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Priority health problem – Impaired safety: Falls risk related to impaired homeostasis

Using current and relevant evidence, write an academic essay to discuss the research related to the following points: 

1.From Anna and George’s case study, identify all assessment data relevant to the chosen problem and interpret these in relation to underlying pathophysiology. Highlight the developmental similarities and differences in the signs and symptoms expressed by the cases. 

2.Define what the goal for care related to the chosen problem would be (use the SMART framework to write the goal) 

3.Choose TWO interventions (one must be a nurse initiated intervention) to address the goal for care and justify your choice by critically analysing the current evidence. Compare and contrast the interventions in relation to how implementation of the intervention would be modified to meet the unique needs of each case considering developmental differences. 

4.Note: if you choose a collaborative intervention you must discuss the nurses’ role in this. 

5.Discuss how the implemented care would be evaluated for each case, physical changes that would indicate the intervention has been effective, and how subsequent assessment would be modified to ensure accurate data is collected and individual needs are met. 

Assessment data from Anna and George's case studies

The essay brings about a discussion on the nursing assignment, which states about assessing all the relevant data from the given case studies of Anna and George. Pathophysiology of these cases has been undertaken for analysing the similarities and differences in both the cases. Pathophysiology describes about the disordered physiological processes, in relation to any disease or injury to an individual. In addition, what are the required goals for these case studies, which ensures effective health and wellbeing of an individual are defined using the SMART aims. In any healthcare, patients health, and safety is the major concern, which should be taken care of by the nurses or healthcare professionals. The essay in the later part discusses about the necessary interventions that can be taken in these cases, to evaluate the physical changes and to meet the needs in each case. Therefore, the essay encloses an in-depth analysis of these case studies and their impact on the individuals (Ball et al., 2016). 

Anna, a 4-year old girl was admitted to the short stay ward, and had a two-day history of vomiting and diarrhoea. Another case study was about a man 85years old, George was admitted to the short stay ward for the treatment of his pain. He had problems of intense abdominal pain and nausea, and prone to the problem of postural hypotension. Postural hypotension, which refers to situation when the blood pressure, decreases when the person suddenly stands up from lying or sitting position (Woodward, Smart & Benavides-Vaello, 2016).

From the given case studies, it can be assessed that both the patients, Anna and George had problems of poor hydration, and fluid challenge. Anna and George both were admitted to the emergency department for the short stay. Anna and George had symptoms of vomiting, diarrhoea, has had 3 episodes of watery bowel motions. On clinical assessment of both patients, it was found that their lips were pale, tongue dry, complains of thirst, and there was decreased or no urine output from 8 hours (Austin et al., 2016). Hence, these were the similarities found with both the cases, i.e. from the case study of Anna and George.

George reported the problem of Orthostatic Hypotension, is a common manifestation of the blood pressure deregulation. There were some differences, and he used walking stick, for stability when he is outside home. Orthostatic or postural hypotension refers to the excessive fall in blood pressure, (BP) when an upright position is assumed. It increases the risk of cardiovascular diseases and affects the mortality. Postural hypotension is found to be common in elderly people, and symptoms are worse in morning (Gurevich et al., 2014).

SMART Goal in context to the nursing practice refers to specific, measurable, attainable, realistic/relevant, and time-bound. The first step in this case is to determine specific goal for two patients in the case who are suffering from the problems of poor hydration, then the next is measurable which refers to decide how are the symptoms of the problem, to which extent they are measurable or not. The step for relevance refers to deciding about the relevant steps or procedure to treat the patients in the given case studies (Kavouras et al., 2017).

Developing SMART goals for care

SMART goal in context to the management of health issue such as poor hydration, and postural hypotension, includes a definite plan for the healthcare professionals and patients both. It includes the steps to be undertaken for the treatment and prevention of the problem of the patient (Ricci, De Caterina & Fedorowski, 2015). Here, the first step is to ensure that the patient will specifically take steps to stabilise the blood pressure, from his/her present condition, then the next step ‘measurable’ refers to checking the blood pressure timely through the same BP machine. The step of action-oriented means that the patient needs to take necessary steps to ensure taking proper diet, and taking a 30-minute exercise. The step of reasonable, mentions about going for a regular check-up to the doctor and ensuring about the status of the improvement in the health of the patient. The last step in the SMART procedure aims at determining and evaluating the progress in the changes or improvement each month, so as to prevent further health issues (Revello & Fields, 2015).

In context to the National Safety and Quality Health Standards, there are some standards, which are developed by the Australian Commission on Quality and health in healthcare with compliance to the rules and laws of the nursing practices of the healthcare professionals. Open disclosure is one of the most important steps in relation to these standards, which must be ensured by the healthcare professionals in the healthcare. Healthcare professionals or nurses must inform the patient as well their support members or family about their health issue timely. In addition, they must be informed about the treatment and prevention, as how they should take care of their health, what they need to avoid in relation to their problems, and how it can be prevented in future (Oates & Price, 2017).

The standards include that there should be governance for the health and safety in the health service organisations, and the healthcare professionals must ensure collaborating with the consumers or patients. They must aim at preventing and controlling the healthcare associated infections, which can infect the patients. Nurses in the healthcare must ensure the safety and standards of the patient, in context to the patient with the poor hydration, and postural hypotension. Assessing  for clinical signs and symptoms of poor hydration or dehydration in children like with the patient in the case study 1, includes symptoms like thirst, weight loss, increased capillary refill time, postural hypotension (Balc?o?lu & Müderriso?lu, 2015).

The goal to treat postural hypotension includes reducing the symptoms, and it also mentions about treating the physiological causes, omitting or lowering contributing medications when possible. Interventions to be taken by the nurses in the healthcare include medications such as drug fludrocortisone is often used by the health professionals to increase the amount of fluid in the body of patient, as it helps in raising the blood pressure of the patient. Midodrine increases the  standing blood pressure levels of the person by limiting expansion of the blood vessels (Gibbons et al., 2017).

Choosing evidence-based interventions

In addition, to the medications as interventions to treat such patients, the other intervention which can be taken to treat the George’s problem of orthostatic hypotension, includes helping the person following a proper diet, such as increasing the salt content in the diet, eating small meals, increasing the fluids in the diet. As per the standards, regarding the healthcare and treatment of the patient, nurses must ensure the quality and safety of the health of the patient, i.e. George and Anna as they were admitted to the short stay in the emergency department in the hospital  (Jones, Shaw & Raj, 2015).

The two interventions for both cases is quite common, and collaborative in nature as the healthcare system, must ensure first proper medication, and then ensuring the health and safety of the patient.  The implementation of these interventions will assess and fulfil the basic physical and development needs of the patients, George and Anna. The physical needs of such patients, as the body in such problems  becomes more susceptible to the issue of dehydration from the loss of a small amount of fluids in the body. Moreover, the patient George may suffer from the problems of increased thirst sensation that further leads to the decreased fluid consumption by the patient (Kenney et al., 2015).

There are some of the implications for the practice of healthcare professionals in treating the patient of postural hypotension, and poor hydration. Healthcare professionals need to develop effective healthcare services to such patients, nurses effective role is to instruct these patients about diuretics. Other roles and responsibilities of the nurses are to ensure that the patient should be encouraged to sit out of bed as they can tolerate (Xie et al., 2016). Psychosocial care is essential for this patient, as they need to take proper nutrition and hygiene. There can be reasons for postural hypotension, as one can be stress. As it has been mentioned in the case that the patients with such problem, indicates some non-specific symptoms such as nausea, vomiting, headache, and abdominal pain. Implementing the interventions of effective medications, include helping in stabilising the blood pressure of the patient, and helping the patient attain effective physical health (Finkel et al., 2018). Nurses may ensure by their effective role in treating the patients help them to cope up with the problems of light-headedness, blurred vision, blood loss and anaemia. Nurses while treating and implementing the interventions must understand the health condition of the patient, ensure prevention of medication errors, or any clinical misadventure. The standards include these things as utmost important for any patient, as it may affect their health leading to the long-term health problems or diseases (Australian Commission on Safety and Quality in Health Care, 2015).

To conclude the above discussion, it has been analysed that both the patient, Anna and George suffered from the extreme problems of poor hydration, decreased urine output and postural hypotension. They must be treated with proper medications, exercises and they must be suggested to adopt changes in the lifestyle. As patients or person with the problem of poor hydration should be involved in exercises, stress test, wearing waist-high compression stockings, especially in the problem of postural hypotension. Nurses must take care of these patients in the healthcare considering their body’s physical health needs, and their present condition. Hence, healthcare services must ensure the implementation of the SMART goals, in context to the case studies, and their treatment.

References

Austin, P. F., Bauer, S. B., Bower, W., Chase, J., Franco, I., Hoebeke, P. & Yang, S. S. (2016). The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children's Continence Society. Neurourology and urodynamics, 35(4), 471-481.

Australian Commission on Safety and Quality in Health Care. (2015). National Safety and Quality Health Service Standards Version 2: Consultation draft.

Balc?o?lu, A. S. & Müderriso?lu, H. (2015). Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. World journal of diabetes, 6(1), 80.

Ball, J., Ballinger, C., De Iongh, A., Dall’Ora, C., Crowe, S. & Griffiths, P. (2016). Determining priorities for research to improve fundamental care on hospital wards. Research involvement and engagement, 2(1), 31.

Finkel, R. S., Mercuri, E., Meyer, O. H., Simonds, A. K., Schroth, M. K., Graham, R. J. & Muntoni, F. (2018). Diagnosis and management of spinal muscular atrophy: Part 2: Pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics. Neuromuscular Disorders, 28(3), 197-207.

Gibbons, C. H., Schmidt, P., Biaggioni, I., Frazier-Mills, C., Freeman, R., Isaacson, S. & Mehdirad, A. (2017). The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. Journal of neurology, 264(8), 1567-1582.

Gurevich, T., Machmid, H., Klepikov, D., Ezra, A., Giladi, N. & Peretz, C. (2014). Head-up tilt testing for detecting orthostatic hypotension: how long do we need to wait? Neuroepidemiology, 43(3-4), 239-243.

Jones, P. K., Shaw, B. H. & Raj, S. R. (2015). Orthostatic hypotension: managing a difficult problem. Expert review of cardiovascular therapy, 13(11), 1263-1276.

Kavouras, S. A., Bougatsas, D., Johnson, E. C., Arnaoutis, G., Tsipouridi, S. & Panagiotakos, D. B. (2017). Water intake and urinary hydration biomarkers in children. European journal of clinical nutrition, 71(4), 530.

Kenney, E. L., Long, M. W., Cradock, A. L. & Gortmaker, S. L. (2015). Prevalence of inadequate hydration among US children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009–2012. American journal of public health, 105(8), e113-e118.

Oates, L. L. & Price, C. I. (2017). Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review. BMC nursing, 16(1), 4.

Revello, K. & Fields, W. (2015). An educational intervention to increase nurse adherence in eliciting patient daily goals. Rehabilitation Nursing, 40(5), 320-326.

Ricci, F., De Caterina, R. & Fedorowski, A. (2015). Orthostatic hypotension: epidemiology, prognosis, and treatment. Journal of the American college of cardiology, 66(7), 848-860.

Woodward, B., Smart, D. & Benavides-Vaello, S. (2016). Modifiable factors that support political participation by nurses. Journal of Professional Nursing, 32(1), 54-61.

Xie, X., Atkins, E., Lv, J., Bennett, A., Neal, B., Ninomiya, T. & Chalmers, J. (2016). Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. The Lancet, 387(10017), 435-443.

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