Case Study Analysis: Mrs. Grace, Nursing Knowledge 2

This case study analyzes the nursing care of Mrs. Grace, an 80-year-old patient admitted to the emergency department after a fall resulting in a femur fracture. The analysis examines her vital signs, medical history (including hypertension, atrial fibrillation, and ischemic heart disease), and the prescribed medications for pain management. The discussion focuses on the nurse's role in assessing the patient, identifying potential risks (such as falls, pressure ulcers, and stroke), and developing a comprehensive care plan. This includes interventions like position changes, occupational therapy, and medication management, emphasizing patient-centered care, effective communication, and patient education regarding medication side effects and self-management. The case study also highlights the importance of considering the patient's age and existing health conditions when administering medications and the need for ongoing monitoring and evaluation of the patient's condition.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author Note

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CASE STUDY ANALYSIS
Introduction
Nursing care is focused on the improvement of the patient’s health condition and
developing the knowledge of the patient as well. The focus of the nurse should be on the
effective management of the care of the patient and supporting the patient. Hence, the nurse
should evaluate the medical history and the medication off the patient. Moreover, the nurse
should also focused on developing effective communication skills and therapeutic relationship
with the patient for better evaluation of the condition and also providing improved support to the
patient. Moreover, it can be stated that the change in the situation can be developed by
implementing the patient centred care approach and the evidence based practice as well. Thus,
the nursing care is one of the most important aspects in the care regimen of a patient. It can also
be found that the nursing care strategies should be developed with the consideration of the
assessment of the patient and prescribed treatment of the doctor. In the following section, the
Mrs. Grace case study will be discussed with details with the consideration of the nursing care
and process of nursing and the medication management of the patient.
Discussion
Mrs. Grace is an 80 year old patient admitted to the emergency department with the
complaint of fall. It has been seen that the patient’s leg was internally rotated and shortened as
well. The vitals were tending to be deviating however, the deviation seen to be very negligible.
For example, her blood pressure is 147/77 mmHg which is normal in her age. On the other hand,
heart rate is irregular and the rate is 112 per minute which can be termed as higher than normal
as well. The respiratory rate is in normal range that is 24 breaths per minute. Her oxygen
saturation level is in good condition as well. The range is in the normal range. However, her
temperature is higher than normal range and it can be highlighted as the result of the

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inflammation occurred in the body after the fall and the pain. Her pain has not been rated with
the pain measurement scale however, as per the patient it is very high and she could not been
stand up after admission to the emergency department. Other than all these, her GCS scale was
13/15 which shows that her cognition is not in normal condition. Thus, based on the views of
Wald and Garber (2018), it can be stated that her vital signs needed to be observed and also
should be prioritised as the condition is fluctuating. Based on the case study it can be stated that
the heart rate, temperature, cognition level and the pain level are deviating and should be
considered for further investigation. In this context, it can be stated that the proper planned care
should be provided as the X-ray report showed that she is experiencing the neck of femur
condition after the fall.
Based on the data and the assessment of the patient the nurse should identify the issues of
the patient and should also ask some questions to the patient and the family members for better
understanding. The nurse should ask the patient about the pain and the feeling of the patient. The
nurse should also ask the questions about the life style of the patient and the past medical history
(Abbott et al., 2018). Other than this the nurse should also ask the family members in this case
son of the patent about the medication, her eating habit, her daily routine and her physical issues
along with the medical issues of the patient as well. Moreover, social history and the family
history of the patient should be asked to the family member for better assessment of the patient’s
condition and treatment procedures. Furthermore, it has been seen that the patient could not
remember of the fall and thus, the nurse should ask the son of the patient for better understanding
of the causes of the fall. All these questions would help the nurse to understand the situation of
the patient and also the providing the support to the patient accordingly (Koenig, Perno, &
Hamilton, 2017).

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CASE STUDY ANALYSIS
The medical history of the patient showed that she has complaint of hypertension, atrial
fibrillation and ischemic heart disease and many fall incidents. However, it has been seen that the
present situation of the fall of the patient was unwitnessed. Moreover, the patient could not
describe the causes of the fall as she has no memory of the incidents leading to the fall. However,
the past medical history of the patient can help the nurse in identify the Pathophysiology of the
fall incident. The patient has hypothyroidism which leads to the atrial fibrillation as it increases
the peripheral vascular resistance and thus the hypertension develops. Increase in the blood
pressure and lead to the situation of the ischemic stroke. The patient already affected with the
ischemic heart disease. Hence, the condition can develop mild ischemic stroke leads to lose over
the muscles of the body and neural system as well. Thus, fall incident caused. The assessment of
the medicines of the patient and the past history of multiple falls showed that this can cause of
the patient’s fall (Berry et al., 2017).
The condition of the patient and the diagnosis of the issues showed that the intervention
plan for the patient would be focused on the effective risk management for the patient. It can be
seen that the most considerable risks of the patient is fall risk, pressure ulcer development as the
patient is immobile and also the issues of the ischemic stroke development as well. Hence, the
nurse should develop the diet chart and communicate with the patient for identifying the changes
in the patient’s condition. Moreover, as per Opsahl et al. (2017), frequent changing of position of
the patient should be considered for the reduction of the risk of the pressure ulcer development of
the patient. Furthermore, the occupational therapy to the patient can be provided for the
betterment of the cardiovascular issues as well as the effective management of the pain of the
patient as pain is one of the most important factors of the patient. Moreover, proper planned
observation and the medication management of the patient should be considered as well. Hence,

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the interventions of the nursing care would be focused on position changing of the patient along
with dietary management for stroke and pressure ulcer risk reduction and pain management
through occupational therapy and medication management (de Moura Sá et al., 2017).
The emergency department prescribed medicines of the patient are focused on the pain
reduction mainly. It has been seen that the Bupivacaine + fentanyl femoral block has been
prescribed to the patient, which is focused on the blocking of neural impulse and also activating
the opioids receptors o reduce the pain. This medicine is administered through the spinal cord
injection above the hip joint (Horst et al., 2016). As the pain of the patient was severe, the
medicine has been provided for the pain sensation reduction. Panadol 1g is one of the
constituents of nonsteroidal anti-inflammatory drug. It inhibits the cyclooxygenase pathways.
Hence, it leads to the increase in the pain thresholds which can reduce the level of the pain for
the patient. Morphine 400 mg activates mu and kappa opioids receptors for the analgesia
development and reduction of the high level pain (Fenten et al., 2017). Neurofen 400 mg is also
inhibiting the cyclooxygenase pathways. Hence, it leads to the increase in the pain thresholds
which can reduce the level of the pain for the patient. The high amount of pain of the patient is
the cause of the administering these medicines (Barletta et al., 2018). The pain reduction of the
patient is the primary focus in this case.
The medications prescribed in the emergency department are focused on the pain
reduction of the patient and all are from the analgesic medicines. These medicines should be
administered with proper dosage and timings for the reduction of the pain in a particular process.
Thus, it can be stated that the wrong dosage of the medicines can lead to the death considering
the age of the patient. Thus, proper medication chart development should be considered by the
nurse for adequate administration of medicines (De Simone, Planta & Cicotto, 2018). Moreover,

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it has been seen that these medicines have different side effects including addiction development
among the patients. As per the views of de Vries et al. (2016), other than addiction, it has been
seen that the medicines if overused can develop ulcer in stomach, develop issues in the kidney. If
the medicines administration is prolonged then neural disorder can also occur among the
patients. As Mrs. Grace is an 80 year old patient it can be stated that the reduction of pain
through medication should be considered with her age. As the patient is an elderly person and
she has several cardiovascular and metabolic issues her medication management should be
prioritised and limited. In this context, it can be identified that the medications of the emergency
department should be provided with consideration of the side effects and her age. Moreover, the
consideration of the evidence based literatures and the patient centred care approach should be
implemented by the nurse for the improvement of the condition of the patient. Hence, it can be
stated that the nursing care should be provided with other interventions such as the position
change, occupational therapy and also spiritual communication for the betterment of the
condition of the patient. However, based on the views of Cavallone et al. (2020), medication
management should be considered with the proper prescribed way of the doctor or physician.
Hence, it can be stated that the improvement of the condition should not be excluded from the
treatment and this treatment should not be focused on the medication management only.
Moreover, the nurse should educate the patient regarding the side effects of the medicines for
reduction of the addiction towards these medicines.
In nursing care educating the patient is also a critical factor. In this context, it can be
stated that the change in the nature of the usage of the medicines and the proper self management
should be considered as well. Based on this factor it can be stated that the nurse should convey
the dosage and timings of the medicine administration to the patient. However, the side effects of

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the medicines and the long terms usage should be conveyed to the patient as well for reducing
the future risk. In this factor the nurse should communicate with the patient with consideration of
the effective and positive communication skills. Fors et al. (2016), highlighted that the nurse
should implement the patient centred approach to educate the patient regarding the medication
management and self efficacy development of the patient as well. The nurse can also implement
the chart based education or training to the patient for the improvement of the literacy of the
patient regarding this condition. Moreover, the therapeutic relationship development with the
patient in this context should be considered for the betterment of the situation of the patient
(Olsson, Hansson & Ekman, 2016).
Conclusion
Based on the above discussion it can be concluded that Mrs. Grace experiencing severe
pain due to the fall incident. Hence, the nursing care should be focused on the management of
the pain of the patient. Thus, the medication management and position changing are the most
prioritised contexts for this situation of the patient. Moreover, the nurse should implement the
patient centred care approach and also use the communication skills for the improvement of the
self efficacy and the knowledge of the patient. Moreover, it can be stated that the change in the
situation regarding the positive outcome of the patient should be considered with higher priority
as well. Hence, the nurse should be focused on the relationship development with the patient and
the safety of the patient as the patient is an elderly person. Moreover, the fall injury is the aspect
which needs to be prioritised by the nurse and reduce the risks of the patient along with the side
effects of the medication by proper medication administration and education providence to the
patient.

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CASE STUDY ANALYSIS
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