The Roper-Logan-Tierney nursing model is one such nursing care theory which is depended on the daily life activities that are shortly stated as ADLs. This model is widely used in various sector but mainly in healthcare sector (Williams, 2017). The theory’s purpose is to be utilized as a tool of assessment during the treatment process of a person. It is more commonly employed for assessing how the life of a patient has been changed as an outcome of illness, accident, or hospitalization than to plan for increased independence as well as standard of living. The notion is an attempt to define what it means to live. Following a thorough evaluation, it categorizes the results into daily tasks, resulting in treatments that enhance independence in regions where the patient may experience difficulties to handle on his or her own. The examination and therapy are aimed at assisting the patient in achieving maximum independence (Holland, K., & Jenkins, 2019). Nursing professionals often utilizes this theory for assessing the relative independence of the patients as well as capability to carry out the daily life activities or ADLs. The degree of patient autonomy is measured on a scale ranging from complete dependence to complete autonomy. This helps nurses determine which interventions lead to increased independence and what ongoing support is needed to minimize the remaining dependence (Williams, 2017). The biological, Psychosocial, spiritual and cultural factors that the nurse need to identify that Kristy and her family going through could be:
The biological factors that can be written in this context is that Kristy has been suffering in fracture that occurred in 2 places in right side of the pelvis and from the CT scan it can be seen that she is also suffering in Cerebral contusion. She has been prescribed with intravenous (IV) morphine for controlling the pain.
From the case scenario and details it can be seen that Kristy is intermittently confused and failed to remember all the incidents that took place after she fall from the horse. Moreover, Kristy is not properly oriented date as well as time. The hit of the head on the ground significantly affected her psychological health.
There is no specific mention about spiritual factors, however, the treatment process must follow and treatment by keeping he spiritual concerns in mind.
While working with the patient a nurse must assess the important information and while doing this, they must consider the cultural belief of Kristy as well as they should avoid by using any casual approach to avoid any legal complication.
According to Australian Law Reform Commission (2022), consent is a free agreement of a person for participating in an activity. Consent may only be given if it is both free and voluntary, without force, fear, pressure, or anything else that prevents people from freely agreeing (Australian Law Reform Commission, 2022). In this case study, a consent needs to be taken from the patient Kristy before proceeding for her surgery. It is always preferable to get the consent to avoid any legal complication after the procedure.
The following element is doctrine of necessity, where it was found that the idea that illegitimate government law is valid as long as it does not violate the Constitution is justified by the argument that maintaining the government is more important than supporting the law. The need is defense in both criminal and civil law. This means that if an activity is “necessary” to prevent greater harm, it can be used to avoid criminal accusations and allegations of civil negligence (Australian Law Reform Commission, 2022). Hence, while caring for Kristy the nurses must avoid negligence to avoid criminal accusations and allegations. Lastly, enduring guardianship is the act or law that enables the patient to appoint them as their guardian as well as authority to take treatment decision when they are not capable (NSW Trustee and Guardian, 2022). In this study, Kristy can appoint her husband as enduring guardian to take the treatment decision on her behalf.
Kristy will undergo for surgery for the fracture that she acquired after falling from horse. In the hospital and care settings the nurses must take care of Kristy properly to give her comfort and less feeling of pain as much as possible. To achieve this, the nurses must follow few actions that might help them to take proper care of Kristy. Three of the major nursing actions in in such case are mentioned below:
The first nursing action in this case would be supporting the fracture site with some folded blankets or soft pillows along with maintaining a neutral position of the body part (which has been affected because of the fall) by using sandbags, trochanter roll, splints, or footboard (Cooper & Gosnell, 2018). The rationale behind this nursing intervention is that this might help the patient by preventing unnecessary movement as well as disruption of alignment (Cooper & Gosnell, 2018). It has been seen that appropriate placement of the pillows might help the patient by prevention of the pressure deformities in the drying cast and giving comfort.
The second nursing action could be caring for the acute pain that Kristy has been experiencing by maintaining the immobilization of the body part which has been affected due to the fall. The immobilization can be done by applying and monitoring bed rest, traction that might help the patient to get relieve from the pain as well as helps the patient in preventing the further displacement of bone and extension of tissue injury (Powell & Weir, 2018).
The last nursing action in this context could be supporting the patient mentally till entering the surgical room for the surgery as Kristy’s husband stayed at home for taking care of their children and Kristy might feel tensed or anxious before going into surgery and in that situation, nurse can provide mental and emotional support to her and assure her about successful recovery to boost her morale.
From the case study of Kristy and the patient details post-surgery it can be found that Kristy has high blood sugar level that indicates about presence of type 2 diabetes. Another cue that can be found from the vital signs is that the blood pressure of Kristy is 105mg/74 mg which indicates that her blood pressure level is very low and she might have been suffering in hypotension that also caused the drowsiness that she is encountering. The third cue in this case could be the high pain score which is 7/10 that indicates about severe pain.
The first cue is the presence of diabetes type 2 that can be known from the blood glucose value which is 6.5 mmol/L, which is higher than the normal blood glucose value. The normal value of the blood glucose always counted under 5.5 mmol/L and the value higher than it considered as presence of type 2 diabetes (diabetes.co.uk, 2022). From the pathophysiological aspect of this disease, it can be stated that type 2 diabetes is featured by resistance of peripheral insulin, improper or disturbed regulation of the hepatic glucose production, as well as declining the function of β-cell, that eventually lead to failure of β -cell (Galicia-Garcia, 2020). In case of failure or dysfunction of the β-cell, that in turn decrease the secretion of insulin that limits the capacity of the body in maintaining the physiological glucose concentrations (Cantley & Ashcroft, 2015). On the other hand, resistance of insulin contributes to elevated production of glucose in the liver as well as reduced uptake of glucose both in the muscle tissue, liver cells as well as adipose tissue. Dysfunction of beta cell is consistently more severe compared to insulin resistance, even in case both the processes are performed initially in the pathophysiology as well as lead to the development of this disease. Hyperglycemia is increased when both ß – cell dysfunction as well as insulin resistance are present, leading to the establishment of type 2 diabetes mellitus (Galicia-Garcia, 2020). Impaired secretion of insulin usually worsens over time, resulting in glucose toxicity and lipo-toxicity. In animal tests, they have been shown to cause a minimization in the pancreatic cell mass when left untreated. The progression of the dysfunction of the pancreatic cell has a significant impact on long-term blood glucose regulation (Kahn et al., 2014). Insulin resistance, on the other hand, is a condition in which the body’s insulin does not exert enough action in proportion to its blood concentration. In type 2 diabetes, impaired action of insulin in main target organs such as the liver and muscles are a typical pathophysiological characteristic (Kahn et al., 2014). Insulin resistance develops and spreads before the beginning of the disease.
The following cue is the low blood pressure or hypotension as the value of the blood pressure is 105 mg/74 mg, which is lower than the normal level (120mg / 80mg). From the aspect of pathophysiology of the lower blood pressure it can be stated that as a combination of the sympathetic as well as parasympathetic nervous systems, blood pressure is constantly maintained by the autonomic nervous system. By stimulating the central nervous system as well as constricting capillaries, the sympathetic nervous system elevated the blood pressure. The PNS or parasympathetic nervous system reduces blood pressure by slowing down the heart rate as well as relaxing the arterioles to widen the vessels (Sharma, Hashmi & Bhattacharya, 2021).
The third cue in this case study is the severe pain that she is experiencing as the pain score is 7/10 which can be denoted as severe pain. This value denotes extreme discomfort that dominates the individual’s senses and severely affects the person’s ability to do basic everyday activities or socialize with other people. Moreover, sleep is disrupted because of the sensation (creakyjoints.org, 2022). From the pathophysiological aspect of the issue, it can be stated that broken bone or fracture can be very painful as the endings of nerves, which surround the bones might consist pain fiber and these elements may become irritated when the bone gets bruised or get broken. The broken bones or fractured portion might cause losing of blood which is related to swelling (edema) that ultimately causes pain (Alves et al., 2016). Another concept about pain stated that during the inflammatory response to a fracture, a number of mediators are produced, which are hypothesized to activate and sensitize primary sensory neurons. Furthermore, pain signaling is assumed to be linked to extensive nerve spreading in the fracture callus area. (Alves et al., 2016). According to the study published by Nencini and Ivanusic (2016), various clinical as well as experimental observations stated that noxious activation of the periosteum or bone marrow can cause significant pain. The periosteum as well as marrow cavity are known to be innervated by sensory neurons, and the majority of them have a morphology and molecular profile that suggests they play a role in nociception.
Reference
Alves, C. J., Neto, E., Sousa, D. M., Leitão, L., Vasconcelos, D. M., Ribeiro-Silva, M., Alencastre, I. S., & Lamghari, M. (2016). Fracture pain-Traveling unknown pathways. Bone, 85, 107–114. https://doi.org/10.1016/j.bone.2016.01.026
Australian Law Reform Commission. (2022). Consent | ALRC. ALRC. Retrieved 28 March 2022, from https://www.alrc.gov.au/publication/family-violence-a-national-legal-response-alrc-report-114/25-sexual-offences-3/consent-4/.
Cantley, J., & Ashcroft, F. M. (2015). Q&A: insulin secretion and type 2 diabetes: why do β-cells fail?. BMC biology, 13, 33. https://doi.org/10.1186/s12915-015-0140-6
Cooper, K., & Gosnell, K. (2018). Foundations and Adult Health Nursing E-Book. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=juJ1DwAAQBAJ&oi=fnd&pg=PP1&dq=Cooper,+K.,+%26+Gosnell,+K.+(2018).+Foundations+and+Adult+Health+Nursing+E-Book.+Elsevier+Health+Sciences.&ots=2
CreakyJoints. (2022). Describing Your Pain With a 0-10 Pain Scale May Be Messing With Your Treatment. Here’s What You Can Say Instead.. CreakyJoints. Retrieved 28 March 2022, from https://creakyjoints.org/doctor-patient/pain-scale-not-best-way-communicate-pain/.
diabetes.co.uk. (2022). Normal blood sugar ranges and blood sugar ranges for adults and children with type 1 diabetes, type 2 diabetes and blood sugar ranges to determine people with diabetes.. Diabetes. Retrieved 28 March 2022, from https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International journal of molecular sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275
Holland, K., & Jenkins, J. (Eds.). (2019). Applying the Roper-Logan-Tierney Model in Practice-E-Book. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=erKMDwAAQBAJ&oi=fnd&pg=PP1&dq=The+
Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet (London, England), 383(9922), 1068–1083. https://doi.org/10.1016/S0140-6736(13)62154-6
Nencini, S., & Ivanusic, J. J. (2016). The Physiology of Bone Pain. How Much Do We Really Know?. Frontiers in physiology, 7, 157. https://doi.org/10.3389/fphys.2016.00157
NSW Trustee and Guardian. (2022). What is an Enduring Guardian?. NSW Trustee and Guardian. Retrieved 28 March 2022, from https://www.tag.nsw.gov.au/wills/appoint-enduring-guardian/what-enduring-guardian.
Powell, R. A., & Weir, A. J. (2018). EMS Bone Immobilization. https://www.ncbi.nlm.nih.gov/books/NBK507778/
Sharma, S., Hashmi, M. F., & Bhattacharya, P. T. (2021). Hypotension. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499961/#article-23295.s5
Williams, B. C. (2017). The Roper-Logan-Tierney model of nursing. Nursing2020 Critical Care, 12(1), 17-20. DOI: 10.1097/01.CCN.0000508630.55033.1c
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