The Healthcare sectors majorly focus on the areas where they can enhance the knowledge of the nurses and focus on the appointing leaders in the sector to have a balance in the organization and to have a safety for the patients. Secondly, the management of the organization should identify the various errors and learn from their mistakes that can benefit them in the future. Thirdly, the management should always set a standard of work and services for the patients. The main objective of the healthcare organization is to work for giving best medical services to the patients (Fayers & Machin, 2013). Therefore, the safeties of the patients are the utmost priority of this sector. Fourthly, the organization should monitor systems of safety that are implemented in the organization. The various procedures and laws are made by the organization for the safety and securities of the patients are the responsibility of the healthcare organization.
Therefore, the following report discusses the nursing managements procedures used for the patient named Audrey Smith.
Many people believe that health care acts as an umbrella for the patient’s safety. The health institutes consider the safety of the patients as the indistinguishable form of the health care. The ancient philosophers including Aristotle and Plato have completed the quality and the attributes of the safety in the healthcare. The quality of treatment was the main idea of healthcare for the Western world (Butcher, 2013).
The concept of patient safety have emerged from the health care quality of the movement that is abstract, with the several approaches for gaining more concrete and essential components. The safety practices in the healthcare organizations for maintaining the safety of the patients includes the usage of the sterile barriers while placing the intravenous catheters that are central to prevent the infections, the usage of appropriate antibiotics that prevents the patients from postoperative infections and the use of pressure relieving bedding materials for preventing the pressure ulcers (Butcher, 2013).
The intervention also includes providing the nutrition to the patients with a particular emphasis on the early entral nutrition for the patients who are critically ill and for the surgical patients for preventing them from any complications. The nursing intervention determines the healthy body weight in accordance to the age and height of the patient. According to their body structure and health, they are referred to the dietitians for completing the assessment on nutrition. It is the duty of the nurses to ensure that they are successful to use the essential form of nutrition. It is their duty to observe the ability of the client to eat that includes the time involved, motor skills, visual acuity and the ability to swallow the several textures of food. If the nurses observes that the client seems to lack the endurance and schedule the rest periods before the meals and open the packages and cut up food for the clients.
The interventions include the elimination that is generally done when the patient has undergone any king of surgery. The elimination majorly includes the dysfunctions in the urinary impairment (Park, 2014). Therefore, the management of the nursing department is very essential.
The main motive of the nurses is to check the patient’s level of mobility. In case of surgeries in the limbs make the patients restricted to bed for a very long time. However, it is very important for the nurses to observe that whether the patient is able to walk properly post the injury. Therefore, the assistance of physiotherapy gives comfort to the patients who have recently undergone a surgery for fracture. The nurses can also motivate the patients for having a normal rate of activity.
The psychosocial care is important not only to the patients of the healthcare organization but also to the staff who are providing the care. The nurses can provide the care and support to the patients who are being admitted in the hospital for their treatments. The cares of the nurses are both in terms of servicing the patients physically but also boosting their morale verbally. The conversations with the patients are very important for those who are recently admitted or the patients who are undergoing any crucial surgery (Park, 2014).
The case history of the patient reveals that the patient has already being diagnosed with eight various diseases. The explanations with its diagnosis are discussed in the following part.
The Atrial fibrillation is diagnosed when there is a family history of AF, based on the physical exams and the results of the tests shows the evidence of the disease (Tehrani, 2014). It may be detected through the physical treatments or the electrocardiogram test done for testing the condition of the heart of the patients (Tehrani, 2014). The patient is also diagnosed with Hypertension.
The patient has the history of Cerebrovascular accident. The CVA is the condition that means the patient is suffering from stroke.
The case history observes that the patient is under the medication for type 2 diabetes. For diagnosing the type 2 diabetes, the healthcare physician should begin with Glycated Hemoglobin (AC1) test where the blood test indicates the average sugar level of the patient from the past two to three months.
The patient also has the history of Gastro-esophageal reflux disease (GORD). Various tests are performed to know that the patient is suffering from GORD or not. The type of tests includes Endoscopy, barium swallow or barium meal test, manometry, 24 hour pH monitoring and blood tests.
The case history of the patient shows that the patient was suffering from Osteoporosis that refers to the condition of decreased mass of the bone. This disease leads to the increased risks of fracture. It is painful that there is no accurate structure of the bones without removing a single piece during the biopsy.
The patient also has the history of total hysterectomy since 1995. The total hystectomy is the most common form of hysterectomy. During the process of abdominal, hysterectomy the doctor removes the uterus of the patient including their cervix.
The patient is also diagnosed with depression in the year 2005. The patient has lost her husband and her daughter lives in Queensland, so she lives alone. Therefore, her loneliness has caused depression.
Mrs. Smith is under several medications for various diseases. Some of the medicines are also affected her health. Therefore, the report will analyze the indications, actions, and side effects of her medicine.
Digoxin : Used for slowing down the heart rate in the patient with chronic fibrillation. It is a form of digital glycoside that works by increasing the force of the contraction of the heart. The side effect includes blurring of vision, nausea and fatigue.
Warfarine: An anticoagulant or blood thinner helps in reducing the blood clots. It is used for treating stroke and heart attack. The major side effect of this drug includes stomach pain, bleeding gums, dizziness, excessive bruising, chest pain and discomfort.
Coversyl: It is used to treat high blood pressure. It helps to control blood pressure by relaxing blood vessels. Perindopril may be used alone or in combination with other medications that reduce blood pressure, especially thiazide diuretics (water pills). It can cause dry cough, diarrhea, dizziness and headache in the patient.
Vitamin D: It is used for treating low level of phosphorus and calcium as the patient is suffering from NOF. The use of this drug can cause nausea, vomiting, extreme thirst, constipation and frequent urination to the patients.
Metformin: An oral diabetes medicine helps control blood sugar levels. It is
used for improving blood sugar levels. They are sometimes used in the format of insulin. This
medicine may cause lactic acidosis.
Esomeprazole: It is used for decreasing the amount of acid produced in the stomach. It may cause blistering, peeling, bloating, cough, darkened urine, fast heartbeat and joint muscle pain.
Effexor: Effexor (venlafaxine) is an antidepressant in a group of drugs called selective serotonin and nor epinephrine reuptake inhibitors. Effexor is used for treating major depressive disorder, anxiety, and panic disorder. Its major side effects includes, lack of strength, severe headache, blurred vision, chest pain and sweating.
Caltrate: It is used for preventing calcium deficiency. It may also be used for other conditions as determined by your doctor. Caltrate 600+D is a dietary supplement. It works by providing extra calcium to the body. It may cause severe allergic reactions like rash, hives, swelling of tongue and lips, loss of appétit and nausea.
The preoperative preparation of the patient is a very crucial for maintaining the health of the patients. The patient firstly prepared psychologically and physically for the surgery. The several interventions are directed towards the treatment and minimization of the pre existing medical conditions. They also provide the information and support to the patients’ through the whole process of the surgery. The nursing activities are planned to get positive outcomes of the patients (Sadati, 2013). The families of the patients are also included in this form of activity. The nurses provide the patients full information about the learning needs that essentially ensures that the teaching of the patient that is relevant and is delivered in an appropriate form for the patient. The preparations for the surgery includes the several nursing activities including the collection of data through the assessment of the patients, teaching the family of the patients, giving an emotional support, planning the care for the intraoperative and postoperative periods and communicating with the team members of the healthcare departments about the condition of the patients (Sadati, 2013). The preoperative nursing are also important for the administration of the antibiotics and the prior to the incision for a certain type of a surgery that can be developed for showing the significant reduction in the in the rates of surgical infections.
Preoperative nurses provide postoperative care. They are often experienced in a specialized area of surgery that requires specific care for the intervention performed. From the time, that a patient leaves the care of the anesthetist after an operation until he wakes in the ward his physiological state should be continuously supervised by the nurses. Postoperative nurses are provided only when the operating theatre has a recovery room. A survey among consultants and nurses in one region showed that many surgical units did not have recovery rooms and that inexperienced ward nurses were often sent to collect patients. The survey showed that most nurses were competent to care for unconscious patients so long as an emergency did not arise.
From the case study, it has been observed that the patient is 75 years old who is undergoing the NOF surgery. Delirium is a common accompaniment of physical illness in old age, affecting approximately one out of five of those admitted to medical wards, the number being higher for elderly with fractured femurs (Sadati, 2013). There are several risk factors that are attached includes, regaining the mobility of the patient, further falls, the development of pressure ulcer, delirium, unresolved pain, constipation, dehydration and delayed discharge. The patients are vulnerable to the pressure damage as the immobilization tends to begin with the initial forms of fractures, the individuals may have fallen and been lying on a hard surface for several hours. The risk can be avoided by introducing the evidence-based pathway includes the early surgeries and optimizing the fluid levels and restore the balance with the clinical imperative for the vulnerable patients. The patient in the post operative scenario also goes through the problem of constipation. The problem of constipation can be genetic and there are possible factors like diet, dehydration and the patterns of the mobility that can increase the risk for the patients. There are several preventing measures that are implemented for overcoming the risks of constipation that includes, having more fluids and roughage in the diet, avoiding the fasting periods, using the prophylactic stool softener, regular toileting, close monetization of the bowel habits and good mobility practices post the surgery.
The other condition post the surgery of the patient is the nutritional deficit or immense dehydration. It is very important for the nurse to identify the various signs of dehydration of the patients. The signs include diminished output, hypotension, and development of delirium or renal failure. The management of the risk factor can be done by fulfilling the dietary needs of the patient.
Delirium is a medical emergency and if not promptly and urgently treated, or even better prevented, may have serious consequences for the patient and the family members. Proper measures for its prevention and treatment result in shorter hospital stay of the patients, less financial cost and better surgical outcome and rehabilitation of the elderly patient. The nursing management team for managing the postoperative issues of the patient implements several strategies (Sadati, 2013). Firstly, it is very important for the patients to manage the pain of the patient. Severe amount of pain is experienced for all the patients who have undergone hip surgeries and it not only contributes to the poor quality of life but it is also associated with a higher amount of risk of the postoperative delirium. However, the main objective of the nursing management is to lower down the aggressive pain of the patient.
The rehabilitation is the cornerstone in efforts to reduce rates of ambulatory and functional impairment, but limited evidence is available to inform on the optimal venue for such therapy. The psychosocial interventions are examined after the fracture of the hip. The specialist nurse care are in the target community can improve the transitional form of care but it has also has a consistent impact on the other outcomes for about twelve months. There are specific forms of venue for the rehabilitation of the rehabilitation after the hip fracture but a sensible approach is to provide an intensive regimen for tolerated by the patients that have addressed both the physical and the instrumental tasks with the interdisciplinary team (Browne, 2014).
The steroids and the nutritional supplements are used by the patients who undergoes any hip fractures and loss in the bone mass that results in the disability. The postoperative oral or the nasogstric proteins and the supplements of the micronutrient are found for improving the mortality or the disability (Browne, 2014). However, it shows a trend towards the reduction in the composite outcome of mortality and the medical complications that is faced by the patient after the hip fracture.
The ambulatory dysfunction that results from the hip fractures increases the risk for the patients. However, the patient needs to be very careful to prevent falling post the hip fracture. The home occupational therapy visits can be a helpful source to assess the safety and the equipment needs of the patients (Browne, 2014).
The guidelines for preventing the additional osteoporotic fractures have been reviewed previously but there are few comments specific for hip fracture patients are noted here. First, bisphosphonates should be strongly considered as first-line therapy for the hip fracture population as good evidence supports not only a 35% reduction in secondary fractures after hip fracture regardless of bone density but also a 20–28% reduction in mortality. Although clinical trial evidence remains best for the intravenous bisphosphonate zoledronic acid, subsequent meta-analyses and population-based studies suggest that the mortality benefit probably extends to oral bisphosphonate formulations as well, and either intravenous or p.o. can be considered based on the patient’s situation. As vitamin D deficiency is extremely common in hip fracture patients, routine high-dose supplementation or verification of sufficient serum 25(OH)D levels should be completed before initiation of bisphosphonates to avoid hypocalcemia (Browne, 2014).
Conclusion
Hip fracture patients are among the most frail, high-risk patients that bone clinicians will encounter. Although morbidity and mortality rates are high, outcomes can be improved with systematic, interdisciplinary care addressing multiple domains as described above. Good evidence supports aggressive preoperative pain management and VTE prevention.
Therefore, the report illustrates about the care that is given to Mrs. Smith from her admission in the hospital until her discharge. The whole process of her included the correct interventions, her surgeries, her medications and planning her discharge plan so that she can maintain her health after returning home.
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