Nursing Care Priorities in Given Case Study Within Clinical Scenario Assessment Answer

Case study of Mrs. Deborah

Mrs. Deborah is a 65 years old woman admitted in public hospitals due to severe fall in her house. She is living with her husband and a pet. It is the third time she admitted in last six months due to fall related injuries. In this assignment we will discuss about the physical condition of Mrs Deborah and identify the care priorities by using Levitt-Jones’ clinical reasoning cycle.      

Mrs. Deborah is an aged woman suffering from severe fall and brought to the emergency department by her husband. Her husband found her lying on the floor of their bedroom. They are old couple living alone with their pet dog. She is high fall risk patient and already admitted two times in last six months. It is her third time admission in hospital due to fall related injuries. The immediate chest x-ray recognised that she has broken ribs and injuries in chest wall which needs medical attention. After the emergency treatment she is transferred into the medical ward under the general physician Dr. Thai for improving her condition.           

The chest x-ray in emergency department suggested that she has broken ribs and chest wall injuries. The fall is responsible for her broken ribs and injury in chest wall. The past medical history of Mrs. Deborah suggested that she has insulin dependent type II diabetes along with hypertension, chronic obstructive pulmonary disease (COPD), and osteoarthritis. She is recommend to take Panadol Osteo to relief her pain (Drugs, 2020), Novolin 70/30 and Metformin to control her blood glucose level (Marks, 2020), Ventolin and Symbicort for treating her COPD, and Atenolol, telmisartan, and spironolactone to control her blood pressure, reduce the risk of heart attacks and kidney problem (NHS, 2019).  Vitamin D is prescribed as she is suffering from osteoarthritis. Broken ribs can injure internal organs and blood vessels. A sharp end of break ribs can rupture the aorta or blood vessels which increase the risk of heart attack or respiratory distress in patients. The incident can also enhance the risk of lung injury and increase the respiratory distress. In general the bottom two ribs in human body infrequently fracture as they are more flexible than the upper and middle ribs (Talbot et al., 2017). But damage of lower ribs can injure the spleen, liver, and kidney of the affected individuals. The case history of Mrs. Deborah advocated that she has already hypertension and respiratory distress which can be increased with pain and injuries.

The medical history of Mrs. Deborah is indicating that her blood pressure level is elevated along with their blood glucose level and she has respiratory difficulties which can raise their heart rate and respiratory rate. Ribs and chest wall injuries can damage her inside organs like lungs, heart, and blood vessels. In this situation she might have severe shortness of breath and her forceful blow to the chest can damage the organs situated in upper abdomen. It can be assumed that blow to the front of the sternum cause heart injury or oesophagus injury. Furthermore, blow to the chest, back of the chest, and side of the chest can damage the trachea, injure the kidney and liver or spleen respectively (Uofmhealth, 2019). The severe pain due to injury can also precipitate breathing difficulties and cause lungs complications. 

The clinical status suggested that moderate ribs injury is painful events which can lead to serious complications. Mrs. Deborah can feel severe pain with her deep breathing. It can increase her risk of pneumonia as she is unable to breathe and cough deeply (Mayo Clinic, 2020). The incident can elevate the risk of lung bruising in her case. It damages the blood vessels and helps in accumulation of fluid or pus in lungs. Excess amount of fluid deposition in lungs can cause oxygen scarcity in body which is life threatening for patients (Healthline, 2020). At present condition the nursing care priorities should mainly focus on pain control and improve the respiratory rate of Mrs. Deborah. It can reduce the life threatening risk factors for her by improving her condition and dipping the further complications. 

Her physical condition is critical due to her respiratory distress and pain. Pain is the main reason behind the scenario. The severe pain related to injury is increasing her respiratory distress and increasing the blood pressure.  The pain can elevate the blood pressure by sending the electrical signals from the brain which stimulates the discharge of sympathetic nervous system (Saccò et al., 2013). Therefore, the sympathetic nerve discharge can cause high blood pressure and tachycardia in individuals. It can also elevate the pulse rate of the sufferers. On other hand, pain can stimulate the adrenaline gland to produce adrenaline which cause hypertension and elevate the pulse rate (Saccò et al., 2013). Hypertension can deteriorate the lungs function by narrowing and blocking the blood vessels present in lungs (Nathan et al., 2019). As a result the body is suffering from oxygen deficiency and increasing the load on heart. The overall situation can eventually increase the risk of cardiac arrest in patients. Furthermore, the accumulation of fluid in the lugs due to injury and pneumonia can also interfere in lungs functioning (American Lung Association, 2020). It reduces the oxygen concentration in body and thus it requires proper medications and support.  

In this situation the main aim of care process is to reduce her pain and eliminate her respiratory difficulties by taking proper intervention. It will help in controlling her elevated blood pressure and respiratory difficulties (American Lung Association, 2020). The broken ribs are generally healing on their own way without any supportive device. Thus, it requires long time for elder people to cure. In this condition pain management and reduction of respiratory difficulties can be beneficial for her.       

In case of Mrs. Deborah, pain relief medicine is already prescribed from the emergency department. In this respect, the injectable pain relief medicines can be started depending on severity of the pain (He et al., 2019). I will talk to the doctor regarding the administration of injectable pain medicine for her. The injectable pain medicines can make the nerves numb around the ribs areas and make the patient comfortable in some extent (Hsu et al., 2019). In addition, ice pack can also apply on the affected areas with wrapping in thin towel to reduce the swelling and pain. I will make her sleep in more upright position it can help in her respiration and reduce the pain. Pain, injury, and shortness of breath can ground anxiety which elevate the respiratory difficulties. Therefore, administration of anti-anxiety medications can improve the condition. I will inform the doctor about the concern and if he agreed then I will start the medications along with the Bronchodilators and Corticosteroids. It can help in respiration process and increase her oxygen saturation and normalised the respiratory rate. If she has any infections in lungs then antibiotics can be given to prevent the flare up. Furthermore, supplementary oxygen can be administrated to reduce her difficulties and progress the condition (Gorguner & Akgun, 2010).          

After implementing the intervention, her pain is reducing and respiratory difficulties is also reducing. As sated earlier, pain is related to shortness of breath and hypertension; therefore, managing the pain is dropping her blood pressure and pulse rate. However, need to monitor her pain rate and oxygen saturation in blood to recognise the breathing status. She has chronic obstructive pulmonary disease which reduces the capacity of lungs and pressurise the heart to functioning stressfully. Thus, we should check her heart functioning within periodic interval to avoid any further consequences. If her condition will deteriorate then inform the doctor for further care and treatment process. She should take sufficient rest and avoid the movement to minimise her pain. Ribs injury requires long time for complete recovery. Thus, the caregivers should extra attentive towards the viral sign of Mrs. Deborah and informed the doctor in case of any emergency.        

The case study of Mrs. Deborah helps me to learn about the skills and techniques in handling the patients with high risk of fall and suffering moderate injuries. It is a great learning experience to enhance the knowledge and capabilities. She has multiple diseases which need to monitor along with her injuries and required long term of hospitalisation for her recovery. The condition is physically and mentally devastating for Mrs. Deborah and her husband. The elderly people with multiple diseases require special skilful monitoring process along with the positive motivation and attitudes. I have learned the skills and behaviours from the case study. I would improve my care in future by utilising the information gathered from the case of Mrs. Deborah.  If I had previous experience about the elderly care and accidental management then I react more efficiently and making decisions confidently. I should have to be more calm and confidence while checking the vital sign of the patients and recognising the possible threat. Now I realise that the incident was destroying her self confidence and she was afraid of the situation. I should motivate her along with the intervention to boost up her confidence and reduce her anxiety. It is also an important intervention for the registered nurses to motivate patients and offer emotional support.