Table of Contents
Describe the relevant pathophysiology evident from the case
Discuss the medications from the case and relate their mechanism of action
Describe your prioritised interventions for the case
Pathophysiology is the study of the biological and physical and abnormalities that take place in the body as a result of an illness. In several ways, pathophysiology is the origin of practice of nursing, as it helps to build a solid foundation for a healthcare provider, such as ordering diagnostic tests, treating chronic and acute diseases, administering medications, and administering general health care and disease prevention. In this particular case study of Jolene several pathophysiological concepts have been identified. She had a motorbike accident that resulted in a compound fractured tibia and fibula and a blunt force head trauma. She had to undergo surgery to recover from the issues. At the same time she was also suffering from pulmonary embolism and DVT. She was in a condition of trauma which leaded to tonic-clonic seizure. The primary concern of Jolene at this state was her depression due to her protracted recovery. She was also in the first trimester of her pregnancy.
In the case of Jolene she had fractured fibula and tibia. The tibia is the shinbone and most of the body weight is supported by it. The fibula runs alongside the tibia below the knee. It is on the outer side part of the leg and is generally smaller in context to the tibia. The fractures of Tibia and fibula are characterized as either low-energy or high-energy. In the case of Jolene it is a high energy fracture that resulted from the motor bike accident. She also had a blunt force trauma due to the bike accident. Blunt force trauma in context to the head happens when the cranium is hit by a hard object (Heymsfield and Wadden, 2017).
The kind of object, velocity of impact and strength, all dictate how brutal the trauma will be. After her surgery she was experiencing leg pain and surgical site discomfort at times. It is common to have some amount of pain for two to three weeks after the surgical procedure and mild pain for up to six weeks after the surgical procedure. After certain weeks of the surgery Jolene conferred with severe chest pain and dyspnoea.
It was mainly because of the blockage in context to a blood vessel. Pulmonary embolism (PE) usually occurs when a blood clot called the DVT often in the leg blocks the blood vessels by travelling to the lungs. It lowers the level of oxygen in the blood. When a DTV travels to its heart or lungs with blood clots, it is known as pulmonary embolism (PE). Symptoms of DVT and PE can vary from individual to individual. It can cause mild shortness of breath and severe chest pain (McCance and Huether, 2018).
A tonic-clonic seizure usually starts on both sides of the brain but it can spread to the whole brain from one side. As a person loses consciousness, the muscles become stiff and trembling movements become visible. This type of seizure usually lasts 1 to 3 minutes and takes a person longer to recover. If the seizure lasts more than five minutes or does not recur in one seizure after another, the person may be in a life-threatening medical emergency and may need immediate medical attention. Her tonic-clonic seizure can be a result of the Blunt force trauma (Liu et al. 2017).
Anticoagulant medication was given to her as she was diagnosed with pulmonary embolus and DVT. Anticoagulant drugs eradicate or decrease the risk of blood clots. They are frequently referred to as blood thinners, but these drugs usually do not make the blood thin. In its place, what they do is they try to stop or break the dangerous blood clots that form in blood vessels or in the heart. When left untreated, these clots can block blood flow, which can lead to a cardiovascular attack or stroke. Anticoagulants impede with the blood proteins involved in the clotting process. These kinds of proteins are referred to as factors. Diverse anticoagulants interfere with diverse factors to stop the clotting of blood.
There are side effects associated with anticoagulant drugs and some can be serious. The most commonly prescribed anticoagulant is warfarin. Treatment with this drug can be recommended by a healthcare expert only if the healthcare users are at risk for any of the problems like they may have had blood clots in the past or had been diagnosed with atrial fibrillation. In the case of Jolene, post her surgery she was diagnosed with a pulmonary embolus and DVT (Carrera, 2018).
She was given medications of traumatic epilepsy due to the tonic-clonic seizure. Traumatic seizures (PTS) should be treated immediately after onset, as the activity of the seizures can cause further damage to the already compromised brain. In context to the seizures that are active, IV phenytoin and sodium valproate are the antiepileptic drugs (AEDs) and are typically successful in stopping the seizure, alongside IV benzodiazepine. These medications can also be subjected for other problems like chronic pain, mood swings or restlessness (Makhni et al. 2017). A few common side effects in context to the AEDs are:
Blood tests are required to make sure that the healthcare user is receiving sufficient of the medication and to subject that the drug is not causing other problems. Even though these drugs hardly ever cause birth defects in newborns, it is very important to tell the healthcare expert about it (pregnancy).
In the case of Jolene, person centred care is very important. Person-centered care has augmented attention over the past decade, including in the developing countries. Person-centered care subjects to the many connections that place the individual at the centre of all clinical decisions, counting their skills, rights and future plans. This form of acre is to understand the person as a whole and not simply as a healthcare user. The case study of Jolene is very vital due to her past injuries and depression. Her long drawn treatment had resulted in depression which can deteriorate her health condition further. Curing depression and finding appropriate therapy in context to depression is time taking and also can be complicated.
Someone like Jolene who has a lot of medical problems, the antidepressant could be ineffective for her. Changing the lifestyle can be very helpful in this regard. There are three most common therapies that are subjected by the experts to treat depression. These therapies include cognitive behavioral, psychodynamic and interpersonal therapy. Eating well, sleeping well, being around loved ones, exercising and managing stress can help to deal with depression. The drug therapy regimen that have been described in this case will be effective to Jolene if she continues to take the medications properly. Anticoagulants drugs were given to her she was diagnosed with a pulmonary embolus and DVT (Barr and Epps, 2019).
Anticoagulants are medicines that stop blood clots as soon as possible or they try to prevent the blood from clotting. Some people say them as blood thinners. Anticoagulants interfere with the chemicals needed for clotting. Warfarin, phenindione and acenocoumarol and block the effects of vitamin K which are necessary to create the causes of the above-mentioned clotting factors. Blocking the vitamin K is very necessary to not let the blood clot. These drugs usually take two or three days to fully function. There are several possible side effects of blood thinning. On the other hand, the main side effect of this is bleeding. Individuals who take warfarin, phenindione and acenocoumarol need to have regular blood tests to measure how quickly the blood clots (Dreijer et al. 2019).
There were several complicacies in the treatment of Jolene. Her motorbike accident had not only left her depressed but also impact on her over all physical health. She was medicated anticoagulants drugs and medications of traumatic epilepsy and was also pregnant (Lau et al. 2019). Although oral anticoagulants or blood thinners such as warfarin, rivaroxaban, apixaban and dabigatran are for the most part normally prescribed, they are not measured safe for the unborn child. In this case, the healthcare expert may suggest switching from a thinning pill to an anticoagulant which can be injected, such as standard or unfractionated heparin and LMWH, as they do not cross and irritate the placenta or enter the bloodstream of the unborn child.
It is considered a safe thing to be to injected and used throughout pregnancy. LMWH is chosen as it has fewer side effects. Females can be certain that the injections are not harmful to the fetus, although it is given in the abdomen, because the needles are too small and do not reach the fatty layers of abdominal tissues just below the skin. Thousands of women have used heparin and LMWH during pregnancy, with no birth defects or problems in bleeding in their unborn child. After childbirth, women with coagulation problems should resume antiogulation or anticoagulant therapy (Henriksen et al. 2017).
In conclusion it can be stated that the case of Jolene was very complex. Her motorbike injury had impacted her physically as well as mentally. Person centred care in this stage is very important for her as she is pregnant. Looking after her and her needs should be the prior concern at this stage. Person-centred care will support her and through it she will expand the knowledge, confidence and skills to more successfully manage and make knowledgeable decisions about her own health and health care. She is in the third trimester of her pregnancy and this stage is very important. However, Jolene in this case needs to allure to what the healthcare experts and the healthcare providers state to do (which drugs to take and which to let go).
Barr, D. and Epps, Q.J., 2019. Direct oral anticoagulants: a review of common medication errors. Journal of thrombosis and thrombolysis, 47(1), pp.146-154.
Carrera, I., Gelber, P.E., Chary, G., Masdeu, M.G., Ballester, M.A.G., Monllau, J.C. and Noailly, J., 2018. An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures. Knee Surgery, Sports Traumatology, Arthroscopy, 26(3), pp.756-761.
Dreijer, A.R., Diepstraten, J., Bukkems, V.E., Mol, P.G., Leebeek, F.W., Kruip, M.J. and van den Bemt, P.M., 2019. Anticoagulant medication errors in hospitals and primary care: a cross-sectional study. International Journal for Quality in Health Care, 31(5), pp.346-352.
Henriksen, J.N., Nielsen, L.P., Hellebek, A. and Poulsen, B.K., 2017. Medication errors involving anticoagulants: data from the Danish patient safety database. Pharmacology research & perspectives, 5(3), p.e00307.
Heymsfield, S.B. and Wadden, T.A., 2017. Mechanisms, pathophysiology, and management of obesity. New England Journal of Medicine, 376(3), pp.254-266.
Lau, B.C., Jagodzinski, J. and Pandya, N.K., 2019. Incidence of symptomatic pulmonary embolus and deep vein thrombosis after knee arthroscopy in the pediatric and adolescent population. Clinical Journal of Sport Medicine, 29(4), pp.276-280.
Liu, F., Wang, Y., Li, M., Wang, W., Li, R., Zhang, Z., Lu, G. and Chen, H., 2017. Dynamic functional network connectivity in idiopathic generalized epilepsy with generalized tonic–clonic seizure. Human brain mapping, 38(2), pp.957-973.
Makhni, M.C., Makhni, E.C., Swart, E.F. and Day, C.S., 2017. Tibia/Fibula Shaft Fracture. In Orthopedic Emergencies (pp. 319-323). Springer, Cham.
McCance, K.L. and Huether, S.E., 2018. Pathophysiology-E-book: the biologic basis for disease in adults and children. Elsevier Health Sciences.
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