Contemporary Nursing Practice 1

Primary Assessment of Mrs. Betty White

The primary assessment of Mrs. Betty White was done using the IPPA assessment that stands for “Inspection, palpation, percussion, and auscultation” assessment (Proctor & Rickards, 2020). Physical examination is necessary as it ensures the identification of the primary health problems. The inspection was done to assess the color, body shape, and facial expression of Mrs. White. During the inspection, it was revealed that Mrs. White appeared pale and uncomfortable. She also seemed a little restless and exhibited heavy breathing. The primary assessment of Mrs. White also revealed that her breathing was short and difficult with persistent pain in the chest area that was dominant during coughs and movements. On touching, Mrs. White appeared to be warm marking an increase in his body temperature, she complained of pain on the scale of 5/10. She complained that the pain was not radiating rather was “all over”. This had also impacted her sleep. The capillary refill assessment was done to identify the blood flow in the body and for Mrs. Betty White it was less than three seconds. Mrs. White appeared to be alert where she successfully responded to the questions regarding her name and date of birth. The handover chart indicated that the oxygen saturation levels were below normal and at 93% after oxygen therapy. The pulse was strong and irregular in Mrs. White.

Focused Assessment

The focused assessment of Mrs. White will include a detailed analysis of the systems. The focused assessments included analysis of the gastrointestinal and gastrointourinary system, urinary system, and cardiovascular and peripheral vascular system.

Gastrointestinal and Gastrointourinary System

Mrs. White possesses a medical history of GORD, that is, Gastro-esophageal reflux disease. Further, she is also expressing decreased nutritional and food intake. Further, there is also an absence of bowel passage. A focused gastrointestinal system assessment is therefore necessary. It is of crucial consideration that Mrs. White might not have expressed her concerns about her digestive problems as during primary assessment she asserted on not bothering the healthcare staff by reporting her pain. Change in bowel habits is a major indicator of gastrointestinal problems and therefore, asserts the need for digestive system examination (Kim & Pritts, 2017). The focused assessment is inclusive of identification in the change in appetite, intolerance to food, abdominal pain, change in bowel habits, etc. To assess the auscultation will be performed to identify any abnormal abdominal sounds. The palpations and percussions will help in the identification of any strain on the muscles and pain experienced by the patient. Further, the patient presents with a history of urinary tract infections. Therefore, it is important to perform this assessment as she presents with a frequent urge to urinate and urinary incontinence has also been observed. The distension in the abdomen and pulsations will be recorded with palpations in all four quadrants to observe any tenderness and anomalies (Urden et al., 2017).

Respiratory System

The patient reports pain in breathing with heaviness. Further, the primary examination reveals that the respiration is short and difficult for Mrs. White. Therefore, a detailed focused assessment of the respiratory system is essential for the identification of an underlying cause of her respiratory problem. The breathing sounds will be analyzed for any anomalies and to assess the lung capacity (Vierula et al., 2019). Mrs. White is already on oxygen therapy and therefore, ideally, she should not experience breathing problems. Therefore, for focused assessment, nasal flaring, and asymmetrical chest expansion are studied. Auscultations are done to ensure the sounds to identify problems like pleurisy and pneumonia. coarse crackles in the breathing sounds may indicate pulmonary edema. Low pitched wheezing sounds are associated with pneumonia, creaking or the pleural friction rub can indicate the presence of pleurisy. It is also important to identify hypoxemia through the presence of cyanosis (Urden et al., 2017).

A Focused Cardiovascular and Peripheral Vascular System

Mrs. White presents with irregular pulse rate and dyspnea; therefore, a focused assessment of the cardiovascular and peripheral vascular system is crucial. Further, Mrs. White also has a medical history of hypertension, hypercholesterolemia, atrial fibrillation, and coronary artery disease that have severely impacted her cardiac and vascular health. Therefore, it becomes crucial to perform a focused assessment of the system. For this, it is crucial to inspect the legs and arms for edema, face, and lips for cyanosis, and pain signs associated with deep vein thrombosis (Van et al.2019). It is also crucial to assess the superficial distension in veins. It is also important to auscultate the peripheral pulse and identify the rate and rhythm. Further, for the cardiovascular focused assessment, it is crucial to palpate the radial, brachial, posterior, tibialis, and dorsal pedis pulse. Pulse deformities can indicate vessel constriction. It is also crucial to note any chest deformities for the examination of cardiovascular anomalies in the patient (Stonehouse, 2017).

Nursing Problems

The importance of identification of nursing problems is crucial as it helps in the development and application of suitable interventions, these problems also indicate the physiological deterioration in the patient and are therefore of utmost importance.

Actual Patient Problems

The two actual patient problems that have been identified in the case of Mrs. White are pain and urinary tract infection.

  • Pain: Mrs. White complains of pain as a major hindrance to her wellness. She complains that she has been experiencing pain for long that has also impacted her sleep. According to Mrs. White, her pain is all over and she rates at index 5/10. Pain is one of the primary problems of Mrs. White as pain can result in aggravation of several other health problems. Severe pain can lead to high blood pressure, breathing rate, and heart rate in patients (Nirula, 2018)). In Mrs. White, it can also be associated with the development of anxiety, sleep apnea, and discomfort (May et al., 2016).
  • Urinary tract infection: Another significant health problem that is associated with the health condition of Mrs. White is the recurrence of urinary tract infection. Mrs. White reports for urination with urgency and fails to release any significant amount of fluid. Further, there have also been incidences of incontinence of urinary tract infection. A major complication of UTI is its reoccurrence as it is highly common in women who have to develop it once (Gupta et al., 2017). Further, untreated infection can spread to the bladder and kidneys causing major health risks. This can also lead to chronic kidney infection making its treatment a primary priority (McLellan & Hunstand, 2016). Since Mrs. White also has problems with mobility, incontinence can result in rashes and major discomfort for the patient. The infection can also cause permanent kidney damage and impair kidney function permanently.

Potential Problems

Potential health problems are the inconvenience and problems that can arise in the future of the patient. The potential problems associated with the health condition of Mrs. White include anxiety and nutritional deficiencies.

  • Anxiety: Mrs. White possesses a history of anxiety. Her current medical condition can cause a relapse and therefore trigger anxiety in her. She is a single carer of her husband who suffers from Alzheimer’s. Therefore, fracture and admission in the hospital can impact her psychological well being where she may get anxious and worried about the care of her husband. Moreover, she also has hypertension that can lead to the development of anxiety (Perna et al., 2016). The patient also seems restless and introverted as she does not readily express her concerns to the healthcare professionals. Mrs. White also experiences problems with sleeping and therefore this can also contribute towards anxiety and problems with her psychological well being. Age is also an essential factor that contributes towards the development of psychological problems like anxiety and depression that can impact Mrs. White as an elderly woman (Perna et al., 2016).
  • Nutritional deficiencies: Mrs., White has developed a reclusive behavior towards the consumption of nutritive food. This can lead to the development of nutrient deficiencies and further lead to secondary complications (Rios et al., 2019). Poor nutrition has been associated with the development of stress, fatigue, and overall negative impact on health and wellbeing. Poor diet intake is also associated with aggravation of comorbid health conditions like hypertension, obesity, and irregular heart rate (Rios et al., 2019). Since, Mrs. White already possesses a medical history of several cardiovascular illnesses like hypercholesterolemia, coronary artery disease, and atrial fibrillation, consumption of healthy and nutritious diet becomes even more essential, ignorance of which can lead to deficiencies, secondary illnesses, and also worsen the existing health problems.

Planning and Care

For the effective treatment and management of the present health condition of Mrs. White, it is important to develop a holistic care plan with a person-centered approach to ensure complete recovery and care (Stone house, 2017). According to the Nursing and the Midwifery Board of Australia, it is crucial to provide the highest quality care to the patient for their complete recovery and maintenance (Cusack, 2018). The complete recovery and effective maintenance of the health condition of Mrs. White can be ensured by setting up achievable, timely, and realistic goals (Stonehouse, 2017). The goals for the health improvement of Mrs. White have been passed on the identifies current and potential health problems. The first goals are to minimize and manage the pain experienced by the patient, the second goal is to limit the urinary tract infection, the third goal for the health promotion and beneficence of Mrs. White is to encourage intake of a nutritious diet. The penultimate goal is to help relieve anxiety in the patient through therapeutic care, and finally to achieve complete recovery.

The following nursing interventions can, therefore, be undertaken for the improvement of the health condition of Mrs. White. First, for pain management, positioning should be done to alleviate or minimize the pain that is experienced by Mrs. White. Positioning functions by aligning the patient body to minimize stress and tension (White & Majerick , 2017). It also aids in the prevention of the development of pressure injuries and bed ulcers that are frequent in patients that have limited mobility like Mrs. White. Since the patient has suffered from a rib injury, positioning must be done with critical consideration. The second essential nursing intervention for Mrs. White will be to encourage fluid intake. Improving the fluid intake in the patient will assist in the improvement of renal blood flow and therefore assist in limiting the number of bacteria (Cai et al., 2016). Further, for the management of UTI, the nurse must record the changes in the urinary pattern that include changes in the frequency, urgency, and hesitancy. It is also important to assess the patient’s knowledge about the use of antimicrobials and assist in undertaking preventive measures.

The characteristics of the patient’s urine including the color and concentration must be critically evaluated. The third suitable nursing intervention that must be undertaken for Mrs. White is to help her consume a nutritive diet (Chamnan & Aekplakorn, 2017). This can be done by offering liquid energy and high protein supplements in case the patient exhibits reluctance towards solid foods Since Mrs. White has developed a reclusive behavior towards nutritious food, her engagement towards a healthy diet can be ascertained by providing adequate patient education. The fourth suitable nursing intervention in the case of Mrs. White is to include relaxation techniques that can help in alleviating stress and also assist in faster recovery (Crocco et al., 2017). This intervention is essential for the health promotion of Mrs. White as it aims to address the psychological problems along with the physical distress of fracture and poor health experienced by the patient.

This can be achieved through a therapeutic approach where the nurse can counsel the patient regarding her needs and concerns and can, therefore, assist in achieving both physical as well as psychological healing. The nurse should exhibit competence and empathy towards Mrs. White to address her anxiety and to provide support for the same. The fifth intervention that can be undertaken by the nurse for the complete recovery and care of Mrs. White is to practice person-centered care (Bummel-Smith et al., 2016). The nurse needs to develop a strong inter-personal relationship with Mrs. White so that she can effectively communicate her needs without any hesitation. This intervention is important as Mrs. White has felt hesitant in reporting her pain in the past. Effective communication will ensure that her needs are communicated essentially and clearly to the healthcare professionals and therefore suitable interventions can be applied timely fir her complete recovery.

Evaluation of Mrs. Betty White

The proposed interventions aim to provide holistic care to Mrs. White and are inclusive of the current as well as the potential problems of her health condition. Successful applications of these interventions must ensure a complete recovery from both physical as well as psychological distress in the patient. To assess the impact and efficacy of the interventions their evaluation is critical, for pain management intervention, the efficacy can be assessed by reduction in pain to scales 3/10 based on the feedback of the patient (White & Majerick , 2017). The urgency and incontinence must decrease with a successful application of the second intervention (Cai et al., 2016). The approach towards nutrition and food should increase with the application of the third intervention (Chamnan & Aekplakorn, 2017). The fourth intervention application can be assessed by checking for stress and anxiety in the patient that should ideally decrease after the intervention (Crocco et al., 2017). Finally, communication with healthcare professionals must get easier and more conducive through the application of person-centered care (Bummel-Smith et al., 2016).

References for Contemporary Nursing Practice 

Brummel‐Smith, K., Butler, D., Frieder, M., Gibbs, N., Henry, M., ... & Saliba, D. (2016). Person‐centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15-18.

Cai, T., Mazzoli, S., Lanzafame, P., Caciagli, P., Malossini, G., Nesi, G., ... & Bjerklund Johansen, T. E. (2016). Asymptomatic bacteriuria in clinical urological practice: preoperative control of bacteriuria and management of recurrent UTI. Pathogens, 5(1), 4.

Chamnan, P., & Aekplakorn, W. (2017). Cardiovascular risk assessment in developing world. Recent Trends in Cardiovascular Risks, 57.

Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current Treatment Options In Psychiatry, 4(1), 33-46.

Cusack, L., Smith, M., Cummins, B., Kennewell, L., Dennett, L., & Pratt, D. (2015). Advanced skills for enrolled nurses: A developing classification. Australian Journal of Advanced Nursing, The, 32(4), 40.

Gupta, K., Grigoryan, L., & Trautner, B. (2017). Urinary tract infection. Annals of Internal Medicine, 167(7), 49-64.

Kim, Y., & Pritts, T. A. (2017). The gastrointestinal tract. In Geriatric Trauma and Critical Care (pp. 35-43). Springer, Cham.

May, L., Hillermann, C., & Patil, S. (2016). Rib fracture management. Bja Education, 16(1), 26-32.

McLellan, L. K., & Hunstad, D. A. (2016). Urinary tract infection: pathogenesis and outlook. Trends in Molecular Medicine, 22(11), 946-957.

Nirula, R. (2018). Postoperative complications after rib fracture repair. In Rib Fracture Management (pp. 159-163). Springer, Cham.

Perna, G., Iannone, G., Alciati, A., & Caldirola, D. (2016). Are anxiety disorders associated with accelerated aging? A focus on neuroprogression. Neural Plasticity, 2016.

Proctor, J., & Rickards, E. (2020). How to perform chest auscultation and interpret the findings. Nursing Times, 116(1), 23-26.

Rios, L. M., de Moraes, P. A. D., de Abreu, L. R., da Silva, P. H. V. A., Moraes, J. R. A., & Pavanelli, M. C. (2019). Nutritional deficiency as a complex cause of reversible dementia and cutaneous manifestations in elderly. Revista de Medicina, 98(Suppl), 17-18.

Stonehouse, D. (2017). Understanding the nursing process. British Journal of Healthcare Assistants, 11(8), 388-391.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.

Van Elten, T. M., Karsten, M. D. A., Van Poppel, M. N. M., Geelen, A., Limpens, J., Roseboom, T. J., & Gemke, R. J. B. J. (2019). Diet and physical activity in pregnancy and offspring’s cardiovascular health: a systematic review. Journal of Developmental Origins of Health And Disease, 10(3), 286-298.

Vierula, J., Haavisto, E., Hupli, M., & Talman, K. (2019). The assessment of learning skills in nursing student selection: A scoping review. Assessment & Evaluation in Higher Education, 1-17.

White, T. W., & Majercik, S. (2017). Rib fracture repair. Open Thoracic Surgery, 144.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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