Comprehensive nursing
Order Instructions:
This is the case study of the subject comprehensive nursing, which is due on 18th of march
Scenario is Mrs Alright is a 77 years old lady who has been brought in by ambulance after being found on the floor by her carer this morning.
She had a fall last night while mobilizing to the toilet
and mechanism of falls looks like she tripped on the corner of a mat in the hallway. found in the hallway on the floorboards.
Pre medical history (from carer)
Type 1 diabetic on insulin Hypertension Hyperlipidaemia Osteoporosis
Recent UTI on ABS ( EColi) AMI 2007
CABGs 2008
CCF
O/E
Obvious facial lacerations above R) eyebrow and across bridge of nose
Left wrist deformity from FOOSH
LHS hip pain, leg shortened and internally rotated? # NOF Bruising to LHS of leg and face
Patient confused and complaining of nausea
Small bedside patient
Pain assessment _ not able to ascertain but vocalizes on movement Diaphoretic
Fruity odour to breathe noted
BASELINE OBSERVATIONS Temperature 35.2 C
Bp 100/55
RR 25 bpm deep and rapid breathing BSL 15 mm
HR 130 bpm
Capillary refill 4 secs/ sluggish
Questions to answer for the case study are
1. list two most likely nursing diagnosis for Mrs Alright and list one reason from the clinical information that leads you to believe this?
2. Due to Mrs Aright’s PMH, identify two potential complications of her fall
3. List two clinical interventions that you would prioritize for Mrs Alright and list one physiological reason each intervention?
4. List two chronic conditions of Mrs Alright that may have caused her fall and list one pathophysiological reason that leads you to believe this?
5. List two reasons why a 77 year old lady is more risk of sustaining a fracture after a fall?
Scenario
MRS Alright is now stable enough for surgery and goes to theatre at 0700 for an ORIF of her right hip. She RTW at 1100 after being stabilized in recovery. You are the nurse looking after her for the rest of your shift. Mrs Alright is complaining of sever pain in RHS
6. List two questions you would ask when assessing this patient’s pain levels?
7. List two ways in which a cognitively impaired patient who is unable to communicate, express that they were in pain?
Scenario
Post operatively the patient has a PCA for pain management
with morphine. This is set at an infusion rate of 2 ml/hr. the infusion has been made up with 100 mg of morphine in 50 ml. Ms Alright is complaining of severe pain in her RHS and the anesthetist has ordered a 5 mg bolus to be given.
8. list two benefits and two risk factors for Mrs Alright caused by the pharmacological actions of morphine?
9. Identify two degenerative changes that occur in the elderly and explain how those changes may cause a pathophysiological response to morphine?
10. state two clinical interventions as your priority for Mrs Alright while on her PCA?
THE FIRST ASSIGNMENT, WHICH IS CASE SCENARIO IS
1 TO 5 QUESTIONS ARE FOR 200 WORDS
6 TO 10 QUESTIONS ARE 200 WORDS
APA style
THE LINK TO THE WEBSITE F0R MORE INFORMATION IS federation university library only for referencing
THREE REFERENCES REQUIRED
ONE OF THEM SHOULD BE FROM BOOK medical surgical nursing (LEMONE AND BURKE )
SAMPLE ANSWER
- The two possible diagnoses for Alright may be acute pain and fluid volume deficit. The patient is suffering from osteoporosis since she fell, she may be experiencing pain (Buffum et al., 2007, p. 325). Additionally the patient may be experiencing fluid volume deficit since she has low blood pressure, rapid and deep breathing, and she is also nauseated (Whitney and Rolfes, 2011, p. 45).
- From her past medical history, she was found to have suffered from osteoporosis. Patients suffering from osteoporosis normally have problems with their skeleton due to weakening of bones. This condition is characterized by low bone mass, and bone tissue is known to undergo microarchitectural deterioration. The fragility of the bone increases and the bones fail to bear weight. As such, the victim may fall with a small trip since the legs cannot support the weight (Buffum et al., 2007, p. 325). Mrs. Alright may also have fallen due to lack of energy. The level of hydration may be low and thus prevent generation of enough energy (Whitney and Rolfes, 2011, p. 65).
- I would prioritize oral rehydration for the patient using oral rehydration salts (Whitney and Rolfes, 2011, p. 67). Due to the pain that Mrs. Alright may be experiencing, I would consider the administration of naproxen. This drug is a pain reliever and will be effecting in easing the pain experienced by the patient (Burke and LeMOne, 2013, p. 65).
- One of the chronic conditions is type 1 diabetes under which the patient is on treatment using The patient may risk suffering from insulin shock. The level of blood glucose may drop causing a consequent reduction in energy produced in the cells. Muscle cells weaken and thus fail to support the body to regain its upright position in the event of tripping (Whitney and Rolfes, 2011, p. 49). Osteoporosis is also another chronic condition that may be attributed to the patients` fall. This condition is associated with thinning and weakening of bones. Bone fractures may also occur with initial falling. The patient may have fallen because the thin and weak bones failed to support her weight during tripping (Buffum et al., 2007, p. 325).
- Women aged 77 years may sustain fractures after a fall because the weakening of their bones, which is associated with increased Additionally, at this age, such women do not exercise a lot to strengthen their bones. Therefore, their bones become fragile and thus can fracture easily (Dagenais and Haldeman, 2012, p. 234).
- The two questions are:
- Where is your pain?
- What makes your pain worse?
- The common pain behavior for cognitively impaired include:
- Facial expressions like frowning
- Verbal expressions like sighing (Buffum et al., 2007, p. 316).
- The use of morphine may be associated with benefits like:
- The patient may experience a faster relief of pain
- The chances of being dependent on morphine are reduced
The risks may include:
- Heightened feeling of nausea
- She may also experience increased sweating
- The process of degeneration of the inter-vertebral disc is common among the elderly. Degeneration of the inter-vertebral disc is associated with problems in the spine resulting in the development of back pain, which is known to spread to the buttocks, as well as the thigh region. Morphine is generally used as medication for easing this pain. Pain is experienced daily as degeneration of discs occurs due to repeated daily stresses. The regular use of morphine to ease pain results in morphine dependence. Osteoporosis is also another example of degeneration of bones among the elderly. Continued use of morphine containing drugs may lead to morphine dependence (Dagenais and Haldeman, 2012, p. 234).
- While Alright is on PCA for management of postoperative pain, I would prioritize administration of morphine at 5 mL/hr infusion rate. The infusion will contain 50 mg of morphine in 25 ml of fluid. I will also consider administration of paracetamol currently with infusion of morphine via PCA (Burke and LeMOne, 2013, p. 78).
References
Buffum, M. D., Hutt, E., Chang, V. T., Craine, M. H., & Snow, A. L. (2007). Cognitive impairment and pain management: review of issues and challenges. Journal of Rehabilitation Research and Development, 44, 2, 315-330.
Burke, L., & LeMOne, P. (2013). Medical-Surgical Nursing. New York: Pearson Higher Education AU.
Dagenais, S., & Haldeman, S. (2012). Evidence-based management of low back pain. St Louis, Missouri: Elsevier Mosby.
Whitney, E. N., & Rolfes, S. R. (2011). Understanding nutrition. Australia: Wadsworth, Cengage Learning.
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