Nursing Management of Patient with Witnessed Fall: A Case Study

This report discusses the nursing management of an 85-year-old patient with a witnessed fall. It includes deviation from normal findings, additional information required by the nurse, pathophysiological issues, nursing diagnosis, pharmacokinetics of prescribed medication, nursing management of prescribed medication, patient education, and long-term and short-term effects of medicine.

Assessment

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Deviation from normal finding...............................................................................................1
Additional information that required by nurse.......................................................................2
Pathophysiological issue........................................................................................................2
Two nursing diagnosis that need intervention and nursing management...............................3
Pharmacokinetic of prescribed medication in ED..................................................................3
Nursing management of prescribed medication in ED...........................................................5
Patient education and long term and short effect of medicine...............................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Nursing management is defined as the performance which consist of quality that is about
leadership in order to manage the function of governance and make proper decision within
workplace to resolve the issue of nurses as well as patient. It suggests the best way to improve
the patient outcome with the help of proper support and care. It includes process that is common
to all management such as planning, organising and staffing, directing and controlling (Chang
and et. al., 2018). As per this, it is also analysing that the nursing management manage the
condition of patient by providing proper education and care to the patient with may be related
with term of medicine or whether self-management that improve their health as soon as possible.
In this report, discussion is based on patient named Mrs. Shopie Joseph which is 85 years old
women was admitted to ED at 1800 with the history of witnessed fall. There vitals sign such as
157/77mmHg show the indication of hypertension whereas heart beat is 128 beat per minute
which higher than normal beat per minute which is evaluated as 72 to 80 beat per minute.
Although, the investigated are used to made which is based on abnormal activity as per test and
screening where proper diagnosis and management is used for the improvement within Sophie.
The nursing agenda is well used which may develop education such as drug interaction effect of
medication which is used (Cornwell, Wilhelm, and Leary, 2019).
MAIN BODY
Deviation from normal finding
As per the case study, it is well analysing uncertain fall has been happening with Shopie
that admitted in emergency ward. She was found on the floor by her son. The condition is critical
because Shopie is unable to walk and due to fall that affect the walking. It is well noted she had
multiple burnishing over her left arm and show the proper laceration that is noted on left lower
arm. There is some condition which show the deviation from the normal range which may
accelerate the chronic condition of patient. In addition to this, the medication is used in order to
prevent the condition that affect the function and prolonging condition of illness. The abnormal
things which is well noticed within case study that is blood pressure which is 157/77 mmHg
which is showing situation of hypertension where the blood pressure is higher. Whereas, it is also
evaluated that the heart rate of Shopie is higher that affect physiological function of body.
Therefore, respiration rate is also enhancing from 16 per minute to 28 per minute. Overall the
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situation is arising due to condition of hypertension that tend to change the overall function of
body (Dengler and et. al., 2020).
In addition, the slight investigation is used to taken which is associated with the artery and
vein of location where laceration is take place to ensure the condition of vein of left arm. X ray is
also used to in order to diagnose the bone which is generally fracture due to fall that is uncertain
and unidentified. It is also recommended that there is various factor which may render condition
of health of Sophie. Therefore, deviation which is evaluated with respect to case study is well
acknowledge hypertension, enhanced heart rate and other that is abnormal and affect health of
individual (Khan, Ekeoduru, and Tariq, 2018).
Additional information that required by nurse
In such cases, the initial additional information that nurse ask for that the height or ways
Shopie fall, and after that the site of pain and what other complication she must observed. In
addition, the nurses known the site of injury and pain. As according to proper, nursing diagnosis
and management they used to manage the condition that affected the comfort of Shopie. The site
of pain is essential to regulate pain management without it, it act as barrier for treatment and in
order to prescribe suitable medication. In this case study, the initial medication is prescribed as
per examination of body and injury majorly laceration and after this nurses require to known
about the incident and site that is predominantly affected. These question are well essential as a
nurse to show the proper concern regards with the Shopie and their situation which affect their
health. It is important for nurses ask such question which is related with and minimise the risks
of consequence that enhance chronic state of patient (Lambert and Goldman, 2018).
Pathophysiological issue
The Pathophysiological issue which is analyse within the case study is usually uncertain fall and
injury that create pain. Therefore, in depth study of injury or laceration in term of
pathophysiology of acute illness and injury well recognise the three main effector, infection,
trauma and ischemia reperfusion injury. Each of them is act initially by itself or showing the
combination with each other in order to develop the inflammatory reaction syndrome that is well
generalised in the morbid events. The laceration show deep injury skin are usually tear and due
to this sometime vine or artery is damaged that affect the overall function of blood vessels.
Shopie require bandage and instant support to cover the area of site of injury to avoid excessive
bleeding (Lambert and Goldman, 2018).
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Two nursing diagnosis that need intervention and nursing management
In the given scenario, Mrs. Sophie Joseph, who was fallen on the floor not able to stand up and
found severe pain. Her left appeared to be internally rotated and shortened. Therefore, two
nursing diagnosis which is essential to diagnose and required instant interventions to Mrs. Sophie
Joseph include a complete CT scan of her head and x-ray of her body parts as left hip and leg
which are unable to move. After the scanning the injury, health worker should have to analyse
the history of fall, mental states of patients, mental status changes, asses some age related
physical changes, evaluate the balance and gait of patient (Dolatowski, and et. al., 2019).
Evaluate the use of mobility assistive devices, some age related disease and prior medication of
patient and surrounding environment after the assessment health worker should provide
appropriate nursing intervention for Mrs. Sophie, which are following. Since Mrs. Sophie have
too much injuries and severe pain due to fall therefore an instant response should be take to
reduce severity and pain of Mrs. Sophie. For prevention some of the instant intervention should
be taken such as:
 Enhanced support aiming to specific high risk times.
 Pain management
 specific behaviour management
 Enhanced monitoring by utilising sensor alarms and devices.
Nursing management which are essential for the Mrs. Sophie consist:
 Care assistance for her fracture and pain (Haider, and et. al., 2020).
 Administration of medications
 Post-partum support to her left hip movement.
 Monitoring of recovery progress.
 Provide some feeding assistance.
Pharmacokinetic of prescribed medication in ED
BUPIVACAINE:
Pharmacokinetics: rate of systemic absorption is depending on the concentration of drug
administration, vascularity of administration site, presence and absence of adrenaline in the
solution and the route of administration.
 Onset action: 1 to 17 minutes (Jain, and et. al., 2019).
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 Periods of action 2-9 hours
 T1/2 : in neonates, 8.1 hours and in adults it is 2.7 hours.
 Time to peak concentration: 30 to 45 min.
 metabolism: hepatic
 protein binding: approximately 95%
 Excretion: renal 6% without change.
Indication: Bupivacaine is used as local anaesthesia.
FENTANYL
Pharmacokinetics: Fentanyl is taken through the buccal cavity that is oral administration. Used
in a combination with bupivacaine, act as opioid. Absorbed through the buccal cavity and the
absolute bioavailability of fentanyl is 71% when administration through buccal cavity and it is
only 35% when taken through oral route. Half-life of oral fentanyl is about 7 hours.
Indication: It act as strongest pain killer as it is an opioid category medication.
PANADOL
Pharmacokinetics: Panadol is readily absorbed through the GI tract with highest concentration
in plasma occurring approximately 10 to 60 minutes after administration through oral cavity.
Panadol is distributed into approximately whole body tissue. Negligible plasma protein binding
occurs at normal dose of therapeutic but it enhances with enhancing the doses. Half-life varies
about 1- 3 hrs. metabolised in liver and excreted through hepatic urine majorly as inactive
sulphates and glucuronide conjugates.
Indication: Panadol tablet is used as an antipyretic and analgesic drug which used to temporarily
relieve from mild or moderate fever or pain.
DICLOFENAC
Pharmacokinetics: Diclophinac PO, administered through oral route, and it principally
eliminated through metabolism. About 60 to 70 percent of the total doses of diclofenac is
eliminated through urine and 30 per cent is eliminated through faeces. Half-life is approximately
2 hours.
Indication: It is indicated to use in the treatment of inflammation and pain.
MORPHINE
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Pharmacokinetics: Morphine IV is administrated through intravenous route. Bioavailability is
100%. Morphine is generally 90 percent metabolised through glucuronide conjugation by
UGT2B7 and sulphonation at 3 & 6 position. In 48 hours approximately 70 to 80 % of the
morphine is excreted.
Indication: Morphine is indicated to the use for primarily pain and also used as a combined
analgesic with sedative effects.
Nursing management of prescribed medication in ED
Diseases Nursing
management
Adverse effects contradiction Side effects
Bupivacaine Bupivacaine is
use as local
anaesthesia. It can
cause toxicity
therefore dose
should be
optimum.
It can cause
hypotension in
Mrs. Sophia. Can
block the nerve
because she is
very old age.
Slow heartbeat. Nerve blockage,
bloating and
swelling.
Fentanyl These drug use as
opioid, necessary
to take care of
Mrs. Sophia
because she is
suffering from
fever.
Long term use
may cause
fractures in
elderly (Kojima,
and et. al., 2019).
Mrs. Sophie is at
higher risk for
ADEs
Depression.
Panadol Used for the
treatment of fever
and pain. Should
be taken in empty
stomach.
Can cause
dyspepsia in Mrs.
Sophia.
Severe hepatic
impairment, or
severe hepatic
illness.
Liver and kidney
damage.
Diclofenac Use as analgesic.
It may cause high
Increase the risk Since Mrs.
Sophia is 85 years
Hypertension,
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risk of CV events
in Mrs. Sophia
case.
of GI bleeding. old. Therefore,
she may have
some kidney or
stomach related
problem which is
contradicted to
this drugs.
swelling and pain.
Morphine Used as local
anaesthesia.
Monitor Mrs.
Sophia
respiratory rate
before
administration.
Can cause
respiratory
depression in
Mrs. Sophia.
Contradicted with
other opioid
analgesic.
Slow breathing
rate.
Patient education and long term and short effect of medicine
As per the given scenario, Mrs. Sophie Joseph is an 85 years old lady, who fallen at her home
and she is unable to move his left hip and legs. Therefore, after treatment some information
which doctor should provide her are as following:
 Mrs. Sophie general health status.
 Her diagnosis, co-morbidities, prognosis (Munoz, and et. al., 2020).
 Her health beliefs, preferences and goals.
 Effectiveness of treatment option, medications, and their risks and side effects.
After the completion of acute treatment of Mrs. Sophia, by the following way doctor can provide
the appropriate information about drug interaction:
 By the effective communication about medication with Mrs. Sophia.
 Provide a medication list.
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 Doctors can provide a brief detail about the prescribed medication through a leaflet
(Segal, and et. al., 2018).
CONCLUSION
As per above discussion, it is well analysed that case study is focus in individual who is
facing the issue of risk of fall where appropriate support and care is required that is fulfilled by
nurses as well healthcare practitioner. In addition, the nurses used to focus on proper diagnosis
and intervention that is help to manage condition and situation. In this, the nursing management
is requiring to focus on the case and provide level of comfort by implementing proper medication
line and diagnosis that reduce the risk of consequence.
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REFERENCES
Books and Journals
Chang and et. al., 2018. Fight Bite with Tendon Laceration. Journal of Education and Teaching
in Emergency Medicine, 3(3).
Cornwell, J.N., Wilhelm, D.J. and Leary, P.F., 2019. A case of traumatic splenic laceration in a
Division II football player: advisable versus safe return to play considerations. Current
sports medicine reports, 18(3), pp.72-75.
Dengler and et. al., 2020. A randomized controlled trial of liposomal bupivacaine for pain
following obstetrical laceration. American Journal of Obstetrics & Gynecology
MFM, 2(3), p.100115.
Dolatowski, F.C., Frihagen, F., Bartels, S., Opland, V., Benth, J.Š., Talsnes, O., Hoelsbrekken,
S.E. and Utvåg, S.E., 2019. Screw fixation versus hemiarthroplasty for nondisplaced
femoral neck fractures in elderly patients: a multicenter randomized controlled
trial. JBJS, 101(2), pp.136-144.
Haider, A.H., Herrera-Escobar, J.P., Al Rafai, S.S., Harlow, A.F., Apoj, M., Nehra, D.,
Kasotakis, G., Brasel, K., Kaafarani, H.M., Velmahos, G. and Salim, A., 2020. Factors
associated with long-term outcomes after injury: results of the functional outcomes and
recovery after trauma emergencies (FORTE) multicenter cohort study. Annals of
surgery, 271(6), pp.1165-1173.
Jain, N.P., Mannan, S.S., Dharmarajan, R. and Rangan, A., 2019. Tuberosity healing after
reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—
does it improve outcomes? A systematic review and meta-analysis. Journal of Shoulder
and Elbow Surgery, 28(3), pp.e78-e91.
Khan, S.A., Ekeoduru, R.A. and Tariq, S., 2018. Traumatic tracheobronchial laceration causing
complete tracheal resection: challenges of anesthetic management. A&A Practice, 11(4),
pp.109-111.
Kojima, M., Endo, A., Shiraishi, A. and Otomo, Y., 2019. Age-related characteristics and
outcomes for patients with severe trauma: Analysis of Japan’s nationwide trauma
registry. Annals of emergency medicine, 73(3), pp.281-290.
Lambert, C. and Goldman, R.D., 2018. Pain management for children needing laceration
repair. Canadian family physician, 64(12), pp.900-902.
Munoz, N., Posthauer, M.E., Cereda, E., Schols, J.M. and Haesler, E., 2020. The role of nutrition
for pressure injury prevention and healing: the 2019 international clinical practice
guideline recommendations. Advances in skin & wound care, 33(3), pp.123-136.
Segal, D.N., Wilson, J.M., Staley, C. and Michael, K.W., 2018. The 5-item modified frailty
index is predictive of 30-day postoperative complications in patients undergoing
kyphoplasty vertebral augmentation. World Neurosurgery, 116, pp.e225-e231.
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