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Nursing Management

Nurses play a central role in the patient care and they are directly connected with patient thus, right management skills are required to deliver the quality of care. Nursing management skills are important to analyse the issue faced by the patient that will help to conduct right diagnosis which is key to the right treatment (Khomami & Rustomfram, 2019). The effective clinical leadership is important is nursing management and it helped to deliver the patient-centric care that is the main aim for the health care services. Patient-centric care help to improve patient participation in the care that is necessary to deliver quality care (Asamani et al., 2016). The case study is about an 80-year-old patient recently admitted to the hospital after a fall and her son found her on the floor then immediately came to the hospital with a complaint of extreme pain. The vital sign of the patient reveals some major fluctuation that needs to be urgently addressed. The essay is going to discuss the right nursing management method that can be unitized for the patient to improve her health status by decreasing the complication.

The vitals sign of the patient reveals that there is a need for further investigation to identify the major issue faced by the patient. One of the major deviations is in the pain that is increasing and can cause complication for the patient. The persistent pain can increase the patient’s stress or discomfort that needs to be urgently addressed. According to Tompkins et al. (2017), pain is a most uncomfortable situation and it can increase the chances of decrease compliant of the other issue thus health care professional should further investigate it to understand the intensity of the pain. The heart rate readings that is normal 60-100 beats per minute also indicate the elevations that indicate tachycardia condition of the patient. The study presented by Henning & Krawiec (2020) discussed that increased rate is the consequence of any disturbance in the heart functioning that leads to an increased cardiac output that is the sign of tachycardia state.

The Tachypnea state is also observed in the patient due to the increased respiratory rate that is 24 breaths per minute that are normally is of 12-20 breath per minute. The respiratory rates directly indicate the functioning of the lung and deviation in the respiratory rate is a sign for the presence of any issue like an infection that has disturbed the respiratory rate. The article presented by Rolfe, (2019) discussed that respiratory rate monitoring is important as major deviation can increase complication like the comma, decreased oxygen saturation level for the patient and have a negative impact over the health status. Fever is considered to be the defence action that body adopt to deal with the infection but it can also increase complication for the patient. The study presented by Plaza et al. (2017) describe that increased body temperature that is a defence mechanism developed to fight with the pathogen is considered to be a defence but persistent fever can increase complication like febrile seizures or brain damage for the patient thus need to be urgently addressed.

Raised blood pressure is considered to be harmful that is also observed in the patient which can increase complication. The patient blood pressure lies in the range of 147/77mm Hg that is the condition of hypertension that needs to be urgently addressed to decrease chances of complication. The study presented by Lin et al. (2016) discussed that blood pressure above 120/80 mm Hg is considered to be the hypertensive state that leads to serious health-related complication. The Glasgow coma scale readings indicate that she is confused with the best verbal response of 4. The study presented by Jain & Iverson, (2020) is important to assess the impaired cognition of the patient to understand the current situation.

The further questions that need to be asked to collect the additional information should be regarding the family history of the patient that can help to identify the reason behind some of the illness. Another aspect that needs to be included is asking patient concerning the scenario before the fall like headache or uneasiness she encountered before the fall.

The fall experienced by the patient lead to the prognosis of the pain that is increasing the chances of dislocation for the patient. The symptoms indicate that condition of posterior dislocation and it is usually occurring due to the falls that increase the force which causes dislocation. The study presented by Xiao et al. (2017) mostly the posterior dislocation due to fall lead to hip dislocation that leads to increase complication like avascular necrosis and nerve damage for the patient. The patient after the hip dislocation experience major pain that increases the reluctance behaviour to stand and walk. The hip dislocation can be posterior or anterior following the position of the dislocation that leads to the increasing complication of the patient. The usual presentation of the hip dislocation includes foreshortened, flexed, internally rotated and adducted (Xiao et al., 2017).

Assessment: The first issue that needs to be immediately addressed concerning the patient is the pain that has occurred due to the dislocation.

Issue: The immense pain has increased stress and uncomfortable situation for the patient and nursing intervention is necessary to reduce the pain.

Goal: The goal of the intervention is to reduce the pain of the patient that has increased due to the dislocation. The intervention will reduce the pain within 1 hour to improve the comfort of the patient

Intervention: Cryotherapy is considered to be the best non-pharmacological method that is utilized for reducing the pain. The reduction in the conduction of the signals from different nerves fibres that occur due to asynchronous transmission of pain that is responsible for the conduction of the pain signal (Silva et al., 2018). The cryotherapy will be followed by the administration of the analgesic that is important to completely decrease the pain as per the prescription of the doctor.

Evaluation: The evaluation process is important to evaluate the impact of the intervention over the patient that is important to reframe the intervention. The evaluation processes start with the planning process that is followed by the designing of the evaluation process. (Lukewich et al., 2019). The evaluation of the intervention will be conducted by feedback from the patient that helps to understand their perspective concerning the impact of the intervention over the pain of the patient.

Assessment: The patient medical histories indicate she is a patient of hypertension and atrial fibrillation that add the chances of complication like heart failure or heart attack.

Issue: The persistent increased blood pressure can lead to a hypertensive emergency that is can increase heart-related issue for the patient.

Goal: The major goal for the intervention is to reduce the blood pressure of the patient that is necessary to improve the health status. The intervention will help to decrease the blood pressure within 1 hour to reduce the future issue and improve the balance of blood pressure

Intervention:  The dietary approach is important to reduce blood pressure by improving the consumption of calories. Different dietary approaches can help to improve the blood pressure which includes increased intake of fruits, vegetable, low-fat dairy and whole grain. Some other aspects that need to be considered include low carbohydrate diet, high protein and low sodium diet (Schwingshackl, et al., 2017). The dietary intervention will help to improve the sodium intake that is necessary for reducing the blood pressure.

Evaluation: The evaluation process is necessary for the measurement of the outcome that is important for improving the services that lead to quality care. The evaluation process helps health care professionals to evaluate their nursing practise following the patient health status (Jones, 2017). The evaluation process will be conducted by interviewing the patient to understand the impact of the dietary intervention over the patient health status.

The pharmacokinetics of the Bupivacaine starts with the 1-17minutes of onset of action with the duration of action of about 2-9 hour. The half-life of the Bupivacaine is 8.1 hour and the time to peak plasma is about 30-45min which has protein binding capacity up to 95%. The metabolism of the Bupivacaine occur in the hepatics cell and it follows the renal excretion with 5% remain unchanged. Bupivacaine is indicated for a nerve block that can be peripheral or sympathetic (Eljebari et al., 2014). The neurofen is the tropical anti-inflammatory gel that is important to reduce pain and the absorption occurs on the percutaneous layer which led to pain reduction. The half-life is about 1.4 hour that finally excreted by the percutaneous layer (Baranowski et al., 2018).

The pharmacokinetics of the panadol start with the absorption with the gastrointestinal tract and the peak plasma concentration reach up to 30 minutes to 2 hours after administration. The main absorption of the panadol occurs in the liver that is about 90-95 and rest is secreted in urine about of which 5% is unchanged. The half-life of the panadol is about 1 to 4 hour with negligible capacity for plasma protein binding (Raffa et al., 2017). The morphine pharmacokinetics star with the absorption starts in the upper intestine with a bioavailability of 80-100%. The 35% of the morphine bind to the protein and it is 90 % metabolized and out of which 70-80%dose is excreted in the urine with a half-life of 2-3 hour (Elkomy et al., 2016).

There are several side effect of the pharmacological intervention that can directly impact the health status of the patient. The health care professionals are expected to provide quality and safe care simultaneously to improve their health status (Al-Saadoon, 2015). The side effect associated with bupivacaine includes abnormal heart rhythms and back pain (Shafiei et al., 2020). Some side effect of the panadol includes nausea, vomiting and constipation (McCrae et al., 2018). Side effect associated with morphine includes the dry mouth and urinary retention (Murphy et al., 2020). The different aspects that need to be considered while administration of drug include the proper dose of the medication, maintaining the daily routine of the medication and last is continuous monitoring to decrease chances of complication (Alshammari et al., 2016).

The patient participation in the care is important to deliver the patient-centric care and it will be ensured by utilizing the therapeutic communication to improve patient understanding concerning the medication and its importance. The nurse will ensure that patient should be communicated with all aspect of the medication from use to its side effect to aware them about the future complication that can occur due to medication. The education about the medication will help the patient to understand its importance concerning the health status and possible side effect that she can encounter due to the administration of the medicine. The educational intervention will be utilized for helping the patient to improve the knowledge and understanding concerning the medication and its side effect. The patient can be provided information about the physiotherapy that can be useful for the patient to improve the walking issue patient is facing. The different referrals can be provided to the so that she can consult to them during any complication. The long term effect of the medication can increase complication for the patient thus this will also address in the educational intervention so that patient can be aware of the long term effect.

The case study can be concluded by adding that patient condition reveals that she needs urgent attention concerning the pain and hypertensive state. The pathophysiological issue has arisen due to the dislocation that may occur due to the fall she has encountered before the hospital administration. Cryotherapy and dietary intervention can be a possible intervention to decrease the complication for the patient. The medication that administered to the patient has many side effects thus there is a need to continuously monitor the patient to decrease the chances of complication. The patient should be communicated with a different aspect of the medication that can be encountered by the patient in future. The patient participation in the care will help to improve the quality of care due to the patient-centric approach.

References for Mrs. Jane Smith Case Study

Al-Saadoon M. (2015). Adverse effects of medicines: Is the Omani population safe?. Sultan Qaboos University Medical Journal15(2), e149–e151.

Alshammari T. M. (2016). Drug safety: The concept, inception and its importance in patients' health. Saudi Pharmaceutical Journal: SPJ: The Official Publication of the Saudi Pharmaceutical Society24(4), 405–412. https://doi.org/10.1016/j.jsps.2014.04.008

Asamani, J. A., Naab, F., & Ofei, A. M. A. (2016). Leadership styles in nursing management: Implications for staff outcomes. Journal of Health Sciences6(1), 23-36. https://doi.org/10.17532/jhsci.2016.266

Baranowski, D. C., Buchanan, B., Dwyer, H. C., Gabriele, J. P., Kelly, S., & Araujo, J. A. (2018). Penetration and efficacy of transdermal NSAIDs in a model of acute joint inflammation. Journal of pain research, 11, 2809–2819. https://doi.org/10.2147/JPR.S177967

Eljebari, H., Jebabli, N., Salouage, I., Gaies, E., Lakhal, M., Boussofara, M., & Klouz, A. (2014). Population pharmacokinetics of bupivacaine in combined lumbar and sciatic nerve block. Indian Journal of Pharmacology46(2), 201–206. https://doi.org/10.4103/0253-7613.129318

Elkomy, M. H., Drover, D. R., Glotzbach, K. L., Galinkin, J. L., Frymoyer, A., Su, F., & Hammer, G. B. (2016). Pharmacokinetics of morphine and its metabolites in infants and young children after congenital heart surgery. The AAPS Journal18(1), 124–133. https://doi.org/10.1208/s12248-015-9826-5

Henning, A., & Krawiec, C. (2020). Sinus Tachycardia. StatPearls Publishing.

Jain, S., & Iverson, L. M. (2020). Glasgow Coma Scale. StatPearls Publishing.

Jones, T., (May 31, 2016) "Outcome measurement in nursing: imperatives, Ideals, history, and challenges" OJIN: The Online Journal of Issues in Nursing, 21(2). https://doi.org/10.3912/OJIN.Vol21No02Man01

Khomami, H. M., & Rustomfram, N. (2019). Nursing efficiency in patient care: A comparative study in perception of staff nurse and hospital management in a trust hospital. Journal of Family Medicine and Primary Care8(5), 1550–1557. https://doi.org/10.4103/jfmpc.jfmpc_37_19

Lin, J. D., Chen, Y. L., Wu, C. Z., Hsieh, C. H., Pei, D., Liang, Y. J., & Chang, J. B. (2016). Identification of normal blood pressure in different age group. Medicine95(14), e3188. https://doi.org/10.1097/MD.0000000000003188

Lukewich, J. A., Tranmer, J. E., Kirkland, M. C., & Walsh, A. J. (2019). Exploring the utility of the nursing role effectiveness model in evaluating nursing contributions in primary health care: A scoping review. Nursing Open6(3), 685–697. https://doi.org/10.1002/nop2.281

McCrae, J. C., Morrison, E. E., MacIntyre, I. M., Dear, J. W., & Webb, D. J. (2018). Long-term adverse effects of paracetamol - A review. British Journal of Clinical Pharmacology. https://doi.org/10.1111/bcp.13656 

Murphy, P. B., Bechmann, S., & Barrett, M. J. (2020). Morphine. Treasure Island, United Kingdom: StatPearls Publishing.

Plaza, J. J. G., Hulak, N., Zhumadilov, Z., & Akilzhanova, A. (2016). Fever as an important resource for infectious diseases research. Intractable & Rare Diseases Research5(2), 97–102. https://doi.org/10.5582/irdr.2016.01009

Raffa, R. B., Pawasauskas, J., Pergolizzi, J. V., Lu, L., Chen, Y., Wu, S., & Devarakonda, K. (2017). Pharmacokinetics of oral and intravenous paracetamol (acetaminophen) when co-administered with intravenous morphine in healthy adult subjects. Clinical Drug Investigation, 38(3), 259–268. https://doi.org/10.1007/s40261-017-0610-4 

Rolfe, S. (2019). The importance of respiratory rate monitoring. British Journal of Nursing, 28(8), 504–508. https://doi.org/10.12968/bjon.2019.28.8.504 

Samuelsen, P.-J., Nielsen, C. S., Wilsgaard, T., Stubhaug, A., Svendsen, K., & Eggen, A. E. (2017). Pain sensitivity and analgesic use among 10,486 adults: The Tromsø study. BMC Pharmacology and Toxicology, 18(45), 1-8. https://doi.org/10.1186/s40360-017-0149-2

Schwingshackl, L., Chaimani, A., Hoffmann, G., Schwedhelm, C., & Boeing, H. (2017). Impact of different dietary approaches on blood pressure in hypertensive and prehypertensive patients: Protocol for a systematic review and network meta-analysis. BMJ Open7(4), 1-6. https://doi.org/10.1136/bmjopen-2016-014736

Shafiei, F. T., McAllister RK, Lopez J. (2020). Bupivacaine. Treasure Island, United Kingdom: StatPearls Publishing.

Silva, D. A. da, Peixoto, G. F. G., Rodrigues, K. M. S., & Farias, V. X. (2018). Analgesic efficacy of the association of cryotherapy and transcutaneous electrical nerve stimulation. Brazilian Journal of Pain, 1(3). https://doi.org/10.5935/2595-0118.20180052 

Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence173(Suppl 1), S11–S21. https://doi.org/10.1016/j.drugalcdep.2016.12.002

Xiao, J., Hamera, J. A., Hutchinson, C. H., & Berger, D. A. (2017). Bilateral posterior native hip dislocations after fall from standing. Clinical Practice and Cases in Emergency Medicine1(4), 329–332. https://doi.org/10.5811/cpcem.2017.8.35161

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