check for irregular outcome of Mrs. Scott while dealing with her. These outcomes included difficult breathing, consiousness, pulse rate, respiratory rate and chest wall deformity. Other than this, some of the other outcomes includesurgical mismanagement, rib fracture non-union, reparatory failure, and enhanced chest wall deformity.
The registered nurse must adopt multimodal pain therapy to reduce the pain associated with the incident. The multi-modal pain therapy combines of opioids and adjuncts of non-opioids. According to paper written by Witt and Bulger (2016), multi-modal therapy helps in improving the pain scores and with limited complications. Thus, multi-modal therapy providessupport, utility, and health benefits to person suffering with rib fractures and other complications. Thus, in the case of Mrs. Scott, multi-modal therapy would show improved health condition with pain reduction and the therapy would be easily adopted by patient, as it is easy to use.
The registered nurse must follow the pulmonary hygiene in the case of Mrs. Scott. Pulmonary hygiene help in reducing the incidence of complications associated with rib fractures and trauma (Chien, 2017). Incentive spirometry can be easily implemented and guided by the medical practitioner. Pulmonary hygiene helps in preventing the atelectasis condition, harmful effect of lung disease, alveoli collapse, and other lung associate disease (Witt and Bulger, 2016).
Along with the above mentioned major critical care parameter, the registered nurse must follow the basic management protocol to ensure the safety of Mrs. Scott. The regular management and adoption of basic principle ensure the early recovery of the patient.Basic practice standards to be adopted by the registered nurse to maintain the overall health of Mrs. Scott include various monitoring and evaluating parameters. She has the medical history of much disease such as type-II diabetes, hypertension, chronic obstructive disease, and osteoarthritis. Thus, the regular check-up must be ensured, for this junior nurse was obliged to perform the medical check-ups . The ribs damage patient need to monitor pulse rate, blood pressure, sugar level, and respiratory level on regular basis (Witt and Bulger, 2016).Her medical statement and medical status on daily basis needs to be maintained on regular basis, so that on every doctor visit, the medical condition can be easily reviewed. The nursing care practise adopted,must clearly define and discussed with the supervisor before implementing. This is because Mrs. Scott witness repeated injury and suffer from lot of disease. Thus, she requires the critical health management care.
The assessment of respiratory scaleof Mrs. Scott must be regularly done. The scale re maintained to fulfil the standard of respiratory and pulmonary health. The respiratory therapist measures the baseline spirometry volume, goalsset to 80% inspiratory capacity(McLaughlin, 2020).The respiratory measures need to be evaluated on regular basis. The body lying position need to be maintained in a way that head of Mrs. Scott must be elevated to 30degree(Witt and Bulger, 2016). Theelevation of bed ensures the proper flow of blood, air and provides a comfortable breathing.The registered nurse must ensure hourly incentive pyrometer, and deep breathing exercise that will help the patient to ensure proper oxygen level insideandensure basic pulmonary exercise. Regular and proper mobilisation of the patient must be done to avoid the development of bedsores.
The movement must be done properly to avoid rib pain, damage and other ill condition. Regular assessment of ongoing evaluation, maintenance of PIC (Pain Inspiratory capacity, and cough) scoreand IS volumes on regular interval(May et al, 2015). The nurse must provide the proper education and knowledge to the patient, family, and junior nurseregarding the proper technique of breathing, coughing, and use of inhalers. The registered nurse must follow the basic management tips while dealing with Mrs. Scott in order to ensure good diet intake, medication use, assess side effects, and any uncomfortable problem.These basic interventions help the patient to recover faster and early. Moreover, the regular adoption of these interventions could also help the nurse to followthe basic standard of care with patient-centric approach.
From the above discussion it can be concluded that the adoption of proper intervention procedure help Mrs. Scott to recover early. The timely adoption of critical care practices and care priorities fulfil the needs of patient and help her to maintain health. Nurse with the effective clinical reasoning skills shows the positive impact on the patient health and outcomes. The diagnosis of the priority-listed disease must be done before medication.The nursing care practise require for maintaining the health of Mrs. Scott must be clearly defined and discussed with the supervisor before implementing. Although with the adoption of health strategies and measure, Mrs. Scott health shows positive response and now can be discharged from the hospital in next four to five days.
Chien, C., Chen, Y., Han, S., Blaney, G., Huang, T., & Chen, K. (2017). The number of displaced rib fractures is more predictive for complications in chest trauma patients. Journal of Trauma, Resuscitation and emergency Medicine, 25, 1-10. DOI 10.1186/s13049-017-0368-y
He, Z., Zhang,.Xiaio, H., Zhu,Q., Xuan, Y., Su, K., Liao, M., Tang, Y., & Xu, E. The ideal methods for the management of rib fractures. Journal of Thoracic Disease, 11, 1-12.DOI: 10.21037/jtd.2019.04.109
Ho, S., Teng, Y., Yang, S., Yeh, H., Wang, Y., Chou, C. & Yeh, C. (2017). Risk of Pneumonia in patients with isolated rib fractures: A nationwide cohort study. BMJ, 7, 1-10.DOI: 10.1136/bmjopen-2016-013029
Koy, V., Yunibhand, J., Angsuroch, Y., & Fisher, M. (2015). Relationship between nursing care quality, nurse staffing, nurse job satisfaction, nurse practice environment, and burnout: literature review. International Journal of Research in Medical Sciences, 3, 1825-1831
Kuo, K. & Kim, A. (2019).Rib fracture.StarPearls Publishing, Finland.
May, L.Hilermann, C. & Patil, S. (2015). Rib fracture management. BJA Education, 16, 26-32. DOI: 10.1093/bjaceaccp/mkv011.
McLaughlin, D. (2020). Management of traumatic rib fractures. Retrieved from https://www.wfsahq.org/components/com_virtual_library/media/9ab73694e7eb5f2964ccec8e41fb4a7c-atow-424-00.pdf
Sarah, T., Hopkins, A., Stewart, S., Slack, J. & Solis, C. (2013). Myocardial contusion and rib fracture repair in an adult horse. Journal of Veterinary Emergency and Critical Care, 5, 1-10.DOI: https://doi.org/10.1111/vec.12096
Witt, C. & Bulger, E. (2016). Comprehensive approach to the management of the patient with multiple rib fractures: A review and introduction of a bundled rib fracture management protocol. BMJ Journal, 2, 1-7. DOI: 10.1136/tsaco-2016-000064.
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