Factors To Consider In Nursing Care: A Case Study Of A Trauma Patient

The Roper Logan Tierney nursing model

The case study is of a patient named Kristy with a history of trauma following her accident and injury. The Roper Logan Tierney nursing model provides a model of nursing care based on activities of living (Brown, Edwards, Buckley et al., 2019). This model highlights the nursing process, including assessment, medical diagnosis, planning, intervention, and evaluation. Nurses use this framework to provide a holistic assessment of patients and are a guide for the care plan (Barnes & Rowe, (2013). There are various factors: biological, psychosocial, spiritual, and cultural factors. Biological factors highlight the impact of overall health or a current injury or illness and consider the individual's anatomy and physiology. In our case, Kristy faces increased nutrient needs as a result of her injury as compared to those of an ordinary person without an injury. Kristy will need diet modification such as a high protein, high-calorie diet to promote wound healing. Diet modification can also be in terms of consistency and frequency. Kristy's family might need to adjust Kristy's diet significantly if the accident has affected her food intake. The family might need to consider enteral or parenteral feeding depending on the outcome.

Psychosocial factors rely on the impact of emotion and also cognitive effects. Kristy and her family may experience paranoid thoughts and anxiety due to the accident. This might affect their communication as a result of stress. Lack of literacy regarding Kristy's condition would also lead to adverse outcomes, especially when the family does not understand the importance of patient care to promote health. The family might also face mental health issues such as stress and depression. They might need to seek psychosocial support and practice stress management techniques to deal with this. Cultural factors explain the impact of culture, which the individual experiences. Culture applies to the beliefs and values practiced by a particular group of people. Certain cultures might have taboos and restrict seeking medical attention. Kristy and her family might face cultural restrictions such as the need to use herbal medicine instead of synthetic medication. The patient might refuse any medication administered to her, especially if it is not herbal medication. This can cause dilemmas and contribute to adverse outcomes.

The religion of the patient dictates spiritual factors. This depends on the religious beliefs of a patient. Some religions restrict the use of prescription medication. Depending on their religion, Kristy and her family might face restrictions on blood transfusions, certain surgeries, or even other treatments that could save a life. The issue can be complicated, especially when the patient and the family refuse the proposed care plan and insist it is against their religion. This can lead to potentially life-threatening situations and could even lead to the death of a patient. However, in some cases, we have alternative treatments such as using blood byproducts such as albumin instead of blood transfusion (Craft & Gordon, 2019). Some cases present ethical dilemmas, and the results can either be negative or positive for the patient. In this case, it is essential to use critical thinking as a nurse following the Nursing Code of Ethics, such as the patient making informed consent (Forrester & Griffiths, 2015).

Biological factors and the impact on Kristy's nutrient needs

Legal concepts of consent emphasize informed consent. This is whereby a health care professional educates a patient on a specific procedure they will undergo. The health care provider tells the patient about the risks, benefits, and proposed outcomes of a particular procedure and offers alternatives (Farrell, 2017). With this information, the patient applies competence and makes a voluntary decision on whether to undergo the procedure or not. Informed consent has four components: capacity to make a decision, documentation of consent, competency, and disclosure. The legal aspect suggests that the patient voluntarily agrees to undertake an action of their own will. Kristy's situation applies as she has to give informed consent if she is willing to undergo surgery.

The doctrine of necessity is whereby emergency treatment can be given, for example, if a patient cannot give consent, such as in patients with mental disorders. Consent can also be obtained in cases where the patient is a child. Situations where those with parental responsibility refuse to give consent, can be difficult. It is essential to apply the law of consent to every patient unless they cannot give consent. In our case study, this might not apply as our patient can give consent. The doctrine of necessity will only apply if Kristy cannot provide consent, such as when she is unconscious.

An enduring guardianship is a form of legal consent whereby the patient chooses a trusted person to become the enduring guardian. This person is responsible for making decisions regarding the patient's lifestyle, health, and medical aspects. Medical choices include the type of treatment offered, such as palliative care or life-extending treatments. To get an enduring guardianship, both parties must be 18 years and above, meaning that they have the legal capacity to make such a decision.

The patient can have more than two enduring guardians, but they must make decisions together. The patient can restrict their decision-making roles. As enduring guardians, they cannot make decisions, not in line with the law, such as approving a treatment when the patient is not for it. The effect of an enduring guardian comes into place when the patient loses the capacity to make decisions or if the patient is incapacitated.

The Next Of Kin is someone a patient chooses to receive information regarding their medical care. A Next Of Kin does not have legal rights like an enduring guardian. They act on behalf of the patient and provide advice and wishes. This person acts on behalf of the patient, for example, if the patient is unconscious or unable to communicate. They also receive information regarding the patient's progress. In Kristy's situation, she can choose a Next of Kin to be her closest person in the family. Getting an enduring guardianship would only apply if her medical condition becomes worse.

Pre-operative care is essential for patients to understand their individual needs and prevent patient anxiety. It is a critical nursing role. Improving pre-operative care is one strategy that promotes faster recovery and improved outcomes. Pre-operative care is mainly led by the nurse and involves the following activities:

Psychosocial factors and their impact on Kristy and her family

A pre-admission assessment is a nursing assessment providing a medical history that includes information about the tests conducted. A relative or a person close to the patient must be present in the evaluation. This is also to offer emotional support and prevent anxiety for the patient. The assessment also ensures that consent is given and relevant adjustments can be made.

Patient and family education- the nurse, has a responsibility to offer information so that the patient can be familiar with the operation procedure. This helps them be more informed of what will happen and what to expect. It is also the role of the nurse to give instructions on activities to be done after the surgery, such as how to manage pain. This helps to decrease the patient's anxiety. Assess the patient's learning needs and involve them in their health decision-making (Haley, 2016).

Preparing the patient for surgery is the last step of pre-operative care and involves several activities. The nurse should have a pre-operation checklist that summarizes all the data about a patient and confirms that the patient is ready for surgery (Forbes & Watt, 2016). This includes ensuring that the patient wears a hospital gown and that hospital policies are followed, such as removing jewelry. The patient's belongings should be well kept and secured. The nurse should also ensure that the consent forms are filled out and signed. The patient's tests, such as X-rays and laboratory results, should be in the patient's chart. All these are important to ensure that a patient is ready for surgery.

Post-operative nursing assessments are interventions carried out by a nurse after the patient has undergone an operation. Some of these interventions include pain control, fluid monitoring, surgical site assessment, assessing the patient's level of circulation and sensation, and monitoring vital signs. There can be abnormal cues in a patient following an operation, and it is essential to identify them as early as possible and evaluate them to prevent adverse outcomes (Bryant, Knights, Rowland et al., 2019).

Blood pressure fluctuations- this can present as hypertension or hypotension. Hypertension is more common and can result from pain or anxiety or from the discontinuation of antihypertensive drugs (Bullock & Manias, 2017). Hypotension can result from blood loss that results in hypovolemia, dehydration, or changes in drug therapy. It is essential to monitor patients' blood pressure after an operation and offer relevant interventions.

Fluid and electrolyte imbalance- during post-operative care, it is important to correct any imbalances by replenishing the lost fluids and electrolytes. Fluid losses can be due to surgical drains. For replenishing, the patient should use the oral route. These imbalances can be detected by monitoring the patient's vital signs. Hypotension is an example of fluid and electrolyte imbalance and can be an indicator of hypovolemia and can also be caused by sepsis. Fluid and electrolyte imbalance can also be caused by blood loss, diarrhea, vomiting, and fluid losses. Fluid overload can also occur in cases where intravenous fluids are administered excessively or in cases of impaired renal or cardiac function. It is essential to monitor fluid input and fluid output in post-operative care.

Abnormal gastrointestinal function- this can present as post-operative nausea and vomiting. It occurs within 24 hours after undergoing a surgical procedure. This can result from a reaction to the anesthesia used during the surgery. This triggers nausea and vomiting as several neurotransmitters are affected. It can also result from the patient (history or as a result of anxiety) or surgical factors. As a nurse, it is essential to make the right interventions such as administering drugs such as anti-emetics. The types of anesthesia used during surgery can be changed to prevent this complication.

Other strategies can also help prevent this complication, such as increasing the intravenous fluids used during surgery when the patient is under anesthesia. Health care professionals should also apply the multimodal approach. If the complication results from a reaction to the anesthesia used, local anesthesia can be used in the future (Bullock & Hales, 2019). It should also be clear why the patient is experiencing nausea and vomiting. Some medications that trigger nausea and vomiting should be avoided. According to some guidelines, intake of unrestricted clear oral fluids until the patient is transferred to the theatre can help reduce post-operative nausea and vomiting. Strategies like the application of acupressure can also be used to resolve this complication (Crisp, Douglas, Rebeiro et al., 2017). This complication can be resolved in nutrition by taking bland diets, as this diet does not trigger the gastrointestinal tract. Fatty and spicy foods should be avoided. Once the patient has begun oral intake of food, they should be encouraged to take small frequent meals. The patient should also avoid any food that triggers their gastrointestinal tract and worsens it. Vomiting can also result from the aspiration of gastric contents and can lead to negative surgical outcomes.

References

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Forrester, K., & Griffiths, D. (2015). Essentials of law for health professionals (4th ed.). Elsevier.