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HLTENN004 Implement Monitor And Evaluate Nursing Care Plans

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HLTENN004 Implement Monitor And Evaluate Nursing Care Plans

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HLTENN004 Implement Monitor And Evaluate Nursing Care Plans

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Course Code: HLTENN004
University: Victoria University

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Country: Australia

Question

Case Study
The following case study explores an 83-year-old man, George, admitted to an acute care hospital setting for a fracture resulting from a fall at home. The patient also presents with peripheral neuropathy and atrial fibrillation (AF) as co-morbidities. In addition, George’s wife has recently been diagnosed with dementia. Environmental change is experienced in terms of the need for hospital admission following his accident and the impact of his wife’s changing health care requirements. ?George, following assessment in the Emergency Department, was admitted to a surgical ward for a fractured left neck of femur (NOF) and multiple skin tears. He underwent an open reduction with internal fixation to repair the fracture, had multiple dressings in place to protect his skin tears and had a sudden onset of confusion after admission which was confirmed to be a consequence of a urinary tract infection (UTI) from postsurgical catheterisation. ?George lives with his 85-year-old wife and has two sons who both live in England. George migrated to Australia with his wife 18 years ago seeking a retirement lifestyle change. George sees his sons and five grandchildren every few years and upon learning of his father’s hospitalisation, one son flew out to be with him. ?Older patients frequently have multiple health co-morbidities in relation to their presenting condition which further complicates their current health status and therefore the patient’s care plan. George has been diagnosed with peripheral neuropathy, secondary to type two diabetes, which is characterised by nerve damage in the peripheries resulting in varying manifestations of extremity pain and numbness (Farhat & Yezback, 2016). As George underwent a surgical procedure to repair his fractured NOF, mechanical venous thromboembolism (VTE) prophylaxis is routinely performed to prevent the formation of harmful clots which can damage vital organs. However, as George suffers from severe lower limb pain due to peripheral neuropathy, TED stockings and sequential compression devices are contraindicated which prevents their utilisation. Likewise, George is also diagnosed with AF which is extremely rapid electrical impulses caused by disorganised atrial electrical activity, resulting in a rapid heart rate and irregular ventricular excitation (Frazer, 2016). Enga et al. (2014) report that individuals with AF are at an increased risk of developing VTE in comparison to those without. These co-morbidities complicate George’s current situation as he is at increased risk of developing a deep vein thrombosis (DVT) due to immobility post-surgery. Together with his history of AF, the importance of implementing interventions which are appropriate for his current situation and health status are vital.

Stereotypes about an individual’s age can be tremendously damaging to the delivery of patient-centred care and the achievement of positive patient outcomes. A common ageist stereotype is memory loss, forgetfulness and confusion as being normal in all older people. This can be detrimental to the care of an older patient, particularly in George’s situation, as these signs can indicate a UTI and if left untreated due to the assumption his age is responsible for his confusion, morbidity and mortality may result.
A recent environmental change that has occurred in George’s life is his wife’s recent diagnosis of dementia. This has rendered George a full-time primary carer for his wife. He is adamant that his wife be cared for in their home. Consequentially, this change in their relationship has negatively impacted on George as the prospect of caring for his wife while he is recovering from his fracture injury, coupled with his worsening co-morbidities, seems near impossible.

Care Plan Template
In your plan you must:
1. Identify and justify the top five objectives for nursing care, 2. Describe and justify evidenced-based nursing interventions to achieve each objective, and, 3. Create and describe the evaluation criteria that you will use to judge whether the plan addressed the identified objectives.
Five nursing objectives.
2. What is nursing objective 1? What is a significant health care need for George?
3. How did you evaluate each nursing intervention? What measures did you use? What time line was chosen and why? Was the plan of care successful?

Answer
Care Plan
Introduction
George is an 83-year-old patient who experienced a fall thereby fracturing his left neck of femur (NOF). The patient also has co-morbidities like atrial fibrillation (AT) and peripheral neuropathy (PN). His wife has dementia, and George serves as her carer when recovering from his conditions. This paper will discuss the stereotypes of old individuals and how it affects their care. It will also justify and discuss three objectives for nursing care from the case study. The goals of care include NOF, AT, and PN. The write-up will address the nursing interventions for the three areas and evaluate the outcome.
The Effects of ‘Older People’ Stereotype on the Patient
Stereotype refers to a fixed thought towards a group of people which is occasionally untrue. Stereotypes about elderly individuals like George and the wife can prevent them from receiving patient-centered care from caregivers. The severe effects of prejudice are negative patient outcomes (Olson, Reiland, Davies, & Koehler, 2018). A majority of individuals associate confusion, forgetfulness, and memory loss with aging. However, the three conditions can happen to anybody regardless of age. George suffers from Urinary Tract Infection (UTI) which leads to confusion. The nurses can assume that the patient’s confusion is due to old age and not UTI. Failure to treat UTI due to stereotype may lead to the death of the patient.
Objectives for Nursing Care
The first objective is to care for the fractured left neck of femur (NOF). The patient suffered the hip fracture due to the fall he had at home. Accidents due to falls are common in elderly individuals, and they result in severe pain and injury to the victim (Ambrose, Cruz, & Paul, 2015). Hip fractures limit the ability of an individual to move from one place to the other. Additionally, the fracture limits the ability of a person to conduct daily chores. The caregivers should attend to the fissure to enable George care for his wife who has dementia.
The second objective is to care for the peripheral neuropathy (PN) that resulted from diabetes type two. PN leads to damage of the nerves at the peripheries, an occurrence that causes numbness and extreme pain to the patient (Farhat &Yezback, 2016). PN also makes George experience severe pain in his lower limb. Caregivers should also offer care for diabetes as it precedes PN. Proper medical attention towards PN will eliminate the numbness and pain from the client.
The third objective is to provide adequate care for Atrial Fibrillation (AF).  The complication interferes with the regular ventricular excitation and leads to rapid pulse rate (Frazer, 2016). Caregivers should prioritize the care for AF; since the patients can develop venous thromboembolism (VTE) (Enga et al., 2014). The three complications that George is facing increase his chances of acquiring vein thrombosis. Therefore, caregivers should attend to the co-morbidities to facilitate the health and the wellbeing of George.
Nursing Interventions
The first interventions target the healing of the fractured left neck of the femur. The care team should assist George to get out of his bed after the surgical procedures. Additionally, the caregivers should help the patient in movement on a day after the operation. The care providers should conduct physical therapy to focus on the strengthening exercises and range-of-motion (Zielinski et al., 2015). George should leave relocate from the health facility to an advanced care facility for specialized care. An occupational therapist should train the patient on how to use the toilet and other skills. Health specialists should also prescribe bisphosphonates to prevent the occurrence of another hip fracture (Shen et al., 2014).
Efficient care for the patient due to peripheral neuropathy (PN) after surgery improves the well-being and the health of the patient. The nurses should help George to look after his feet since the PN resulted from diabetes. The caregiver should help the patient to check for calluses or blisters. The patient should wear padded shoes to assist in movement. The patient should conduct a regular physical exercise to elevate pain due to neuropathy (Colloca et al., 2017). The caregivers should monitor and help regulate the blood sugar levels of the patient.
The third nursing intervention targets Atrial fibrillation after surgery. The health specialists should reset the heart rhythm and rate to normal ranges. Resetting the rhythm of the heart is achievable through drug and electrical cardioversion (Brieger et al., 2018). The medications that bring the heart rate to the acceptable ranges include Dofetilide, Flecainide, and Propafenone (Ferguson et al., 2014). Electrical cardioversion involves delivering an electrical shock to the heart of the AF victim. The shock lowers the electrical activity of the heart.
Evaluation
The nursing interventions after the fractured left neck of femur were successful and took six weeks. The caregivers helped the patient to get out of bed on the day after surgical operations. The patient could now get out of bed without assistance on the remaining days. The caregivers assisted the patient in his movements for few weeks after surgery. The patient can now move from one place to the other without help. The physical therapy has made the patient speed up his movements.
The care towards peripheral neuropathy took four weeks with great success. The patient is carefully looking after his feet following the caregivers’ instructions. George is also monitoring his feet to check for calluses or blisters. He reports any of the above features for further medical attention. The patient has started wearing padded shoes to enhance his movement from one place to the other.  The client is also conducting a regular physical exercise to ease the pain due to neuropathy. The caregivers have also succeeded in regulating the patient’s blood sugar.
The nursing interventions towards AF have been successful. The patient collaborated with the caregivers to manage the condition in four weeks. The health specialists performed both drug and electrical cardioversions. The patient is currently taking the prescribed drugs which are resetting both the pulse and the heart rates. George has admitted that his heart rate is gradually coming back to normal due to the medications. The electrical cardioversion has been a viable supplementary to the medicines. The shock has reset the pulse rate thereby eliminating AF.
Conclusion
George is an elderly patient who experienced a fall and fractured his left neck of the femur. He also has co-morbidities like AF and PN.  Stereotypes against elderly patients prevent them from receiving patient-centered care. The three main objectives in the case study are to find appropriate nursing interventions toward fractured NOF, AF, and PN. Strategies like physical therapy are essential for fractured NOF after surgery. Physical exercise aids the recovery of PN patients after undergoing surgical procedures. Resetting the pulse and heart rate assists in the elevation of AF. The nursing interventions were successful as they improved the well-being and health of the patient.
References
Ambrose, A. F., Cruz, L., & Paul, G. (2015). Falls and fractures: a systematic approach to screening and prevention. Maturitas, 82(1), 85-93. https://dx.doi/10.1111/jgs.15008/
Brieger, D., Amerena, J., Attia, J. R., Bajorek, B., Chan, K. H., Connell, C., … & Hendriks, J. (2018). National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. The Medical Journal of Australia, 209(10), 1. https://dx.doi/10.1016/j.hlc.2018
Colloca, L., Ludman, T., Bouhassira, D., Baron, R., Dickenson, A. H., Yarnitsky, D., … & Eccleston, C. (2017). Neuropathic pain. Nature Reviews Disease Primers, 3, 17002. https://dx.doi.org/10.1002/14651858.CD011669
Enga, K. F., Rye-Holmboe, I., Hald, E. M., Løchen, M. L., Mathiesen, E. B., Njølstad, I., … Hansen, J. B. (2014). Atrial fibrillation and future risk of venous thromboembolism: The Tromsø study. Journal of Thrombosis and Haemostasis, 13, 10-16. https://dx.doi.org/10.1111/jth.12762/
Farhat, N. M., &Yezback, K. L. (2016). Treatment of diabetic peripheral neuropathy. The Journal for Nurse Practitioners, 12(10), 660-666. https://dx.doi.org/10.1016/j.nurpra.2016.07.030
Ferguson, C., Inglis, S. C., Newton, P. J., Middleton, S., Macdonald, P. S., & Davidson, P. M. (2014). Atrial fibrillation: stroke prevention in focus. Australian Critical Care, 27(2), 92-98. https://doi:10.1016/j.aucc.2013
Frazer, C. (2016). Atrial fibrillation. MedSurg Nursing, 25(2), 125. Retrieved from: https://link.galegroup.com.libraryproxy.griffith.edu.au/apps/doc/A452585836/HRCA?u=griffith &sid=HRCA&xid=6283ddd4
Olson, A., Reiland, S., Davies, S., & Koehler, A. R. (2018). Learning about the experience of living with chronic conditions: A framework analysis of nursing students’ reflections on their conversations with older adults. Gerontology & geriatrics education, 39(3), 295-315. https:dx.doi/10.1111/opn.12061/full
 Shen, S. H., Huang, K. C., Tsai, Y. H., Yang, T. Y., Lee, M. S., Ueng, S. W., & Hsu, R. W. (2014). Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. Journal of the American Medical Directors Association, 15(10), 725-731. https: dx.doi/10.1016/j.jamda.2014.05.010
Zielinski, S. M., Hidding, S. H., Petri, K. R., Van Hooff, H. J. A., Heetveld, M. J., & Bhandari, M. (2015). Physical therapy after discharge following internal fixation of femoral neck fractures: characteristics of treatment. Internal Fixation of Femoral Neck Fractures; treatment and effects, 145.Retrieved from:  https://repub.eur.nl/pub/78144/150521

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