Nursing Assignment: Case Study Analysis of F Davis

This nursing assignment discusses the case study analysis of F Davis, a patient with severe injuries. It focuses on nursing priorities, SMART goals, and interventions for hypovolemic shock and mobility issues.

Running head: NURSING ASSIGNMENT
CASE STUDY ANALYSIS F DAVIS
Name of the student
Name of the university
Author note

1NURSING ASSIGNMENT
Introduction
According to Davis Boykins (2014), family centered or patient centred care are care
strategies that includes patient and their families as a primary stakeholder of care and then
depending on their healthcare priorities, provide healthcare interventions. Nursing priorities
are categorizing the healthcare complications of the patients so that depending on their
healthcare complications, interventions could be applied (Pelletier & Stichler, 2014). Hence,
according to Kieft et al. (2014), application of priority based nursing interventions help
nursing professionals to include person centred or family centred care as a holistic approach
of care.
Similar case would be discussed in this paper, as Mr Davis (25) has been admitted to
the healthcare facility after a severe motor injury. This paper would prioritise two problems
in the health condition of patient and then depending upon the identified problem, SMART
goals would be developed, so that effective care could be provided to the patient. Finally,
with proper justification, two nursing interventions would be developed for Davis so that his
health condition could be improved.
Two nursing priority for Davis
As mentioned in the case situation, Davis, a 25 year old boy has met an accident and
due to severe injuries in his leg and fractures in Mid shaft femur and proximal tibia, he has
been admitted to the emergency department of the healthcare facility. Upon admission, it was
seen that the patient developed low blood pressure and tachycardia, as per Gulati (2016),
which could be the result of hypovolemic shock that arise due to the severe blood loss and
fractures/injuries that occurred in his accident. Further, the patient rated his pain in the pain
scale as 7/10 and hence, the patient was provided with morphine so that his pain could be
controlled. Hence, after complete assessment of Davis’s health condition, two nursing

2NURSING ASSIGNMENT
priorities that should be selected for the healthcare of patient would be associated with his
severe fractures and associated lower blood pressure. As mentioned in the case study, after
accident, patient’s leg were stuck in between his vehicle for a long time and hence, severe
mid-shaft femur and proximal tibia fractures occurred. Further, due to this the patient
underwent severe blood loss and consequently, his blood pressure dropped. As per El Ayadi
et al. (2016), this is a severe condition as due to hypovolemic shock he has dropped his blood
pressure and due to this, his heart rate has increased abnormally to meet the oxygen
requirement of his body. Hence, tachycardia was also observed after the ECG related
diagnosis. Further, it was also noted that the pulse rate of patient has also increased and it is
noted as 105 pulse per minute and hence, proper intervention and nursing care should be
provided to the patient. The care plan that should be developed for this nursing problem
should be inclusive of healthcare interventions for his pain and blood pressure (Kogan,
Wilber& Mosqueda 2016). As mentioned in the case study, the patient was provided with
morphine and after administration of morphine, the pain score reduced to 4 from 7/10.
Therefore, the developed care plan has been demonstrated below:
Assessment: complete assessment of patient’s fracture would be conducted and with
complete observation of fracture and nearby areas, the blood loss rate would be assessed.
This would hence help the nursing professionals to understand the diagnosis method that
should be conducted for the complete assessment of patient’s condition.
Diagnosis: the nursing diagnoses that would be conducted for patient condition
assessment would be associated with MRI of the fracture area, with X-ray imaging and
scanning of the associated bones so that the degree of fracture and associated complications
could be assessed.

3NURSING ASSIGNMENT
Planning: after diagnoses, the nursing professionals would develop a care plan
including interventions for hypovolmic shock, severe blood loss and associated tachycardia.
Further, the patient would be also be provided with interventions for his low blood pressure
as McDowell and Clements (2014) mentioned it could affect his cardiac health and lead to
severe disorders.
Implementing: Implementation of care plan would only be achieved after collecting
consent from the patient or his family so that with informed care, the ethical and legal aspects
of the care process could be achieved.
Evaluating: The interventions would be evaluated after 1 week of application of
intervention so that depending upon the improvement; the applied intervention could be
modified.
The second care priority would be his inability to move and the risk of pressure ulcer.
As mentioned in the case study, Davis is unable to move on his own and with support of
nursing professionals he was moving for his pressure ulcer checking. However, in the
absence of healthcare professionals, inability of his movement, could lead to pressure ulcer
and hence this should be assessed in a frequent interval so that the severe risk could be
eliminated (Ham et al., 2014). The care plan for Davis’s mobility, activities of daily life and
the risk of pressure ulcer has been mentioned below:
Assessment: the patient should be assessed for bed sores and decubitus ulcers present
in his body every 12 hours so that the presence of pressure ulcer could be assessed. After
completion of risk assessment, the patient should be assessed with pain score so that his pain
score could be assessed.
Diagnosis: the diagnosis method should be inclusive of pain diagnosis, movement and
decubitus ulcers so that after this, the interventions could be applied.

4NURSING ASSIGNMENT
Planning: the planning of interventions should be done on the basis of patient centred
and family centred care and in both the implementation and planning of process, the patient
would be provided with support so that his risk of pressure ulcer could be avoided.
Implementation: with the help of nursing professionals and family members the
mobility related interventions would be applied on the patent so that his risk related to
pressure ulcer could be eliminated.
Evaluation: the evaluation of the intervention would be done after 2 weeks so that the
improvement in patient’s condition would be assessed.
Person centered gaol for each nursing priority
The SMART gaol for the first nursing priority would be as follows:
Specific: for his hypovolemic shock
Measurable: his blood pressure would be controlled
Attainable: with the help of nursing professionals and family members
Realistic: blood pressure would be moderately controlled
Timely: within two days
Therefore, the goal would be: to achieve a control over hypervolemia shock and low
blood pressure within two days with the help of family members and nursing professionals
involved in care.
The SMART goal for the second nursing intervention would be associated with is
mobility and risk of pressure ulcer due to limited movement and inability to move on his
own. The SMART goal would be as follows:
Specific: risk of pressure ulcer would be eliminated

5NURSING ASSIGNMENT
Measurable: rate of pain related to movement would be controlled
Attainable: the patient would be able to roll on his own
Realistic: with complete support of nurses and family members
Timely: within 1 week
The SMART goal would be: to reduce the pain associated with movement and
eliminate the risk of pressure ulcer so that with the complete support of the nurses and family
members he could roll on his own within 1 week.
Interventions and rationale
Goal 1
The first intervention that would be applied in the care process would be associated
with fluid resuscitation so that the severe hypervolemia associated condition could be
eliminated. It has been mentioned that the patient has been provided with normal saline at
100ml/hr. rate and hence, for proper control over his hypovolemic condition, blood
transfusion would be conducted. As per Cannon (2018), providing blood to patients in such
condition helps to normalise their condition within a specific time and hence, their risk of
cardiovascular disease and other severe complication is eliminated. Further, the second
intervention would be associated with his low blood pressure and hence, as per McDowell
and Clements (2014), NSAIDS would be applied so that with treating his blood pressure, his
shock due to severe accident could also be treated.
Goal 2
The first intervention for mobility issues of the patient would be associated with his
inability to move on his own and due to this inability he developed risk of pressure ulcers.
Hence the patient would be provided with a support so that with the help of the supporting

6NURSING ASSIGNMENT
staff, he could roll frequently and eliminate the risk of pressure ulcer condition (Bodavula et
al., 2015). The second intervention would be associated with his inability to move and
perform activities of daily life and hence, in this condition his family members would also be
included so that with their support the patient could be provided with privacy and dignity in
care process.
While justifying both of these goals and their associated nursing interventions, the
cues and pathophysiology of the complications should be mentioned, It was seen that the
patient developed two severe fractures in the accident and as per El Ayadi et al. (2016), in
case of severe blood/plasma loss or fluid loss, the body compensates the loss by increasing
the sympathetic tone that increase the heart rate, decreases the blood pressure as well as
peripheral vasoconstriction hence, these interventions related to blood transfusion and fluid
were provided to Davis so that he could overcome his risk of cardiac conditions. On the other
hand, the patient was provided with effective interventions related to pressure ulcer as per
Bodavula et al. (2015), after accident the microcirculatory occlusion is causes by the resultant
pressure and consequently, v occurs and hence, the interventions related to pressure ulcer was
applied in the care process (Abdoli Tafti, Sajadi& Rafiei, 2015).
Conclusion
This paper discussed about the case study of Davis who met an accident while riding
his motor vehicle and after the accident developed two severe fractures. This paper discussed
about the patient and family centered care that has been provided to the patient with
developing two nursing priorities. Further, in the paper, SMART goals has also been
developed each of the nursing priority and then with rationale, two nursing interventions has
been provided to each nursing goals so that the health condition of patent could be improved.

7NURSING ASSIGNMENT
References
Abdoli Tafti, A., Sajadi, S., & Rafiei, H. (2015). Pressure ulcer stage IV caused by cervical
collar in patients with multiple trauma in intensive care unit. International wound
journal, 12(5), 606-607.
Bodavula, P., Liang, S. Y., Wu, J., VanTassell, P., & Marschall, J. (2015, August). Pressure
ulcer-related pelvic osteomyelitis: a neglected disease?. In Open forum infectious
diseases (Vol. 2, No. 3, p. ofv112). Oxford University Press.
Cannon, J. W. (2018). Hemorrhagic shock. New England Journal of Medicine, 378(4), 370-
379.
Davis Boykins, A. (2014). Core communication competencies in patient-centered care. ABNF
Journal, 25(2).
El Ayadi, A. M., Nathan, H. L., Seed, P. T., Butrick, E. A., Hezelgrave, N. L., Shennan, A.
H., & Miller, S. (2016). Vital sign prediction of adverse maternal outcomes in women
with hypovolemic shock: the role of shock index. PLoS One, 11(2), e0148729.
Gulati, A. (2016). Vascular endothelium and hypovolemic shock. Current vascular
pharmacology, 14(2), 187-195.
Ham, W., Schoonhoven, L., Schuurmans, M. J., & Leenen, L. P. (2014). Pressure ulcers from
spinal immobilization in trauma patients: a systematic review. Journal of Trauma and
Acute Care Surgery, 76(4), 1131-1141.
Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and
their work environment affect patient experiences of the quality of care: a qualitative
study. BMC health services research, 14(1), 249.

8NURSING ASSIGNMENT
Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person‐centered care for older adults with
chronic conditions and functional impairment: A systematic literature review. Journal
of the American Geriatrics Society, 64(1), e1-e7.
McDowell, K., & Clements, J. N. (2014). How can NSAIDs harm cardiovascular and renal
function?. Journal of the American Academy of PAs, 27(4), 12-15.
Pelletier, L. R., & Stichler, J. F. (2014). Patient-centered care and engagement: nurse leaders’
imperative for health reform. Journal of Nursing Administration, 44(9), 473-480.