Nursing Care Practice; a Case Study

This case study discusses nursing care practice for a patient with osteoporosis, neck of femur fracture, wound healing, and communication difficulties. The article provides nursing care requirements and actions, subject to maintaining a safe environment, mobility, sleeping, and activities of living communication.

Running Head: NURSING CARE PRACTICE
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Nursing Care Practice; a Case Study
Student’s Name
Institutional Affiliation

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Table of Contents
Overview of pathophysiology....................................................................................................3
Osteoporosis...........................................................................................................................3
Neck of femur fracture...........................................................................................................3
Wound Healing.......................................................................................................................3
Activities of Living Communication.........................................................................................4
Nursing Care & Rationale..........................................................................................................5
Maintaining a safe environment.............................................................................................5
Mobility..................................................................................................................................5
Sleeping..................................................................................................................................6
Ms. Marley’s Nursing care requirements and actions............................................................7
References..................................................................................................................................9

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Overview of pathophysiology
Osteoporosis
This is a condition whereby the density and strength of a person’s bone decrease
thereby making the bones fragile and compressible. People suffering from this condition are
more susceptible to fractures compared to people with normal bones. Osteoporosis occurs
majorly after the age of 65 years and is very frequent in women especially after the
menopause stage (Qaseem, Forciea, McLean, & Denberg, 2017). Ms. Marley is 80 years old
and has a history of osteoporosis; this makes her vulnerable to fractures (Shiel, 2018).
Osteoporosis does not have any definite symptoms nor signs, its presence is noticed when a
person fractures his/her leg. However, it can be diagnosed and cured before a person suffers a
fracture (Cosman, et al., 2014). Patients suffering from Osteoporosis have a higher risk of
suffering from a hearing loss (Kshithi, et al., 2018). Ms. Marley is suffering from a hearing
deficit. This is probably due to the osteoporosis she is suffering from. Osteoporosis affects
women past the menopause stage and comes with the risk of a hearing loss. Ms. Marley is 80
years old and has Osteoporosis, this justifies her hearing deficit.
Neck of femur fracture
Fracture in the neck of the femur majorly affects older people who have decreased
density and strength of bones and are more prone to fractures. Ms. Marley is 80 years old
thereby faces a high risk of neck of femur structure. Neck of femur fracture occurs when the
femur breaks at the top, below the ball and socket joint. This condition is common among
patients suffering from Osteoporosis, especially women (Babu & Gaillard, 2009). Ms. Marley
suffers has a history of Osteoporosis and is very old, this makes her more vulnerable to neck
of femur fractures. Neck of femur fractures majorly occurs through falls among the older
people (Goh, Samuel, Ching Su, Chan, & Yeo, 2009). Ms. Marley tripped and fell thereby
suffering a fracture in the right neck of femur. She probably might have fallen on her hip and
the body twisted thereby fracturing her femur. Furthermore, Osteoporosis is the major reason
why Ms. Marley suffered the fractures. Her bones are fragile and weak.
Wound Healing
Ms. Marley had a surgery after she had a fall and fractured the right neck of her
femur. The surgical wound that developed after the surgery is a bit red and the nurses are
quite worried. Pain and redness is a sign of inflammation. In this phase, the damaged cells
release chemicals such as histamine, which in turn cause release of fluids into the blood
vessels thereby causing swelling of the skin (J.M. & H, 2012). In the proliferative phase, the
skin is recreated with a network of blood vessels and tissues which causes the wound to close

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(J.M. & H, 2012). The process of the damaged tissues being substituted by new tissues is
referred to as regeneration. The wound heals through a scar formation which reduces with
time as a new skin is regenerated (J.M. & H, 2012). Wound healing is a consistent medical
problem. Therefore, wounds need to be effectively managed to avoid a creating risk of an
infection (Velnar, Bailey, & Smrkolj, 2009). Surgical wound infections are common among
older people, redness in the wounds and increase in pain are signs of an infection (MaryAnne
& DePietro, 2016). Ms. Marley is 80 years old and has redness in her wound. This justifies
that Ms. Marley has a wound infection and thus the nurses are worried. The nurses should
therefore prescribe antibiotics to Ms. Marley as well as clean the wound thoroughly and
properly dress it.
Activities of Living Communication
The activities of living entail the necessary skills needed to manage the basic physical
needs, for instance, keeping a clean and safe environment, breathing, eating & drinking,
working, sleeping, communication, mobility and toileting (Mlinac & Feng, 2016). These
activities can be done by any normal person unless he/she has a medical condition. Therefore,
the person is evaluated upon admission into hospital in order to check for changes in the
activities of living. A consistent review of the patient as done as a plan of care is
implemented. Ms. Marley was admitted to the surgical ward with a broken neck of femur.
She therefore has a complication in moving around since she cannot walk freely without
support.
Assessment of Ms. Marley is difficult however, since she has a hearing deficit.
Hearing loss is a common problem among older people. Those who suffer from Osteoporosis
have a higher risk of suffering a hearing loss (Kshithi, et al., 2018). The fact that there is too
much noise in the wards makes it even very difficult for nurses to assess Ms. Marley. Even
though she has hearing aids, she does not like them the aids are irritating. The nurses should
transfer Ms. Marley to a very quiet ward first. The nurses can then assess Ms. Marley’s
ability to hear without hearing aids and with the hearing aids (Wendling, Pimple, Adams, &
Titler, 2008). Once a communication medium is established with the patient, the assessment
of other conditions starts. Ms. Marley’s hearing impairment is the major hindrance to the
independent activities of living (Boyle, Cohen, Paul, Moser, & Gordon, 2002).
The activities of living are assessed by nurses using speech. The nurses should
implement the care plan for Ms. Marley’s hearing impairment to ensure effective
communication (Larkins, Worrall, & Hickson, 2013). It is evident that Ms. Marley can barely
walk on her own considering the wound on her femur. The nurses should therefore find a way

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of moving her around, for instance, wheelchairs can be used. A nurse should be assigned to
Ms. Marley in order to assist her in her daily endeavors while at the hospital (Roper, Logan,
& Tierney, 2000). The nurse should be well informed about Ms. Marley’s hearing deficit on
order to establish a good communication medium with her. The nurse should be able to assist
Ms. Marley in her physical hygiene maintenance.
Ms. Marley requires assistance in washing, dressing and toileting. The nurse assigned
to her should be able to know when Ms. Marley needs to go to the toilet. The nurse can only
know this if she asks Ms. Marley about it. The nurse should ensure that the question is clear
to the patient so that she does not make assumptions. The nurse should have a routine plan of
Ms. Marley’s bathing, dressing and washing. There are no complications mentioned about
breathing complications in Ms. Marley’s assessment therefore she does not need assistance
for that. Ms. Marley can eat and drink on her own provided that food and drinks are availed
to her. However, the nurses should be able to know if Ms. Marley is allergic to any type of
food or drink. This is to prevent development of other medical conditions.
Nursing Care & Rationale
Maintaining a safe environment
Maintaining safe environments for patients is very important to the patients’ recovery
plan. Improving the environment’s safety helps in avoiding errors and incase of errors it helps
in finding solutions (Stone, Hughes, & Dailey, 2008). When the nurses’ working environment
is improved, the safety of patients’ environment is also enhanced. When all the necessary
resources of work are availed to nurses, patients benefit from the quality of services offered.
There is a lot of harm prevented from adversely affecting patients. Certain health
complications are avoided. This has a bearing on the financial status of patients. The risk of
spending a lot of money on health is reduced since the patient environment is safe.
The necessary information required in promoting the safety of patients; knowing the
major risks pertaining to the medical care, application of safe and approved practices and
gauging the barriers to and options for safe patient care (Oliveira, et al., 2014). Ms. Marley is
at risk of having a fall again due to her Osteoporosis. Ms. Marley’s hearing deficit could
cause a communication inaccuracy with the nurses. This could either lead to wrong medical
prescriptions. Having going through a surgical operation, Ms. Marley is at risk of getting
infections around the wound.
Mobility
This entails the ability of patients to move from either one place to another or from
one bed to another. In order to do the daily living activities, the patient should be able to

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move from one place to another. Ms. Marley needs to be in a position to move in order to go
to the toilet. The nurses ensure that Ms. Marley is able to go to the toilet. It is evident that Ms.
Marley has a right neck of femur fracture and she had a surgical operation recently. The
surgery created a wound that seems to be infected owing to the pain and redness. The wound
should be closely monitored and treated. The pain could inhibit Ms. Marley’s movement
(Johnston, Morton, Harding, & Taylor, 2013).
Ms. Marley also needs to wash and dress. Washing and dressing is a physical basic
need learnt at childhood. But owing to the fact that Ms. Marley has a fractured femur and is
very old this activity is inhibited. The nurses need to ensure that Ms. Marley is able to wash
and dress. A nurse assigned to Ms. Marley should draw out a routine plan for her washing
and dressing. When the patient washes and dresses clean clothes, the risk of an imminent
infection is reduced. Even though Ms. Marley’s wound is already infected, regular cleaning
and dressing will help treat the infection.
The hospital rooms should be designed in a way that they are able to enhance
mobility. The hospital rooms should be spacious and the walls around the hospitals should be
fitted with handrails (PT in Motion News, 2016). Handrails will greatly assist patients like
Ms. Marley who have mobility issues in moving from one place to another. It is very evident
that the nurses are less compared to the patients in hospitals. Therefore, nurses can be
available at all times to assist patients in moving from one place to another. Handrails would
be a good solution for patients recovering from fractures to practice walking on their own.
Ms. Marley’s risk of having frequent falls will be greatly reduced when handrails are fitted
(PT in Motion News, 2016).
The nursing care applied to patient’s ability to move from one place to another, is
evaluated if the patient is able to successfully move from one place to another. For instance,
Ms. Marley has a right neck of femur fracture and a surgical wound. The nurses’ care
evaluation is done considering Ms. Marley’s ability to move from one place to another
without having regular falls.
Sleeping
Ms. Marley can barely sleep while at the hospital ward. There is too much noise at the
hospital such that Ms. Marley is able to hear the noise even with her hearing problem. The
pain in the surgical wound could also be the reason why Ms. Marley can barely sleep. Sleep
is a very important constituent of a perfect health (Pilkington, 2013). Pain and noise are
disruptors of sleep among many patients. Sleep deprivation exposes patients to other
complications. Stress is one outcome of sleep deprivation (Xu, Wick, & Makary, 2015).

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Stress causes ulcer which is a chronic illness. An ulcer is health condition that is very
difficult to treat. Nurses should ensure that patients’ environment is conducive for sleep. This
reduces the risk of stress and thus the risk of suffering from ulcers.
Pain is an inhibitor of sleep (Xu, Wick, & Makary, 2015). Ms. Marley has surgical
wound that has developed an infection. This is the reason why Ms. Marley is unable to sleep.
Ms. Marley has suffered a fracture on the right neck of the femur due to a fall. The fracture
was operated on and thus a surgical wound was developed. The wound developed an
infection and has redness around it. The wound is the cause of Ms. Marley’s sleeplessness
due to the infection. Ms. Marley’s wound should be treated in order to reduce the pain and
enable her have a good sleep.
There is too much in the hospital wards where Ms. Marley has been admitted. This
noise hinders Ms. Marley from have a good sleep thereby affecting her health. The nurse
should ensure that the wards are quite silent for patients to recovery process to be very
effective. If possible, the hospitals should be designed in such a way that each patient has
his/her own ward room. This will enable Ms. Marley and other patients who are unable to
sleep due to noise have a good sleep that will aid their recovery process (Pilkington, 2013).
The noise also affects Ms. Marley’s hearing. Ms. Marley has a hearing deficit and is
very vulnerable when put in very noisy place. The best solution to Ms. Marley’s situation
would be to isolate her from the rest of the patients. The more her hearing gets worse, the
more the communication between her and the nurses is impaired. Ms. Marley does not like
hearing aids therefore her ears should be well taken care of at the hospital. This will ensure
that she can be able to effectively communicate to nurse when she has a problem with sleep.
Ms. Marley’s Nursing care requirements and actions
For safe environment maintenance, the nurses should use wheelchairs to move Ms.
Marley around. This reduces the risk of having sudden falls again. Ms. Marley’s infection
should be properly cleaned and dressed in order to reduce the risk of the wound getting
infected. The nurses should have prior knowledge about Ms. Marley’s Osteoporosis, hearing
impairment, wound infection and neck of femur fracture as they plan for her care. The major
barrier to providing a safe environment to Ms. Marley is her hearing impairment. However,
she has hearing aids that she can use when a communication with the nurses is necessary. Ms.
Marley should also be transferred to a very quiet place in order to ensure an effective
communication. Even though Ms. Marley does not like hearing aids, she can use them
occasionally when the nurses urgently need her to make some things clear.

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Ms. Marley’s condition should be regularly assessed in order to identify the necessary
changes that should be made to her environment (Samet, 2005). Ms. Marley’s surgical wound
should be keenly monitored to and treated. Ms. Marley’s wound is already painful and quite
red. It could be that it is already infected and that is why the nurses are very worried. An
appropriate diagnosis should be made and a treatment plan prescribed. The nursing care
evaluation will be made when Ms. Marley’s condition becomes better. When the wound
becomes better, the fracture is treated and the risk of Osteoporosis is reduced, the nurses will
have done their duty diligently. An evaluation of Ms. Marley’s nursing will be determined by
her condition at the time of discharge from the hospital. If her wound is properly and
completely treated and a solution to her hearing impairment is found then the nursing care is
described as perfect.

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