Ans 1) Roper Logan Tierney (RLT) model of nursing has been applied to discuss the biological, psychological, spiritual, and cultural factors the patient and her family may be going through after an accident. In the present case, as per the X- ray reports the patient Kristy had fracture in the pelvis at the right side in 2 places and the CT scan reports demonstrated that the patient had cerebral contusion on the right side. In line with RLTmodel; the biological factors aid in addressing the impact of the injuries and accident on the overall health of the patient (Holland & Jenkins, 2019). In the present case, the pelvic fracture hampers the mobility of the patient after the surgery also. This can be attributed to the fact that fracture healing takes time even after the surgery therefore, the patient needs to follow the proper bed rest regime. In such cases, the family also needs to support the patient with mobility and daily routine work. Moreover, this accident definitely impacted the whole family including the patient at the psychological level. This is because the injury and accident impact the patient’s mental well- being due to continuous pain (Vieira et al., 2021). Moreover, the patient after an accident also experiences post- traumatic stress and anxiety. In the present case, the patient might experience the post- accident stress as she had a fracture in the pelvic region; which might make her concerned that she could not be moved for a few weeks.
In the present case, the patient and her family was undergoing a tough time and under such a situation there are spiritual and cultural factors that might be experienced by the patient and family. The grief and pain during the accident and followed by injury can impact the patient Kristy and her family at a spiritual level. During this time, they might be praying for the better recovery of Kristy. In contrast, the patient might lose her faith or feeling of being punished or abandoned by God (Holland& Jenkins, 2019). Roper Logan Tierney (RLT) model aid in understanding the spiritual factor which impact the patient and whole family during and after the treatment (Vieira et al., 2021). Enhancing the spiritual health might not cure the fracture; but it will aid Kristy to feel good and satisfied.
However, at the cultural level, Kristy’s husband was handling the whole family and cattle, which might impact the patient as she was all alone in the hospital during the treatment process. The patient’s husband could not give proper attention his wife due to household responsibilities. In such condition, Kristy might feel depressed as no one would be there with her while she would undergo through the surgery. Similarly, his husband might be in dilemma due to responsibility of both the house and her wife.
Ans2) it is evident from the case study that Kristy needs to be sent for the surgery for the proper management of the pelvic fracture. For the same, it is essential to take the consent from the patient and enduring NOK/guardianship (Shlobin et al., 2020). The informed consent aids in promoting the patient’s right and gives them the sense of autonomy. As per the existing literature (); the healthcare workers need to gather the written consent from the patient and their family prior to any treatment or surgery; which is the part of the legal consideration and documentations. Moreover, if the patient is not in the proper senses with severe mental illness; then there is provision to skip this step or take the consent from the family members after discussing the case thoroughly. The consent can be given in the verbal or writing form (Convie et al., 2020). For instance; the person can get agree for the X- ray process. However, for the surgical process; the person needs to give written consent after understanding the associated benefits and consequences with the surgery (Shlobin et al., 2020). Similarly, in the present case, if the patient is in a position to decide regarding surgery, then the consent can be taken from her or the family member, specifically husband can take this process.
Ans 3) The three pre-operative nursing actions that are needed in preparing the patient Kristy for the surgery are as below:
To access Kristy’s level of understanding level related to the treatment she is getting and future surgery process. This nursing intervention will help the nurse to plan the pre-surgery teaching program and to recognise the content needs of the patient (Ertürk&Ünlü, 2018). Furthermore, the nurse must review the anticipated operation procedure and specific pathology process to render the specific knowledge to the patient to make the choices between the informed interventions. Moreover, the consent for the chosen intervention must be gathered from the patient before surgery (Convie et al., 2020).
Developing rapport and trust with the patient to help her with coping up with the preoperative fear and anxiety. Under the same, the nurse must discuss and identify the anticipated things or factors which might concern Kristy ; for instance, mask on face and nose, lights, injection, bovie pad, BP cuff, suction noises, and autoclave (Suganandam, 2019).. Developing trust and rapport help in reducing the anxiety and fear associated with the surgical procedures and equipment that will be used during or after the surgical process. Furthermore; recognition of the specific fear will aid Kristy to deal the same in a realistic manner (Ertürk&Ünlü, 2018). In the present case, pain can be one of the potential factors which can cause anxiety to the patient before surgery. Therefore, the nurse must follow the current medication chart which includes morphine as a pain reliever. Lastly, the nurse must check and evaluate the intensity of pain on regular time interval also to evaluate the effectiveness of the medication (Ertürk&Ünlü, 2018).
Another nursing intervention includes, recognition of risk factors associated with infection and to decrease infection incidence. Under the same, the nurse must follow the aseptic procedures and policies. Additionally, the nurse adheres to the sterilization and infection control protocols, in order to reduce the risk of infection. This can be attributed to the results obtained from various researches that any kind of infection before and after surgery can delay the healing process. Upsurge white blood cell count prior to surgery can increase the risk of abscess formulation and organ infection which impact the surgery process (Suganandam, 2019).
Ans 4) The patient had undergone surgery, upon coming to the ward, the nurse has coned the assessment which revealed the following abnormal clues in the patient:
Hypotension: on a nursing assessment, the patient had blood pressure 105/74mmHg; which demonstrated that the patient had developed hypotension. This can be attributed to the fact that the surgery increases the risk of alteration in blood pressure. As per the American Heart Association, 120/80mmHg is the normal blood pressure; 120 is systolic pressure which demonstrates the systolic pressure (calculate the pressure when the heart pumps blood and beats) (Ostermann& Liu, 2017). In contrast; 80 mmHg is diastolic pressure which shows the pressure when the heart is at rest - the phase between the beats. During or after the surgery the blood pressure can drop due to various reasons(Ostermann& Liu, 2017). Anaesthetic drugs are the most common reason for hypotension in the patient followed by surgery. After induction of the anaesthetic drug; hypotension is generally linked with the vasoplegic effect caused by an anaesthetic medication and the start of the mechanical ventilation(Futier et al., 2017). Moreover, during operation, hypotension is also associated with hypovolemia, heart failure or high anaesthetic drug dose. In the present case, the nurse must evaluate and assess the skin turgor and colour of the patient. Furthermore; the nurse also recognises and monitors the electrolyte and fluid imbalance signs and symptoms including body weakness, vomiting and nausea. The patient can be supported through the administration of inotropic agents and vasopressors as these agents aid in increasing blood pressure through upsurging systemic vascular resistance(Sessler et al., 2019). Furthermore; fluid administration can be an effective intervention for hypotension linked to hypovolemia. IV fluid administration helps in increasing cardiac output and stroke volume which results in enhancing blood pressure (Futier et al., 2017).
Pain: additionally, the patient was moaning that she is sick and her pain score was 7/10; which demonstrates that the patient was in intensive pain followed by surgery. The pain can be associated with disrupted skin, muscle, and tissue integrity. The other reason can be bone and musculoskeletal trauma (Zielinski et al., 2020). In the present case, Kristy had undergone surgery for the correction of the pelvis fracture. Tissue trauma followed by surgery causes activation of nociceptors. Therefore, Kristy suffered pain at rest, also experienced pain at the injury site which indicates primary hyperalgesia. Furthermore; mediators are released systematically and locally after and during operation which leads to sensitization of nociceptors, including neurotrophins, interleukins, prostaglandins, neurotrophins - 3 and 5(Zielinski et al., 2020). Additionally, reduced oxygen tension and tissue ph and upsurge concentration of lactate at the surgical site lead to sensitization of muscle C- fibres. The nursing approach to post-surgery pain intervention and management is grounded on various factors. Under non-pharmacological intervention, the nurse can guide Kristy to follow lateral Sims or semi- Fowler’s position as these positions relieve pain by increasing circulation. The nurse must render information to Kristy regarding discomfort transitory nature, which might persist for several hours (nearly 48 hours) followed by surgery(Zielinski et al., 2020). The opioid therapy is prescribed by the physician but is followed without any fail. It must be followed by evaluation of the pain intensity of the patient through adopting the verbal and facial pain scale. It must be followed by rendering information to Kristy related to intervention effectiveness.
Postoperative tachycardia: as per the assessment of the pulse rate of Kristy, her PR was 95bpm. The normal resting heart rate is 60-90 beats/minute. A heart rate of more than 90 beats/ minute is higher than the normal range. In the present case, Kristy might develop postoperative tachycardia (heart rate more than 100 bpm) if the patient would not be treated for the same. The surgery might result in an increased heart rate due to chemo-receptor grounded cardiovascular responses, which might be triggered through postoperative hypoxia, acidosis and hypercapnia; which swiftly alter the variability of heart rate of the patient (Poulsen&Coto, 2018). Moreover, as per the existing literature (Poulsen&Coto, 2018); increased heart rate followed by surgery is linked with infectious morbidity and pulmonary morbidity followed by surgery. The intervention in the present case is to regular access and monitoring of blood pressure and heart rate. This can be attributed to the fact that compensatory tachycardia is the usual response for Kristy with reduced blood pressure to decrease cardiac output. Furthermore; the nurse must check for the skin moisture, temperature, and colour, as it is secondary to the upsurge stimulation of the sympathetic nervous system and decreased cardiac output. The nurse must continue the IV fluid therapy of the patient to improve the tachycardia condition of the patient. Fluid therapy will aid the patient to have cardiac output within the normal range and also enhance the blood pressure (Auda et al., 2017).
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