Case scenario:

Evelyn Goldstone

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Table
of Contents

INTRODUCTION………………………………………………………………………………………………………….. 1

Background:…………………………………………………………………………………………………………. 1

MAIN BODY:………………………………………………………………………………………………………………… 4

Nursing process and Evelyn:……………………………………………………………………………….. 4

CONCLUSION:…………………………………………………………………………………………………………… 11

REFERENCES…………………………………………………………………………………………………………… 13

 

 

 

 

 

INTRODUCTION

This
assignment is related to an elder lady whose name is Evelyn. She is 92 years
and resides in a care home. She has a past medical history of gastric reflux,
osteoarthritis, Alzheimer’s disease and short-term memory loss. For treating
these diseases Evelyn is currently taking the following drugs including:
Calcichew-D3 forte 1 tablet twice in a day, Omeprazole 40 mg once a day,
Paracetamol 1g 4 times in a day as needed, Donepezil 10 mg at night, Zopiclone
3.75 mg at night.

Under
this report, one night she met with an accident. She slipped and fell in her
bathroom which resulted in marked swelling to her left hip. Her leg externally rotated,
and a few noticeable shortcomings occurred in the limb (Dening, Jones and
Sampson, 2011). She is suffering from the pain in her left
hip and groin. After taken to the hospital and undergoing examinations, Evelyn
is found to have a fractured left neck of femur which was operated on the next
day under orthopaedics surgery.

Under
this report, various set standards are made to help Evelyn treatment and stay
in the hospital become effectively. Under person
centred care Evelyn Goldstone post operation care will be discussed. Her post
operation assessment will be done, care plan will be put in place to help
Evelyn after surgery nursing recovery.

Background:

Person
centred care is the manner of thinking and doing things which overview the
individual implementing health and social services as identical partners in
planning, emerging and controlling care to make sure it meets their
requirements. Which simply refers to putting people and their families at the
centre of decisions and cross checking them as a specialist, working
additionally professionals to get the best result.

Person
centred care is not just about rendering people whatever they need or rendering
information (Tina Sinatra-Wilhelm RN,2012). This is about
adopting people’s needs, values, family situations, social conditions and
lifestyles; observing individual, and functioning together to emerge an
adequate solution.  Being compassionate,
this can be said that thinking about the things from the individual’s point of
view and being respectful all are imperative. This may be reflected via sharing
decisions with patients and assisting individual to manage their health, but Person-centred
care does not only concern to activities but also relates to care where
professionals and patients think about care and their relationship as the
genuine service available which will be discussed in Evelyn Goldstone case
below.

This
is observed that the care plan is person centred as people covers in and
centred to their care which recognised as the main component of emerging high-quality
health care (Houben and et. al., 2014). Person centred care
helps to improve quality of the service available including finding ways to
help Evelyn with her confused state and memory loss by getting consultation
with Neuro surgery and dementia team. Enhance experience individual must assist
them to feel great satisfied. Stimulate individual to lead effective lifestyle,
like-exercising or eating so hygienic. Stimulate individual to lead to make
decisions about their care henceforth, they could get services and assist which
are adequate for their requirement. Impact on individual health outcomes, like
their blood pressure. Limit how frequently people use services. This might in
turn limit an entire cost of care.

Care
plan is individual centred because of that offering care in a highly
person-centred manner often enhance an outcome (Jordan O’Brien and Cowman, 2011).
Most of the common manner which have investigated to enhance person centred
care which covers assisting people learn much about to their conditions,
stimulating people to be healthier engagement in the health consultations and
training professionals to enable care which empower individual to participate.

McCormac & McCance
framework:

By
using on a person-centred nursing framework, a framework model of
transformational, situational leadership in nursing homes incorporate people
centeredness with leadership thinking for affecting performance of the members
in delivering Person centred care. This analysis claims that no one leadership
styles work in the entire situations and design four set of leadership
behaviour which are: directing, coaching, supporting and delegating.

 By merging these factors of situational
leadership existing nursing climate can be achieved. Emerging a shared visions
of people centeredness and determining significant results, concentrating on
the impact of the context and determining situational position which affects
the delivery of the patient care in the practice, identical leadership style to
the emergence level of the assistant implementing directive behaviour; and
varying the leadership behaviour dynamically so that they can take help via
levels from the beginner to proficient and committed carer (Mullick,  Martin and Sallnow, 2013).

By
using these all the obstacles which arise in the nursing care practices will be
overcome by effectively applying these tools in Evelyn centred care.

MAIN BODY:

Nursing process and Evelyn:

Nursing
process is a systematic problem-solving approach implemented to determine,
prevent, and treat actual or potential health issues and promote wellness. This
has a four-step assessment which covers assessment, diagnosis, implementation
and evaluation. The main objective is to assess components which affects
application of the nursing process among nurses in hospitals (Kleinpell, Aitken and
Schorr, 2013).

In
the cited case, Mrs Evelyn got fractured and her left hip bone were dislocated.
This was found by doing so many tests such as CT scan, X-ray of limb and neck
of femur so that her exact area of dislocation can be identified, and the
specialist Orthopaedics doctor can treat her well. However, this can be said
that the problems of the Mrs. Evelyn various issues related to the health can
be identified by using various tools in an effective manner. Although, various equipment’s
can be used by the doctors and nurses for identifying the real problems.

Nursing
process for identifying the problems of Mrs Evelyn is elaborated as under:

The
common thread consolidation various kinds of nurses who work in the changes
areas is the nursing procedure- the crucial practices for the certified nurse
to deliver holistic, patient- oriented care. However, this can be said that the
nursing care process is having multi-purpose approach which enables nurses to
perform their activities with valid justification. This protects right of both
patient and the nurse (Papastavrou, Andreou and Efstathiou, 2014).
Nursing process implementation can be more affected by the diverse components
which could to lack of quality of the nursing care, disrupting of the service,
conflicting roles, medication issues, lack of disease prognosis, readmission,
dissatisfaction with care rendered, and enhanced mortality. These kinds of
issues are handled if the nursing process among nurse in the chosen nurse in
hostility.

Care
plan:

It
is termed as communicating and organizing the actions of a regular variation in
nursing staffs. As, the patient required to attend the updated plan which is
passes by the nursing staff at different shift to them (Morton and et. al.,
2017). It provides perfect direction for individuals’ patient
care to make them healthy more quick and fast. With this, they provide
continuity of care for the patient with every department. It consists of
various aspects such as:

Collect
and exchanging data: Every situation of patient is
continuously record and summarise in a document form (Sudore and et.
al.,  2014). It is based on
persons, family and professional’s aspects.

Structure
review: It is related with the critical analysis of
patient detail that are facing serving issues. It is a systematic way to
collect information according to the condition of the patient.

Exploring
information: Under this, it is essential to work out on
those plans which are mostly important for the patient.  The situation of patient is exploring through
gather data about the health position (Purnell, 2012).

Action
planning: In a care plan, the planning is done through
determining the exact actions which are requiring to be implemented to improve
the condition of the patient.

Standards:

            It is a care plan that
come from various sources to help the patient. A care plan which is written by
doctors and staffs are needed to be follow in proper manner. It will helpful to
feel patient more comfortable (Hockenberry and et. al., 2016).
Sometimes, it is not effective in practice as one can-not able to make plan
according to the current condition of the patients.

A
care plan is essential for Evelyn because she is facing various kind of medical
problems and going through severe pain. This plan will assist her in overcoming
some of her critical medical issues and it will ultimately make her heath
better then present condition.

Pain
control (48 hours)

Assessment
She
is suffering pain in various part of body. Initially her pain was acute but
gradually it enhanced. Her VAS pain score is 10/10.

Diagnosis
She
has severe pain in various part of her body because of fracture and less
hearing power.

Plan
(Goal)
To
reduce pain of patient within 48 hours from 10/10 to 2/10.

Intervention
Assess
her condition in every two hours and remind her to press the morphine patient
controlled analgesia pump when she is in pain

Evaluation
Goal
is achieved through regular check s 
and level of pain comes down to 10/10 to 2/10.

 

Improve
Memory Loss (7 weeks)

Assessment
She
does not remember anything, even normal thing which is included in every
personal lifestyle like eating food, going to toilet etc.

Diagnosis
Evelyn
is suffering from short term memory loss and she also has Alzheimer.
 

Plan
(Goal)
Reassure
Evelyn that the student nurse is there to help and that she is safe

Intervention
Get
advice from the Alzheimer care support and making sure Evelyn has familiar
personal items and family around her for support. 

Evaluation
By
focusing on her feeling and showing support from staff as well as her son
helps her to settle down get treatment in terms of food and medications.

 

Reduce
Weakness of bones (10 weeks)

Assessment
She
has pain in her bones and they are getting weak with time.

Diagnosis
She
has osteoarthritis and osteoporosis.

Plan
(Goal)
Strong
bones and reduction in weakness of bones.

Intervention
Tablets
of vitamin and dietary supplement will be used for healing.

Evaluation
Her
bones get strong and she gets stronger in terms of walking short distance
without falling or   any support.

These
care plan will help the student on placement to achieve nursing practices
within the time-frame

Assessment:
The nurse assigned to look after Evelyn Goldstone applies
organized, dynamic manner to gather and assess data about the patient, the
first step in delivering nursing care. Assessment covers psychological,
sociocultural, spiritual, economic, and life cycle components as well. For
instance, a nurse’s assessment of Mrs Evelyn covers physical causes and
manifestations of pain, but Evelyn response- an inability to get out of the
bed, refusal to eat, confusion and memory loss (Ausserhofer and et. al., 2014).
Assessment can be done by asking from the patient about the issues they have.
Registered nurses can put a care plan in place according to Evelyn
circumstances.

 

Mrs.
Evelyn at the time of observation was found to have no memory of the accident
or where she was and from her past medical reports, this has been observed that
she was having gastric reflux, osteoarthritis, osteoporosis, Alzheimer’s
disease. During observation, she was having: BP 121/73; pulse rate was 96; SPO2
98%; body temperature was 37.6°C; VAS pain score 10/10 on the movement. All her
vital signs were ok considering her age and situation, but the VAS pain score
was considerably high because her she had PCA of morphine attached but because
of her confused and denial state she wasn’t able press the medication button
which resulted in acute pain state.

Diagnosis:
The nursing diagnosis is the nurse’s clinical judgement about the client’s
reply to the actual or effective health conditions or requirements (Rothärmel and et. al.,
2011). The diagnosis demonstrates not only the patient is in trouble,
but that pain has caused other diverse issues like anxiety, lack of nutrition,
refusal to do anything, or has potential to cause complications. For instance,
respiratory infection is a most effective hazard to an immobilised patient. The
diagnosis is the fundamental factor for the nurse care plan so that they could
identify their disease in an effective manner. although, this is the main tool
that can be used by the patient. Diagnosis of the disease of a patient is
analysed by way of certain medical equipment so that the patient attendants could
get to know about their health condition (Shanley and et. al., 2011).
However, this is observed that the resident doctor observed that the patient is
suffering from gastric problems and osteoarthritis, osteoporosis and Alzheimer’s
disease that can only be controlled by using various drugs such as:
Calcichew-D3 forte is going to treat her ostia related issues such as
osteoarthritis and osteoporosis; apart from that, gastric related problems are
treated by taking omeprazole capsule; Alzheimer’s related problems and short
term memory loss are treated by using donepezil and Zopiclone. But now she is
suffering from the acute pain judging from the VAS pain score done during observation.
While in the orthopaedics ward post-surgery Evelyn was confused and keeps
trying to get out and go home; she is also in a severe pain. However, she was
denying taking her breakfast in the morning and complete unaware of what
happened and where she was.

Implementation:
Nursing care is applied as per the care plan, henceforth, consistency of care
for Evelyn at the time of admission and preparation for discharge requires to
be done. Care is documented during Evelyn patient’s record. By knowing the issues
of the patient, the registered nurse applies their rational practices for
practising in an effective manner. The implementing of a firm process This is much
effective tool that can be applied by the nurses so that Mrs Evelyn major
health issues can be overcome. During implementing of the nursing care plan,
consistency of the patient at the time of hospitalization for Evelyn.

Evaluation:
Most of the patient’s condition and efficiency of the nursing care needed to be
regularly evaluated and the care plan modified as per the requirement. There is
a need to make certain tools that can be made to make certain tools that can be
used to provide various tools. By evaluating the Evelyn patient problems,
routine assessment can be done in terms of blood pressure, blood sugar and
others (Short-term memory loss: Causes and treatments, 2018). Mrs.
Evelyn regular assessment can be done by the student nurse so that they could
effectively analyse her in a better manner (Finkelman, 2015). By implementing
nursing process, evaluation can be done in an effective manner so that the
hospital management can make certain strategy related to the management of the
hospital.

Nursing care plans:

In
health care firms, HER, oral reports, handoffs, conferences and health
information technology are required to enable information flow (Sudore and et.
al.,  2014). More specifically, care
planning process is the structuring framework for cope communication which
would emerge in the safe and effective manner. care planning process is the
structuring framework which are used for co-ordinating communication which
would emerge in safe and effective care. The patient care planning is a major
department of thoughts, studies and interventions (Lehne and Rosenthal,
2014). The key subdivisions of patient care planning are the
improved care planning, case management, and critical protocols for handling diseases.
The care plan is the performance oriented as this would help to treat the Evelyn
so that she could not feel unsafe and unhappy. This is the most crucial factor,
which are required to be adopts by hospital staff the during practices. Everything
must be included under this so that patients do not feel unhappy during admission
in the hospital. However, this is observed that every hospital must have
effective nursing care plan which would help to achieve their goals.

CONCLUSION:

In the above case study, it can state
after analysing case study and preparing plan for care that proper care of
patients is required. Initially, Evelyn patient diagnosis information was being
explored by care home staff, following through identification and review of the
major prioritising issues of nursing. After this procedure, the problem quality
of nursing was understood in detailed information of patients. Exploration of
issues importance was forwarded along with issues of nursing and its mobility
impact. After the preparation process of identification and patient review, the
care plan is being developed concentrating with goals and aims of patients, planning
and care execution for Evelyn, effectiveness evaluation of given treatments to
her and the rationale of utilising better evidenced based causes for the plan
which is proposed and undertaken.

This
report also explains the care techniques i.e. person-centred care which is the
manner of thinking and doing things which overview the individual implementing
health and social services as identical partners in planning, emerging and
controlling care to make sure it meets patient requirements. Mrs Evelyn had a
fractured neck of femur and dislocated her hip which is issues for which proper
planning of care through analysing and review previous issues should be done. Nursing
process implementation can be more affected by the diverse components, which
could lack quality of the nursing care, disrupting of the service, conflicting
roles, medication issues, lack of disease prognosis, hospital readmission,
dissatisfaction with care rendered, and enhanced mortality. This comes to show
that a patient’s person-centred care is very important and effective in helping
with their recovery and wellness.

 

 

 

REFERENCES

Books and Journals

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Brinkman-Stoppelenburg,
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Papastavrou, E.,
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Sampson, E.L., and et.
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Tina Sinatra-Wilhelm
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Houben, C.H., and et.
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Mullick, A., Martin,
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Jones, T.L., Hamilton,
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Online:

Short-term
memory loss: Causes and treatments. 2018.
Online. Available through: .