Nursing Care Plan: Lina Case Study, Clinical Reasoning Cycle Analysis

This case study presents a nursing care plan for Lina, a patient with a compression fracture of L2 and osteoporosis. The plan outlines SMART goals focused on increased mobility, pain relief, fall prevention, and functional independence, with specified timeframes and assessment tools. Nursing interventions address fracture management, pain control, and fall risk reduction. The evaluation section details the use of functional assessments, fracture assessments, and pain scales to measure patient progress. The reflection section highlights the challenges in communicating with the patient initially and the shift to a talk therapy approach. The care plan integrates the clinical reasoning cycle steps and includes references to support the interventions and assessments. This is a detailed analysis of a nursing care plan, providing insights into patient management and clinical decision-making in a healthcare setting.

Nursing Care Plan
Lina Case Study

Clinical Reasoning Cycle step 5
Based on the patient situation and the nursing diagnosis – the following
SMART Goals are established :-
• GOAL 1 – Achieving increased mobility. [from immobilization to mobilization to ambulatory phase]. Time – 4-5 weeks
• GOAL 2 - Pain relief– Line has low pain and bone pain due to L2 fracture). Goal is to be achieved in 1- 2weeks. Assessment
– Numerical Pain Rating Scale [NPRS], VAS [Visual Analogous Scale].
• GOAL 3 – Fall prevention – Goal is to be achieved within 1-2 weeks. The Measurement/evaluation - Fall Risk Assessment
Tool.
• GOAL 4 : Functional Independence – Lina has self care deficits, cognitive deficits and functional restriction. For
measurement and evaluation - Functional Independence Measurement (FIM) tool. Time – 3- 5 weeks.
Picture link -
https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAzMjYEKIvEocDQnTr8BDuBoQEh_Q
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Clinical Reasoning Cycle step 6
NURSING INTERVENTIONS to manage COMPRESSION FRACTURE L2 with OSTEOPOROSIS:
Objective Intervention Clinical rationale Expected clinical
outcome
1. Maintaining immobilization,
preventing contractures and
maintaining muscle strength
(around hip and limbs)
[in immobilization phase] (Holla et
al., 2017).
Aiding the subject with slings and
braces
• The braces and slings will aid in
immobilization and faster healing of
fracture (Baumgarten et al., 2018).
Improved stabilization of the joints
and healing of the fracture.
2. Developing functional mobility
[in mobilization phase]
ADL and mobility training • Promoting mobility and ADL in
the patient with help in
improvement of functional
independence (de Souto Barreto
et al., 2017).
Improved mobility and bone
growth.
3. Pain management (in the fracture
and surrounding area)
Administering the prescribed pain
reliever medication at proper times
of the day.
• Low back pain ( of muscular origin)
and bone pain ( due to fracture) can be
treated by administering the analgesics.
Reduced pain.
4. Preventing falls and re-
traumatization
Observation and supervision of
patient environment
• Monitoring and assessing for risks in
the patient environment will prevent
falls ( in the ambulatory phase) Improved functional walking.
5. Maintaining the nutrition status
of the patient
Fat and cholesterol free diet must
be given. Providing a diet rich in
vitamin, minerals, carbohydrates is
crucial to faster healing of the
patient.
Reduced cholesterol and fat in the
diet will improve high blood
pressure.
Better nutrition will promote bone
growth and treat osteoporosis.
Improved nutritional status of bone
and body.
.

Clinical reasoning cycle step 7
Nursing evaluation
For nursing evaluation, in the case of Lina, there are certain evaluations that are required to be
taken for the chosen health issue - COMPRESSION FRACTURE L2 with OSTEOPOROSIS.
The evaluations are as follows –
• Functional assessments –
 As the patient in the case study has mobility and ADL restriction. Hence, after the mobility training and
ADL training intervention, the functional status of the patient pertaining to ADL and IADL skills has to be
undertaken (Brent et al., 2018).
 FIM scale will be used (Mlinac & Feng, 2016).
• Fracture assessment –
 the nature, structure and size of the fracture has to be analysed and the factors pertaining to
healing of fractures has to be identified and evaluated as well (Anita et al., 2018).
 One of the important aspects of fracture assessment is pain assessment.
• Pain assessment –
 NPRS (Numerical Pain Rating Scale)
 VAS ( Visual Analogue Scale) can be used.

Clinical reasoning cycle step 8
• Nursing reflection
In the beginning, when Lina was admitted in the hospital, she was very confused and disturbed and it was
difficult to communicate with her, as nurse. Instead I communicated with her niece who bought her to the
hospital. In spite of my attempts of developing an effective communication with Lina one the first two days – it
did not work out. She was afraid, emotional and very guarded. I realised the trauma of falls in addition to
feelings of loneliness (which has been caused by her social isolation) has resulted in her present clinical
condition. When, assessed, she was diagnosed with a L2 decompression fracture along with osteoporosis. I
developed the nursing care plan with the help of my senior nurse and begun the nursing interventions of
fracture, pain, blood pressure and fall risk management. As Lina was very nervous and anxious all the time, I
changed my nursing communication approach with the patient to a talk therapy.
Picture link - http://intro7721.blogspot.com/2019/

References
Anita, D. A., RA, G. N. R., Ika, E. K., & Ratri, I. (2018). Factors Related to Decubitus in Patient with Bed
Rest and Physical Immobilization: A Systematic Review.
Baumgarten, K. M., Osborn, R., Schweinle III, W. E., & Zens, M. J. (2018). The position of sling
immobilization influences the outcomes of anatomic total shoulder arthroplasty: a randomized, single-blind,
prospective study. Journal of shoulder and elbow surgery, 27(12), 2120-2128.
Berry, S. D., Rothbaum, R. R., Kiel, D. P., Lee, Y., & Mitchell, S. L. (2018). Association of clinical
outcomes with surgical repair of hip fracture vs nonsurgical management in nursing home residents with
advanced dementia. JAMA internal medicine, 178(6), 774-780.
Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018). Nursing care
of fragility fracture patients. Injury, 49(8), 1409-1412.
Holla, M., Driessen, M., Eggen, T. G., Daanen, R. A., Hosman, A. J., Verdonschot, N., & Hannink, G.
(2017). A New Craniothoracic Mattress for Immobilization of the Cervical Spine in Critical Care Patients.
Journal of Trauma Nursing, 24(4), 261-269.
Mlinac, M. E., & Feng, M. C. (2016). Assessment of activities of daily living, self-care, and independence.
Archives of Clinical Neuropsychology, 31(6), 506-516.
Ratanasiripong, P., Park, J. F., Ratanasiripong, N., & Kathalae, D. (2015). Stress and anxiety management in
nursing students: Biofeedback and mindfulness meditation. Journal of Nursing Education, 54(9), 520-524.