Nursing Case Study

Introduction

Hi! Your revision instructions are as follows: Q1 you are going way too in depth with fall prevention, the second paragraph is more to do with when she discharges. Concentrate more on how a nurses intervention can implement a plan of care to ensure decreased risk of secondary injuries from the fall, ie neuro observations as stated she can't remeber anything from the fall, telemetry monitoring to ensure it was not a syncope episode. Atrial kick to do with AF and anticoagulants.. Please confirm that you are working on it as soon as possible

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Question One

Olive is at risk of falling; therefore the best nursing intervention is necessary to prevent further and future injuries related to falls. Research on the High rate of immobility and mortality in the elderly shows that elderly patients suffer a higher risk of injury and death due to frequent falls (Cameron et al., 2010). The best nursing practice in this scenario is to implement fall management strategies after the risk of fall is assessed. The nursing team dedicated to fall prevention engage the patient through simulation.

It is an interdisciplinary approach that the fall nursing team work closely with the patient, the physical therapist, and health facility safety team. Monitoring Olive's room is an essential nursing practice in this scenario because the frequency of Olive falls is yet to be determined. As a nurse, it is important to assist Olive during the recovery process to learn how to use a quad cane and provide education on the elastic stocking to ensure she learns again how to rise again. It is also prudent to ensure that items frequently used by the patient are at her reach to avoid strain while accessing them such as call light, water, telephone and urinal (Walker et al., 2016).

In case of an emergency, nursing intervention it is key in responding with speed to a call from the patient's room avoid further injury from falls as well as avoid legal lawsuit regarding abandonment of patient during diagnosis period (Bunn et al., 2014).Planning for care reduces Olive high-risk patient, this is substantial in providing a hip pad and other supportive devices like TED stocks which prevents fractures. Engaging Olive's family to participate in the process of preventing falls is crucial for her recovery process. Plan to engage and educate family members on the safety ambulation at home to ensure that Olive gets the necessary to reduce risks of secondary injuries from fall (Stubbs, 2015) support. For example, live bathroom at home should have handrails in this cases of fall would be minimized.

Another intervention of managing Olive's risk of falling, it is appropriate application of anticoagulants in managing her atrial fibrillation condition. Administration of oral anticoagulant in the case of Olive help to prevent her from contracting thromboembolism condition. Use of Anticoagulants suppresses coagulation flow which they activate platelets, thus, acts as the best antithrombotic treatment that prevents the emergence of prothrombotic effects commonly in patients with atrial fibrillation (Veitch et al., 2016).

Question Two

The Bruise is a common complication in patients who are elderly. Olive medication helps in the shift from warfarin to rivaroxaban prevents cases of excessive bleeding. Rivaroxaban is a preferred anticoagulant since it has a great positive impact on warfarin drug (Papou et al., 2017). According to this study, the effective use of warfarin and rivaroxaban, it increases the risk of excessive bleeding for the patients using both rivaroxaban and warfarin as an anticoagulant at any age.

However, rivaroxaban was associated with decreased intraparenchymal, subdural and intraventricular activities compared to the use of warfarin (Veitch et al., 2016). As a nurse, it is important to monitor the patient's hemoglobin levels using a noninvasive continuous hemoglobin monitor device. The use of this device to monitor hemoglobin reduces the risk of high blood loss during surgery. Besides this device, it is easy to maintain blood volume by using Intraoperative cell salvage machine that can accumulate and wash the lost blood (Anderson et al., 2014).

After surgery, it is prudent as a nurse to routinely monitor Olive's blood level to avoid the risk of anticoagulation. It is also significant to check Olive's body temperature to ensure that it does not fall below the normal level risking contraction of hypothermia. Provision of oxygen support machine is necessary during surgery to help Olive to breathe as the best way of increasing oxygen circulation in the body (Clevenger et al., 2015).

Another risk of postoperative healing is poor healing of the wound among the elderly as a result of the anticoagulation condition. The risk of postoperative bleeding involves a delay of diagnosis process; therefore, it is important for nurses to monitor Olive's signs of bleeding. Additionally, it is important to report changes in Olive's condition after surgery for purposes of quick doctor response. Another ultimate role of a nurse in this scenario is to ensure the patient and the family are aware of the diagnosis process (Thorell et al., 2016).

Question Three

It is essential for Olive to receive sufficient analgesia as a way of managing pain in the emergency department before radiographic imaging. Most research recommends the use of Femoral Nerve Block it leads to high pain relief result both in the preoperative and postoperative stage. The nursing intervention, therefore, requires cooperation with different professionals at the health facility that Olive is admitted in to ensure appropriate pain management technique and protocol is followed.

Regional anesthesia is used in clinical care to reduce pain that results from fractures. RA is only used to save time and costs as a result of limited hospital stay and lack of extensive nursing interventions. In most cases, RA is used to prevent patients from periodic opioids and ischemic pain. However, a patient exposed to RA is prone to develop great complications since it delays the diagnosis process. On the other hand, patient-controlled analgesia (PCA) a popular postoperative pain management technique.

The use of PCA is popular in orthopedic since it prevents adverse effects of opioid. PCA like RA has masks the signs of CS causing a delay in the patient treatment process. However, research by Driscol et al. (2016) shows that the current nursing practice reveals that there is no delay in diagnosis as a result of the use of RA and PCA (Nishio et al., 2014). The use of femoral nerve block (FNB) technique is known for having little tendency to cause complications in surgical and postoperative pain control.

Kopp & Horlocker (2010) assert that the use of FNB extends induction period, but it can be mitigated through the use of unique RA. Besides FNB ability to minimize complications during injury management and surgery, the use of oral analgesia is an appropriate strategy that lower the patient's pain because patients undergo progressive guiding and counseling. According to a research conducted by Madsen et al. (2018) indicate the use of oral analgesia as the most effective method with a higher rank on the pain scale measure.

The use of RA and oral analgesia is appropriate for Olive's case to manage pain. For cost management and appealing diagnosis results, it is essential to assess the existing nursing facility procedures, policies and practice to decide on which technique is appropriate to use. However, to effectively manage acute pain, most physicians recommend the use of oral analgesia (Moore et al., 2015; Murty, 2003).

Question Four

Olive requires a well-designed discharge plan to ensure that she recovers in full by preventing secondary falls. Discharge of patients admitted to a health facility occurs between the 8th days of admission up to 30th considering 16 as a mean of stay (Papou et al., 2017). By using care pathway forms, it becomes easy to initiate Olive's care plan because they entail patients care needs and quality of primary care. There is need to consider continuous tracking of Olive's medical progress through a recommendation for regular visits so that up to date medical information can be recorded for future reference.

Additionally, tracking will involve discovering the patient's location and auditing of clinical report. Considering the age of Olive, it is important to discharge her to the nearest nursing home to prevent long traveling distance. Olive need regular exercise plan, therefore, by following report compiled by the physical therapist, recommending daily soft exercise will be appropriate for full recovery of femur fracture. Research indicate that most patients discharge at home has positive ambulation outcome (Walker et al., 2016). Olive will need crutches to assist her with mobility while at home to regain her pre-injury mobility ability.

Olive will be discharged only if she has shown improvement signs of complications caused by atrial fibrillation and pain due to femur fracture. However, it is essential to inform the family of relevant information regarding the use of oral anticoagulants. It is also necessary to educate the family and Olive regarding the use of drugs that are nor prescribed by the doctor (Walker et al., 2016). It is also important to emphasize on the drug dosage as prescribed by the doctor to prevent atrial fibrillation. Since Olive suffers from atrial fibrillation, Olive should be enlightened not to use stimulants that contain caffeine concentration.

Conclusion

Use of highly caffeine stimulants increases heartbeat considering Delicate Olive case can lead to the fatal accident of stroke. Besides being keen on the lifestyle, Olive and the family should always monitor the incision to check whether there signs of infections at once a day. In case there are signs of the infection, it is essential to contact the nurse and physician responsible for her medication to initiate medical checkup that will prevent further infections of the femur. It is recommended to keep away tripping hazards from Olive to ensure that olive does not fall again (Bunn et al., 2014).

References

Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., .. & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.

Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C., & Victor, C. (2014). Preventing falls among older people with mental health problems: a systematic review. BMC Nursing, 13(1), 4.

Cameron, I. D., Murray, G. R., Gillespie, L. D., Robertson, M. C., Hill, K. D., Cumming, R. G., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database System Rev, 1(1).

Clevenger, B., Mallett, S. V., Klein, A. A., & Richards, T. (2015). Patient blood management to reduce surgical risk. British Journal of Surgery, 102(11), 1325-1337.

Driscoll, E. B., Maleki, A. H., Jahromi, L., Hermecz, B. N., Nelson, L. E., Vetter, I. L., ... & Riesenberg, L. A. (2016). Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review. Local and regional anesthesia, 9, 65.

Kopp, S. L., & Horlocker, T. T. (2010). Regional anesthesia in daystay and shortstay surgery. Anaesthesia, 65(s1), 84-96.

Madsen, S. B., Qvist, N., Moller, S., & Schultz, H. (2018). Patient-controlled oral analgesia for acute abdominal pain: A before-and-after intervention study on pain intensity and use of analgesics. Applied Nursing Research, 40, 110-115.

Moore, R. A., Derry, S., Wiffen, P. J., Straube, S., & Aldington, D. J. (2015). Overview...