Analysis Of Accident Impact Through Roper Logan Tierney (RLT) Model, Legal Concepts Of Consent, The Doctrine Of Necessity, Enduring Guardianship, Preoperative Action Of Nurses, Abnormal Cues, Pathophysiology - Essay.

Impact of the Accident through Roper Logan Tierney (RLT) Model

The Roper Logan Tierney (RLT) model of nursing can be defined as a nursing thirty that focuses on the activities of daily living (ADL)s the healthcare service users after a health issue. This models aims at understanding and evaluating biological, psychological, spiritual as well as cultural impacts of a sudden health issue on the patient and her family members. Considering the fact that Kristy has undergone a sudden accident which has resulted in major heath issues, in the following section detailed analysis of the biological, psychological, spiritual as well as cultural impacts of the accident on Kristy and her family member, has been done.

When it comes to biological impact, it can be defined as the impact of the illness on the overall health of the patient that includes the anatomy and physiology of the patient and his family members. In case of Kristy, she is likely to be suffering from unbearable pain due to her fracture in the pelvis region. This in turn has limited her ability to move and perrom daily life activities of her own. As a result of the accident, Kristy’s husband has to look after both her and their son, along with talking his professional life. This is more likely to create a physical stress for him.

When it comes to psychosocial impact, it can be defined as the impact of the accident on the psychological and social wellbeing of the client and his family member (Jeong et al. 2021). In case of Kristy, as a result of this sudden accident, she and her family members are more likely to be in shock. Her sudden inability move and major physical illness, can result in mental illness like depression and anxiety. Additionally, since she is staying away from his family members for a prolonged period of time, it impose negative impact on his mental wellbeing as well.  When it comes to her husband, the fear of losing her wide, may result in depression and anxiety. Sam, since he is only 3 years old and is staying aware from his mother for a prolonged period of time, it is more likely to affect his social and psychological development.  

When it comes to the spiritual impacts, it includes the impact of the illness or accident on the spiritual wellbeing of the patient and his family members. In case of Kristy, The sudden accident leading to major health issues like fracture in pelvis and right sided cerebral contusions indicates loss in spiritual beliefs. As per Marcinkevics et al.  (2021), sudden loss of body parts, accidents or unexpected death lowers the spirituality of an individual. This is also true for both Kristy and her family members.

Finally, when it to comes to cultural impacts, it can be said that the culture of Kristy’s family is appreciable, since, her husband is taking care of her as well as the family, when she is absent. However, prolonged illness of Kristy may affect he culture off his home in an adverse way.

Legal Concepts of Consent, The Doctrine of Necessity and Enduring Guardianship

The term consent can be defined as the act of giving approval. Consent is a legal requirement in healthcare, and each and every healthcare service users possess the right to provide consent before initiation of any kind of operation, medication and healthcare procedure on him or her. When it comes to doctrine of necessity, it can be considered as a part of emergency management. As per Cartwright et al. (2018), in case of emergency situations, where the care user is not in a state of providing consent to a care, however, lack of care or any delay may result in fatal consequences, the healthcare service providers can assume the primary decision making role for performing interventions under the “doctrine of necessity”. The term enduring guardianship refers to the process when the healthcare service user, is aware of the act that he or she may lacks the ability to make appropriate decision making in future and hence, appoints one of his trusted friends or family members, or even nurses, to make decision, on behalf of him or her, at that point off time. In case of Kristy, since she has undergone Cerebral Contusion and is already suffering from confusion and lack of ability to remember certain information, she may require the help of NOK or Enduring guardianship in near future.

As per White et al. (2019), a nurse possess arrange of responsibilities before taking a patient to the operation theatre. These responsibilities and actions, are known as preoperative responsibilities or actions. The first action that should be focused on by the nurses before taking Kristy to the operational theatre includes educating the patient about the operation to be performed. This is a highly crucial pre-operative step, since it not only reduces the anxiety of the patient, but also ensure a better outcome post operation. Given the fact that Kristy is undergoing operation in her pelvis region she should be educated about how exactly the operation will take place, the key reason behind the operation and the side effects associated with the same.

The second most important action that the nurse should perform includes monitoring the current condition of the patient. As per Holland and Jenkins (2019), it is the responsibilities of a nurse to assess the physical state of the patient before the surgery is to be conducted, to understand whether the patient is ready or the survey. The basic aspects that the nurse should monitor includes the blood pressure level, cardiac evaluation, the RR of the patient. Kristy should be sent to the operation theatre once everything is found to be fine.

The third most crucial action of nurse includes preparing the patient mentally and physically for the operation. In this case, the nurse should demonstrate genuine empathy for the condition of Kristy and movie her for the operation through effective communication. Effective mental support should be provided to the patient. Also, the nurse should dress up Kristy for the operation theatre in an appropriate way. 

The first and foremost abnormal cue that can be noticed from the assessment conducted on Kristy, post operation includes delayed cap refill to both feet. The Capillary refill test (CRT) can be defined as the rapid test that is used to assess the flow of blood through the peripheral tissue. Normal CRT range from  1 to 2 seconds . This indicates a normal blood volume and perfusion. a CRT that is longer than 2 second indicates poor perfusion as a result of peripheral vasoconstriction. The CRT for Kristy is 3 seconds which indicates same. Kristy is suffering from poor perfusion of blood in both of her feet.  As per do Valle and da Cruz (2018), the pathophysiology behind poor perfusion of blood in both the extremities includes decreased flow of arterial blood to the extremities. This can be the result of sudden embolic event that result in obstruction of the arterial flow, or a chronic obstructive procedure leading to decreased arterial flow to the extremities. A patient who have successfully gone through a pelvis fracture surgery, is not likely to be suffering from poor perfusion. Hence, CRT above 2 second can be considered as a major abnormal cu for Kristy.    As per Mahanani et al. (2020), one of the most common reason behind high CRT post operation in the pelvis region is arterial embolism. A fragment of plaque which resembles a clot is known as an "embolus." The term "emboli" can be defined as the presence of a significant number of clots or plaque pieces.  One or more than one clots can result in an arterial embolism. Arterial emboli have higher prevalence in legs and feet. Strokes are caused by embolism in the brain.

Preoperative Action of the Nurses

When it comes to the second abnormal cue, the excessive pain faced by the patient that is indicated from Kristy’s pain score which is 7 out of 10 can be considered as the 2^nd one. As per Gervaso, L., Dave and Khorana (2021), post-operative pain after pelvis surgery is common amongst patient and it can range from 3 to 6 score. However, a pain score more than 6 signifies potential risk of damage in tissue or even in organs, post-surgery. It also indicates the chance of infection in the operated site of the patient. According to Etkin et al. (2021), the pathophysiology of post surgery pain includes peripheral as well as central sanitizations along with humoral actors that contributes in the formation of pain during rest or at the time of movement. It has also been found that post surgical pain is related to enhance tariffing of the GluR1 subunit of AMPA-receptors by phosphorylation of Ser-83. PKC membrane transfer is enhanced by surgical plantar incisions, but not by alternative PKC isoforms, as well as phosphorylation of the Ser-831 region of the GluR1 subunit from AMPA-receptors. Pain beyond toleration often results in affecting the biological function and every day activities of the healthcare service users like consuming food and sleeping. 

Gervaso, Dave and Khorana (2021) have highlighted that the pathophysiology of pain post pelvis surgery includes inflammation in the operated site or nerve injury at the time of operation.  As a consequence of the inflammation, the health care service user's mobility may be restricted for an extended length of time. Nociceptive pain is categorized into two kinds: somatic pain as well as visceral pain, commonly known as pain caused by tissue destruction. Somatic pain receptors can be found in the skin, subcutaneous layer, other connective tissues, ligaments, synovial membrane, as well as joint capsules. When these receptors are activated, they usually cause acute or minor localised pain, although severe pain is not uncommon when the skin or subcutaneous tissues are involved. Also, development of hyperalgesia post operation in the pelvis region is a major reason behind post-operative pain. Excessive pain pot operation imposes negative impact on both the metal as well as physical wellbeing of the patient and thus reduces his quality of life (Etkin et al., 2021). This is true for Kristy as well.

The 3^rd abnormal cue that can be detected from the report generated includes bi lateral cold feet. Cold feet after surgery suggest a lack of blood flow in extremities.   Hypothermia is typically indicated by this indication, as well as a longer CRT. According to Jeong et al. (2021), a person who has had pelvic surgery is unlikely to have chilly foot. This sign implies blood clotting in the lower limbs of the body of the patient, as well as obstructed blood flow. A considerable percentage of individuals have been discovered to have atrial thromboembolism following a pelvic surgery. When one or more restricting blood arteries becomes ischemic, an arterial embolism occurs, leading to infarction as well as tissue death (necrosis). 

References

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