Detailed Case Study: Nursing Care Assessment in Healthcare Practice

This case study presents a comprehensive nursing care assessment of a 54-year-old female patient who developed complications following hyaluronic dermal filler treatment, complicated by a history of acute renal failure and recent dental procedures. The assignment details the nursing care process, including patient history, clinical assessment techniques, and diagnostic reasoning. It explores the importance of thorough medical reviews, clinical interviews, and laboratory tests, specifically focusing on urinalysis, blood chemistry, and radiographic imaging. The study emphasizes the potential risks associated with dermal fillers and dental procedures, including the development of infections and the need for careful patient management. It outlines the diagnostic confirmation of acute renal failure, potential management strategies, and the importance of interdisciplinary collaboration. The conclusion underscores the significance of clinical assessment in patient diagnosis, promoting quality care, and developing critical skills in the nursing practice. It also highlights the need for precautionary measures, interdisciplinary approaches, and the development of nursing assessment protocols.

Nursing Care Assessment in Health Care Practice
University
Task
Name
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Introduction
The nursing care process is an essential aspect of care delivery and focuses on ensuring
that patients receive quality care. In this case review, an assessment of a female aged 54 years
who has been receiving medical care at the medical clinic is being focussed on. The patient
has been a client at the facility for the last eight years. The patient current state demonstrates
she has received care on Hyaluronic dermal filler. This a cosmetic medication regime applied
through an injection administration on the face to reduce the appearance of the fine lines and
wrinkles and to enhance the facial structure, framework, and volume of the lips and face
growth (Fakhari & Berkland, 2013). The patient has returned to the clinic one-week post-care
treatment with complaints of inflammation, redness, heat in the affected surface, hardened
lumps and pain on palpation. Her previous medical history indicates that she has acute renal
failure and an occasional smoker. She has a history of rheumatoid arthritis medication intake.
Past medical appointments for the patient reveals that she had a 3-week dental intervention
post dermal filler treatment, however, she did not disclose this before her dermal filler
management. Currently, the patient is presenting an increased intensity of symptoms. As a
nurse practitioner with critical competencies based knowledge in aspects of nursing and
pharmacological science, there is a need to engage actively in establishing patient state and
evaluating evidence-based approaches able to deliver a care process for the patient. This will
be enabled by critical approaches to improve the state of the patient.
Key aspects inpatient health history
An assessment of the medical regime of the patient is an essential aspect of the care
process. Dermal fillers are described as gel-like substances that are injected beneath the skin
to restore lost volume, smoothen lines and soften creases or enhance facial contours. Dermal
fillers have been described as wrinkle fillers, they are essential in being much more than just
smoothening wrinkles. Filers are mad of approved filler products that are used cosmetically
by surgeons (). Hyaluronic acid is a component of dermal filler. It is a naturally occurring
substance in which they are found beneath the skin, it is essential in making the skin to plump
and has a feeling of hydration. Hyaluronic acid fillers are gel-like; their effect on the skin is a
temporary effect between 6 to 12 months before the body absorbs the particles. Hyaluronic
acid dermal filler has been demonstrated to be consistent across a wide of species and has the
limited potentiality of immunogenic with a longer duration effect on the face. It has a
hydrating effect which is crucial for an aging face (Kim & Sykes, 2011).

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Further, the patient has a previous history of acute renal failure which is requiring
urgent attention and being a smoker. Acute renal failure is a sudden state where the kidney is
unable to filter waste products in the blood; when the body losses its filtering ability, the
body's blood make can get out of balance (Alscher, Erley, & Kuhlmann, 2019). This state
requires urgent attention for the patient. Moreover, the patient dental procedures in the
vicinity of the HA dermal filler can lead to an emergence of complications. This can entail
infections that can mimic dental infection, thus this possesses a crucial risk for patients'
overall wellbeing and state of health and thus requires urgent medical attention (Han, Park &
Lee, 2019).
Clinical assessment techniques
Clinical assessment procedures for the patient are a critical step that is geared towards
gathering information from various sources. Medical reviews and consultations have shown
to be complex issues that necessitate deep nursing understanding and sound knowledge of
various areas ranging from communication techniques to clinical reasoning steps and
physical assessment skills. Clinical assessment procedures are an integral aspect of the
clinical consultation process (Silverston, 2013).
Assessment in clinical practices is a key component in the nursing practices, it a state
which requires adequate planning offering care for the family. According to The Nursing and
Midwifery Board of Australia (NMBA, 2020), national competency standards, nursing
practitioners’ needs to conduct a comprehensive and systematic nursing assessment, planning
care with others and engaging in an interdisciplinary approach towards patient-centered care
approach. A critical outline of assessment for the patient entails admission assessment,
observation, clinical interview, laboratory tests which are categorized as a focussed
assessment of the patient (Hagiwara et al., 2016).
Upon admission assessment of the patient, there is a need to document patient history
which entails the current history of illness and relevant history of the patient information.
This covers also medications, reactions allergies, and the current care process. Then the next
phase is proceeding with a general appearance for the patient. Undertaking patient vital signs
is a critical step. This information is recorded as part of the admission process. Vital
assessment entails aspects such as temperature, respiratory rate, heart rate, blood pressure of
the patient, saturation of oxygen and pain levels on the face. Patient physical assessment is
vital. A structured methodology of the examination allows a complete assessment of the

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patient. These details will entail inspection features, palpation, percussion and auscultation
techniques which are beneficial in gathering information (Christalle et al., 2018).
In-depth investigative assessments
Focussed assessment findings for the patient entail an assessment of renal activity.
Renal assessment entails critical aspects of urine elimination. This details the urinary
patterns. This can be characterized in for of incontinence, urgency, frequent or dysuria. The
urinary pattern of the patient can signify incontinence since there is acute failure of waste
removal hence limited amounts of urine. Patient hydration status is essential in establishing
self pitting edema on soft tissues. An assessment of urine output levels is crucial (Lukacz, et
al., 2017). This will reveal the level of urine load in the body.
A critical fundamental aspect is an assessment of the skin. Diagnostic observation
entails skin color observation especially at the face, any occurrence of rash in the face due to
complications arising from the dermal filler treatment coupled with ongoing dental care
management. Palpation of the skin is undertaken to check on the temperature, moisture
levels, edema and turgor (Alves & Goncalo, 2019).
Fundamental findings of the patient entail aspects regarding dermal facial treatment
complications and acute renal failure developed by the patient. Lack of caution during the
dermal filling process for the patient is an essential aspect which is of interest in the nursing
care process. Dental procedures carried out at regions which are secondary to the orofacial
swelling towards dental procedures occurring near regions of injectable filler materials is of
the essence. There is an inherent potential risk of dental procedures on the facial rejuvenation
process. More often usage of dermal cosmetics coupled with facial injections or any
inflammations which mimic dental infection can lead to a severe problem that warrants
attention. This attention to the possible association of pathological relationship between eh
occurring dental procedures and dermal fillers is essential in finding appropriate treatment
management (Chiang, Pierone & Al‐Niaimi, 2017).
From the initial assessment, there are three key fundamental and critical assessments
informed by the clinical procedure undertaken entails a laboratory assessment of urinalysis,
blood chemistry assessment and radiography examination.
Diagnostic reasoning aspects

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Urinalysis in health care assessment entails the detection and management of a wide
range of disorders using urine. An assessment of urine details various components that are
crucial to assess the level of load and kidney renal function towards the filtering process in
the body. Urine analysis can show color, turbidity, specific gravity, ketones, proteins, nitrites,
RBCs among other essential components. An essential parameter in this context entails urine
specific gravity. It is a measurement of urine concentration and is often a clear picture of the
ability of the kidney to concentrate urine, the comparison entails the amount of the solute
compared to that of water (Bezinque et al., 2017).
Blood tests are an essential element in laboratory analysis. Key fundamental blood
chemistry tests entail kidney function tests. This process measures the blood urea nitrogen
and cretin levels excreted in the kidney. Blood chemistry plays a key role in that it assesses
blood electrolyte state, levels of chemicals and to facilitate advice for the next line of
treatment (Pai & Kohli, 2019).
Undertaking radiographic diagnostic imaging is vital for the patient. Dental radiographs
are an essential element in diagnosis to check hidden dental structure, bone loss, and presence
of cavities. A radiographic image can penetrate the patient oral structure and then striking a
film. an observation of lighter teeth due to limited penetration of the radiation to reach the
film. This will be an essential aspect to assess the filled teeth which the patient was
undergoing treatment before. With the patient state having a positive history of dermal fillers,
there was need for extra caution during the dental treatment however this process was not
undertaken thus leading to increased feeling of pain intensity on the location of dental feeling
leading to a facial infection or dental infection which can pose serious health challenges
(Ramzi, Kassim, George & Amin, 2015).
Acute renal management diagnostic confirmation, management of acute renal failure is
fundamental as it can lead to the development of kidney damage leading to decreased blood
flow to the kidney, increased exposure to harmful substances and obstruction due to urinary
tract infections which affect the flow of urine. Acute kidney failure can lead to the
development of other complications such as metabolic acidosis, high potassium levels, and
fluid balance and uremia aspects. Patients with renal failure can lead to the development of
chronic kidney disease later in the future (Arnold-Chamney et al., 2018).
Potential management of the acute kidney failure for the patient is undertaking a review
of the potential underlying cause. Initial treatment care is to prevent the occurrence of

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cardiovascular collapse and death. The involvement of other health care staff such as
nephrologists is vital at this stage. After management procedures are undertaken, kidney
function monitoring is taken into consideration. A urinary catheter is placed in the kidney to
offer relief and monitor the output of urine and relieve obstruction of the bladder (Foster,
2019).
Assessment of radiographic information on the management of possible risks of dental
procedures to dermal fillers is essential at this phase. Injectable fillers have demonstrated the
occurrence of the development of complications at the injection sites. The underlying causes
are many and may entail biofilm infection. There is a positive history of the development of
complications when dermal fillers are used when carrying out treatment procedures for the
dental cavity. Antibiotic management is essential in the stage. However essential and active
elimination method is implant removal and biofilm in the patient is key (Blanchard et al.,
2019).
Undertaking blood samples tests analysis is essential in reviewing the progress of the
patient. Blood samples establish blood content and show the presence of compounds which
could have significance in establishing the levels in the body. These essential tests for the
patients are expected to offer to relieve and prevent the development of other complications.
Dermal filler site infection management is geared towards managing and reducing the
occurrence of further complication and pain severity to the patient ().
Conclusion
Hence clinical assessment in nursing practice is an essential element in patient
diagnosis and improving quality of care. More often patients with dental care procedures may
lead to the development of orofacial swelling. Appropriate patient history is essential;
undertaking a positive history of the injectable dermal fillers needs to be often precautionary
measures before initiating dental management procedures. As a nurse developing a nursing
assessment and protocol is essential; part of the nursing practice and developing the critical
skills in the care practice processes. Engaging in an interdisciplinary approach is crucial in
establishing partnerships with other relevant health care staff is critical to enhancing
teamwork and collaborative approach in facilitating quality care to the patient. Thus
undertaking essential steps as a nursing practitioner is essential in conducting appropriate
nursing and diagnostic care for the patient.

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