NURSING INTERVENTIONS A CASE STUDY

Running head: NURSING INTERVENTIONS: A CASE STUDY
Nursing interventions: A case study
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NURSING INTERVENTIONS: A CASE STUDY1
Olive’s medical history
Syncope: Paramedics suspect syncope as the cause of Olive’s fall as she cannot
remember the reason. Syncope, also called passing out or fainting, is a momentary
unconsciousness due to inadequate blood flow to the brain. It occurs as a result of
hypotension or decreased blood pressure and the failure of the pumping of the blood into the
brain (Jansen et al., 2015). The risk of syncopal episode increases in older people with
cardiac disorders and rhythm and contraction conditions. Physical assessment of blood
pressure, respiration rate, pulse and pain can help the nurse gather relevant information about
the event (Wold et al., 2014).
Atrial fibrillation: Olive is detected with atrial fibrillation (AF), which is the most
widespread rhythmic cardiac disorder resulting in blood clots, heart failure, strokes and other
complications of the heart. Patients with AF possess a higher risk of strokes than those
without the disease (Lip et al., 2015). It is thus suitable for Olive to continue her oral
anticoagulant medication and will be appropriate for her to undergo an anticoagulation
therapy, which is also the concern of her son. The nurse should carefully listen for arrhythmia
and examine the presence of any neurological cardiac or cranial nerve disorders.
Anticoagulants prevent the development of clots and decrease the chance of strokes.
Anticoagulants such as rivaroxaban cause ill-effects like syncope, hypotension, high risk of
bleeding and dizziness (Song et al., 2015).
Nursing interventions
Nursing interventions at the hospital, as well as home, can provide additional support
to Olive and significantly reduce her risk of another fall. The primary step includes a
comprehensive risk assessment of Olive, followed by creating a patient-centred plan for risk
management and care. The A-G assessment tool and the Glasgow coma scale are useful tools

NURSING INTERVENTIONS: A CASE STUDY2
to evaluate Olive’s conditions. The A-G assessment comprises of a series of evaluation steps
which include airway, breathing, circulation, disability, exposure, further information
(involving family and friends) and goals (Perry, Potter & Ostendorf, 2015). Besides, the
Glasgow coma scale refers to a neurological indicator to assess the patient’s level of
consciousness and can be used as a useful tool to check Olive’s consciousness (Reith et al.,
2016). Fall-related injuries can be a significant burden for the patient as well as the family
members. Olive and her son must be educated on the ill-effects of fall, such as the
incapability to return to the previous living conditions, increased supervision and care,
reduced mobility and risk of developing secondary fractures. Some of the nursing
interventions that might lower the risk of another fall include locating Olive’s bed near the
nurse’s site for close observation, keeping her bed close to the ground with bedrails, keeping
a call bell within her reach, providing hip protection equipments and pressure socks, ensuring
no wires or other trip hazards near the bed, ensuring bed-side commode facilities, providing
night light, and sensor mats on the floor at all times. The nurse also plays a role in referring
Olive to a suitable occupational therapist or physiotherapist to prevent another fall (Alves et
al., 2017). An occupational therapist can assess her home for any potential risk and suggest
appropriate measures to minimise them based on her daily living style. The therapist might
recommend a walker or walking belt and non-slip shoes during mobilisation, handrails in
some places of her home, chairs with armrests, shower chairs in bathrooms, a ring bell or
some provision to call the nurse at any time and provide means to decrease trip hazards at
home. A physiotherapist may be recommended by the nurse to help Olive restore her fitness
and enable normal movement by a stepwise exercise procedure. Apart from these
interventions, the nurse must ensure an adequate intake of water by Olive to keep her
hydrated and alleviate the risk of low blood pressure by maintaining the volume of her blood
while also keeping a check on peripheral edema.

NURSING INTERVENTIONS: A CASE STUDY3
Olive’s medications
Olive has been prescribed with rivaroxaban in addition to the already prescribed
amiodarone and thyroxine. Amiodarone treats arrhythmic heartbeat and has numerous side-
effects such as live and thyroid problems, lung toxicity, fatigue, nausea and tremors
(Elnaggar et al., 2018). Thyroxine treats hypothyroidism and other disorders of the thyroid
gland. Thus, thyroxine reduces the thyroid problems caused by amiodarone to treat Olive’s
AF.
Warfarin to rivaroxaban
Olive’s medication is changed from warfarin to rivaroxaban. Both of these medicines
act as anticoagulants and prevent the coagulation or clotting of blood. Anticoagulants reduce
the risk of strokes related to AF. Warfarin, an anticoagulant, is an antagonist of vitamin K,
which is needed for the formation of clots. It blocks the development of vitamin K-
dependent clotting factors that minimizes the chances of stroke by 60%. A disadvantage of
using warfarin is that it interacts with certain food substances such as beetroot and green
leafy vegetables, which affect the INR of the patient (Larsen & Lip, 2014). Thus, due to a
low therapeutic range of warfarin, it requires close monitoring of the patient’s international
normalized ratio (INR).
On the other hand, rivaroxaban does not require frequent monitoring of the patient’s
INR and has fewer effects when taken with other medicines and shows minimum interactions
with the food consumed. Rivaroxaban directly stops the formation of fibrin clots by
activating platelets for the degradation of fibrin to fibrinogen. It is a useful oral anticoagulant
in patients with AF to minimize the risk of stroke. Thus, rivaroxaban and some other newer
direct-acting oral anticoagulants (NOACs) such as apixaban are preferred over conventional
ones like warfarin (Halperin et al., 2014). Also, rivaroxaban displays fewer instances of