Integrated Nursing Practice for High Risk Patients

This integrated nursing practice guide covers nursing interventions for high risk patients, including those with skin integrity impairment, cardiac insufficiencies in renal failure, and behavior issues. It provides specific interventions and rationales for each issue, as well as references for further reading.

Running head: INTEGRATED NURSING PRACTICE
Integrated nursing practice
Name of the Student
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Problem Nursing interventions Rationale
High risk for falls 1. A secure wristband
identification can be
implemented for risk
for fall behaviour
2. The move items that
patient use should be
kept within his reach
like urinal, telephone
and water.
3. Nurse should respond
to the call light
immediately when
called by the patient.
4. Side rails should be
used when required
and in case of split side
rails, one of the rails
should be kept down at
1. By using wristbands,
healthcare
professionals would be
able to acknowledge
the condition and the
patient whereabouts
promoting patient
safety and prevention
of falls (Urquhart
Wilbert, 2013).
2. Items kept far away
from the patient can
contribute to risk of
falls and may be
hazardous.
3. This would prevent the
patient from getting up
from the bed without
any assistance.
4. If one of the rails is
kept down, it reduces

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the foot of the bed.
5. There should be proper
light in the room.
6. There should be no
cluttering of the
patient’s primary path
with any sort of
furniture. Chairs, beds
and bathroom fittings
should be supported or
assisted with alarms
the chances of falls for
a confused or
disoriented person
(Ganz et al., 2013).
5. This would help in
increased visibility and
reduced chances of
falling if the patient
gets up at night.
6. The patient may find it
difficult to walk
around objects
obstructing their
primary path.
Skin integrity impairment 1. Monitoring of the site
of impaired skin
integrity once daily for
any changes like
redness, colour
changes, warmth,
swelling, pain or any
chances of infection on
1. Systematic inspection
of the scalp can help in
the identification of
impending problems
(Talan et al., 2015).

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the scalp due to
psoriasis
2. Monitoring of skin
care practices by
noting down cleaning
schedule, type of soap
used, water
temperature and
cleansing frequency.
3. Monitoring of vital
signs at regular
intervals
4. Antibiotic
administration and tell
the patient not to
scratch or rub the scalp
and use gloves, of
necessary
5. A diet plan is
2. Individualized plan of
care is important for
psoriasis depending
upon skin needs,
condition and
preferences.
3. This can be helpful in
examining skin under
general circumstances
and occurrence of no
new injuries.
4. Topical agents can be
helpful in fighting
infection. Rubbing or
scratching can delay
healing and cause
further injury.
5. High-calorie and
protein diet can be
helpful in promoting

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necessary for
nutritional needs
6. Bath oil can be
used
healing (Barrea et al.,
2016)
6. This helps in the
reduction of scales
formation and keep the
skin moist to avoid
itching or rubbing
cardiac insufficiencies in renal
failure
1. Auscultation of lung
and heart sounds.
Evaluation of
peripheral oedema
presence, dyspnea and
vascular congestion
2. Hypertension
assessment with
monitoring of BP and
noting of postural
1. Tachycardia,
tachypnea, irregular
heart rate, wheezes and
muffles tones in S3
and S4 indicate heart
failure due to renal
failure
2. Hypertension is caused
due to RAA system
because of fluid deficit
and response to side

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changes like lying,
sitting and standing
3. Evaluation of heart
sounds, capillary refill,
temperature or
sensation
4. Assessment of activity
level
5. Monitoring of urine
input and output along
with vital signs of
heart
6. Patient education on
diet and nutrition
effects of anti
hypertension
medicines (Te Riet et
al., 2015)
3. Narrow pulse pressure,
pallor, sudden
hypotension with
mental deterioration
can cause tamponade
4. Weakness can
contribute to anaemia
and heart failure
5. Urine retention and
continence can be
evaluated through
urine input and output
as the patient is
suffering from renal
failure. Foley catheter
can be used in case of
incontinence.
6. Limiting of salt intake
and daily weights is

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important in case of
renal failure (Ha,
2014)
behavior issue- agitation,
aggression and confusion
1. Assessment of
frequency of agitating
and aggressive
behaviour, stressors
that precede such
behaviour
2. Identification of
feelings experienced
by the patient
preceding aggression
3. In every shift, the
nurse should assess the
thought ability of the
person by observing
memory changes,
cognitive functioning,
and changes in
1. Identification of
circumstances and
patterns surrounding
this type of injury can
help in designing
nursing interventions
and teaching activities
according to patient
preferences (Maki,
Yamaguchi &
Yamaguchi, 2013)
2. Feelings serves as
guidelines for
interventions planning
3. Any type of change in
these statuses may
indicate deterioration
or improvement in
mental health status

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thinking and difficulty
in communication.
4. Assessment of level of
disorientation or
confusion
5. Utilization of cognitive
function testing
6. Provide the patient
with positive
reinforcement
strategies and feedback
for positive behaviours
(Freitas ett al., 2013).
4. This would be helpful
in assessing the
effectiveness of
treatment or
deterioration in
condition.
5. The current level of
Alzheimer can be
determined
6. This greatly reinforces
progress and boost
patient’s confidence
References
Barrea, L., Nappi, F., Di Somma, C., Savanelli, M. C., Falco, A., Balato, A., ... & Savastano, S.
(2016). Environmental risk factors in psoriasis: the point of view of the
nutritionist. International journal of environmental research and public health, 13(7),
743.

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Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2013). Montreal cognitive assessment:
validation study for mild cognitive impairment and Alzheimer disease. Alzheimer
Disease & Associated Disorders, 27(1), 37-43.
Ganz, D. A., Huang, C., Saliba, D., Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Ensrud, K. E.
(2013). Preventing falls in hospitals: a toolkit for improving quality of care. Ann Intern
Med, 158(5 Pt 2), 390-396.
Ha, S. K. (2014). Dietary salt intake and hypertension. Electrolytes & Blood Pressure, 12(1), 7-
18.
Maki, Y., Yamaguchi, T., & Yamaguchi, H. (2013). Evaluation of anosognosia in Alzheimer's
disease using the symptoms of early dementia-11 questionnaire (SED-11Q). Dementia
and geriatric cognitive disorders extra, 3(1), 351-359.
Talan, D. A., Salhi, B. A., Moran, G. J., Mower, W. R., Hsieh, Y. H., Krishnadasan, A., &
Rothman, R. E. (2015). Factors associated with decision to hospitalize emergency
department patients with skin and soft tissue infection. Western Journal of Emergency
Medicine, 16(1), 89.
Te Riet, L., van Esch, J. H., Roks, A. J., van den Meiracker, A. H., & Danser, A. J. (2015).
Hypertension: renin–angiotensin–aldosterone system alterations. Circulation
research, 116(6), 960-975.
Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program In
Reducing Patient Falls: A Retrospective Study. JOCEPS: The Journal of Chi Eta Phi
Sorority, 57(1).

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