Write an essay on Evelyn Goldstone person centred care.
You have to identify 3 problems and do one care plan based on the main priority problem and discuss briefly about the other 2 problems.
Include the following in the essay:
• Also use Roper, Logan and Tierney activities of daily living.
• What is Person centred care
• Confidentiality (Nursing and Midwifery Council) code of conduct.
• Involving the family in the decision making
• Understanding legal and ethical implications for your actions.
• Mccormack and Mccane framework
Evelyn is a 92 year old lady who currently resides with her daughter Jane in a bungalow.
Whilst getting up in the night to go to the toilet Evelyn slipped and fell in her bathroom. Evelyn has marked swelling to her left hip, with her leg externally rotated and some noticeable shortening present in the limb. Evelyn is complaining of pain in her left hip and groin and her daughter called for an ambulance.
Evelyn’s daughter says that her mother is becoming reluctant to eat and drink, resulting in her clothes and rings becoming looser and a dry sore mouth. She has also noticed that Evelyn has episodes of urinary incontinence although her mother denies that there are any problems with her getting to the toilet on time.
Evelyn’s past medical history includes gastric reflux, osteoarthritis, osteoporosis, Alzheimer’s Disease and short term memory loss.
Evelyn’s current drug history includes:
- Calcichew-D3Forte 1 tablet twice a day,
- Omeprazole 40 mg once a day
- Paracetamol 1g 4 times a day as required
- Donepezil 10 mg at night
- Zopiclone 3.75 mg at night
Evelyn is taken to her local accident and emergency department where, following an x-ray and examination by the duty orthopaedic registrar, she is diagnosed with a fractured left neck of femur. In line with NICE Clinical Guidance on Hip Fracture management (2011, 2017) Evelyn is operated on the following day, where she undergoes a Left Dynamic Hip Screw (DHS).
Observations on admission to the orthopaedic ward are: BP 121/73; Pulse 96; SPO2 98%; Temp 37.6°C; VAS Pain score 10/10 on movement.
You are on placement on the orthopaedic ward and you and your mentor are assigned to look after Evelyn the following morning after her operation. Evelyn has no recollection of her accident and does not know why she is in hospital; she has a urinary catheter in place and intravenous fluids running. Evelyn is confused and keeps trying to get out of bed to go the toilet; she is also in a lot of pain. Evelyn has a morphine patient controlled analgesia pump running however, this has not been used. Evelyn has refused her breakfast this morning and states that she ‘Wants to go home as she doesn’t know what all the fuss is about’. Your mentor has asked you to help write some care plans for Evelyn while she is on the ward.
Evelyn’s daughter Jane is due to come and visit her later this afternoon to discuss her care and plan for her discharge.
Identify 3 problems
1 Care plan for the main priority problem
- Left Hip Fracture
- 92 years old
- Past Medical History- Osteoarthritis, Osteoporosis, Alzheimers and Gastric reflux.
- BP- 121/73
- Pulse- 96
- Saturation Level 98%
- Temperature- 37.6
- VAS pain score 10/10 on movement
- Acute pain as evidence by moaning, left hip fracture, pulse of 96 and pain score of 10/10 on movement.
- Risk of falls
- Eating and drinking
- Assess Evelyn pain using Bolton pain assessment tool
- Review the analgesic regime because the patient controlled analgesia pump is not suitable for Evelyn because of the Alzheimer’s and short term memory loss.
- Do not give anti-inflammatory drugs because of the gastric reflux
- Monitor pain pre and post analgesia
- Provide ice packs
- Uninterrupted rest
- Repositioning if the pain allows
- Re-evaluate after 24hours
- To maintain Evelyn comfort and pain to a level that is manageable for her.
- Review Evelyn pain score every 4hours
- Review analgesia regime after 24hours
- Monitor vital signs
- Assess mean pain score after 24hours.