Critical Thinking in Nursing: Case Study of Patient Audrey Smith

This case study presents a comprehensive analysis of the nursing care provided to Mrs. Audrey Smith, a 75-year-old patient admitted with a fractured femur. The assignment delves into critical thinking skills essential for nurses, emphasizing patient safety, comfort, and the management of psychosocial needs. It explores the importance of effective communication, flexibility, and continuous learning in providing optimal care. The study examines various nursing interventions, including medication management (digoxin, warfarin, etc.), nutritional support, and pre- and post-operative care for arthroplasty. The analysis also addresses the patient's concerns about her dog and her overall well-being. The study highlights the nurse's role in assessing pain, providing emotional support, and coordinating comprehensive care to minimize adverse outcomes and improve patient health status.

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Critical Thinking case study

Case Study Essay
Introduction
The case study involves a 75 year old Mrs Audrey Smith, admitted at the emergency
unit awaiting treatment with diagnosis upon admission being fractured left neck of femur.
Her physical observation like the eye sight and sense of touch are functioning well and has
effective breathing patterns. Upon diagnosis, she has been put on medication and is admitted
in the ward. However, as she is being diagnosed she keeps on remembering her dog puppy at
home. She is worried about who will care for him since she is in hospital. At the hospital, she
has been managed and being given drug administration and is recuperating the ward.
Body
Nurses play critical role in ensuring that patients receives the needed care and
treatment. Ensuring that you get a grasp of valuable skills is essential. As a nurse there is
need for effective communication, being flexible, desire to learn, paying attention and lastly
developing critical skills, (Grumbach & Bdenheimer, 2004).
In practising critical thinking skills for patient Audrey, as a nurse there is need for
ensure that successful interventions are adopted. As a care nurse, patient safety is of outmost
priority. For patient Audrey, the critical role as a nurse is to ensure that there are no further
injuries, infections and minimizing patient pain, (Conley, 2015).
In ensuring patient safety, there is need for me to ensure practices that reduces adverse
effects related to diagnosis and conditions are minimised. This will be ensured through
appropriate usage of the prophylaxis to prevent venous thrombo embolism in the leg region,
usage of preoperative beta blockers which prevent morbidity and mortality. Ensuring there is
appropriate use of sterile barriers during the catheters placements, using the right antibiotic
prophylaxis to prevent further infection and ensuring the usage of pressure relieving bedding
materials which minimises pressure ulcers.
Nursing role on patient safety and comfort is critical to nursing care approach. For
patient Audrey, I will focus on ensuring she gets the needed comfort in the ward, as it is the
cornerstone of quality health care. Much of the nursing practice is to ensure patient safety
practices and prevent harm that focus negative outcomes for the patient, (Carayon et al 2014).
As a nurse , critical surveillance and coordination of comfort care is essential in reducing
adverse outcomes. thus need for evaluating the impact of nursing care on positive quality
outcomes and appropriate self care for improved health status of the patient, (Shekelle et al.,
2013).
Ensuring adequate nutrition for the patient is critical. Appropriate provision of good
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and proper nutrition for the patient with key emphasis on early enteral nutrition is essential
for surgically ill patients, so as to prevent complications. The current state of the patient it
regard to hypertension and osteoporosis is critical in ensuring faster recovery process. Hence
nutrition priority food need to be geared towards nutrient rich foods and adequate supply of
vitamin D and calcium rich food to boost the bone strength and improve the frail bones,
(Wakabayashi & Sakuma, 2014).
Patient Audrey activity levels have shown that the patient is physically active. However
nursing interventions is to prioritize for the patient is to ensure, that nursing intervention and
physical therapy education on the patient to demonstrate post operation exercise to increase
mobilization ability. The need for increased wearing of stocking by the patient and SCD
device is to decrease DVT development. A critical aspect for patient Audrey is to be taught
on how to change positions to relieve pressure with little pain possible. There is need to
educate the patient on how to use trapeze bar when transferring in the bed, (Banaszkiewiz,
2014).
On tackling the psychosocial needs of the patient , there is need to address and
encourage the patient to express concerns back at home regarding care and explore any
possible solutions which the patient might be experiencing. The patient may have special
problems that need to be identified so that solutions are identified. This will improve the
patient on his or her ability to be relaxed and develop strategies to deal with identified
problems, (Kunutsor et al 2017).
Key nursing interventions in assessing the pain is to ensure that the patient is
encouraged to discuss the possible outcomes of the fractured leg. As a nurse it is key to instil
the patient with verbalization so as to deal with the problems of thoughts and feelings. In this
way, coping mechanisms can be discussed by the patient and sharing concerns of burden,
(Moore et al, 2017).
Thus as nurse there is need for critical surveillance for the patient and coordinate
appropriate care so as to reduce impact of nursing care and minimise adverse impacts.
Drugs medical history
Drug medication for the patient is to ensure that drugs are used to modify the pain. As a
nurse, the prescribed analgesics are paramount. Thus encouraging the patient to use is key
towards pain management. Analgesics reduce the pain, relax the muscles and decrease the
discomfort. Assessment of effectiveness of the drugs is essential for future diagnosis and
adverse reactions are necessary for corrective measures to the patient.
Digoxin drug treatment on the list for the patient is used to treat heart failure. This drug
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is essential for atrial fibrillation. It is a rhythm disorder of the atria. Hence when applying
care for the patient it is important to note the patient allergic process and other aspects which
might affect and strain the normal regular heart beat.
Warfarin drug prescribed to the patient is essential for treatment of anticoagulation. It is
essential in treat and prevent blood clots in the veins and arteries. This aimed at reducing the
risks of stroke and heart attack. This drug is in line with the Digoxin drug. However in
management of this drug to older persons above the age of 65 years is crucial. Hence the
nursing intervention appropriate is to ensure wound healing for the patient is cared for to
minimise bleeding effects, (Ruff et al 2014).
Coversyl drug is referred to as perindopril and it falls under angiotensin drugs and is
used to treat high blood pressure and helps to control blood pressure and is used to control
blood vessels. It is used to treat congestive heart failure and is used with other diuretics. Thus
nursing care will be geared towards ensuring that blood pressure for patient Audrey is
managed to the controllable levels, (Ega & Vadde, 2015).
Vitamin D medication is an indicative of osteoporosis in old age. The patient status and
the level of decline of the calcium levels and the fracture she is currently nursing is key
towards getting Vitamin D supplementation. Thus nursing interventions based on this
supplement is to ensure that the patient gets the right nutrition management and gets adequate
nutrients in the food which are able to supplement the supplement drugs getting.
Metformin drug being taken by the patient is meant to cortol blood sugar levesl and
control diabetes. Metformin is used to improve blood sugar levels. Hence this is celar that the
patient is diabetic. This is essential in planning care for the patient. In ensuring that
appropriate nutrition care is planned for control of diabetes, (Adam et al., 2015).
Esompremozoel is used to ensure that treatment of gastro oesophageal reflux disease is
managed. Hence from this medication it is evident that the patient is having problems with
stomach upsets, this will have an impact on the medication management and nutrition care
interventions, (Becker et al., 2015).
Effects or management drug has been utilized for the patient to improve the appetite
taste for the patient and also to ensure that the patient is relieved through abnormal anxiety
and to improve changes in appetite. Thus in caring for the patient there is need to ensure that
the appropriate food intake are given to the patient. Hence nutritional care interventions will
be introducing small amounts of food and increasing them progressively as the patient
appetites improves.
Caltarte medication supplement to patient Audrey is meant to improve calcium
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supporting collagens and ensuring the patient receives adequate strength in the bones and has
the most vitamin D to help maximize calcium and support stronger and healthier bones,
(Hanson, 2016).
Mylanta medication is meant to ensure that the patient heart burns are relieved and also
management of acid indigestion and to relive symptoms of gas bloating and to facilitate faster
healing process. Hence this affects the nursing intervention through provision of appropriate
foods and drugs which are meant to reduce heart burn development for the patient, (Kraft et
al 2014).
Drugs prescription for patient Audrey
IVT drug management for the patient is crucial in ensuring ophthalmological care is
achieved. The IVT injection is meant to ensure that the patient eye sight is maintained and is
geared towards removal of cataracts and reduce inflammation for the eyes, (Peyshaert et al.,
2017).
The nursing implications of this drug is to ensure that the drugs are injected
appropriately and carefully to the patient. This drug is essential for the patient as she is
currently receiving anti-angiogenic drugs. The treatment involves injection in the eye so as to
ensure blood vessels that cause blood vessels to grow and leak under the retina are managed
effectively.
The drugs administration to the patient is meant to ensure that the patient dont develop
macular oedema, as the patient is already diabetic based on the drug medication history.
Nursing actions towards surgery process for the patient
Arthroplasty is a surgical procedure which restores the joint function. Patient Audrey is
scheduled to undergo the resurfacing of bones. This treatment management has been
preferred for the patient since the normal medical treatments are no longer effective and also
regarding his age status.
Nursing precautions to undertake for the patient are bleeding control, managing
infection, controlling blood clots and ensuring that the prosthetic parts are loosened. The
nerves area in the foot may be injured, which can result in numbness. Thus critical medical
intervention is needed to manage the patient effectively, (Cox et al., 2016).
Nursing actions in preparing the patient involves in explaining to the patient the whole
procedure and offering the patient to ask questions and seek clarification about the whole
procedure. Further as part of medical preview of the patient, i w ill take the medical history
and filling physical exam to ensure that the patient is in good health before undergoing the
whole procedure. This will involve blood tests and other diagnostic tests. I will further
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elaborate and discuss with the patient on any other allergic conditions which she might be
experiencing, (Olsson et al., 2014).
As part of pre surgical procedure, i will ask the patient to fast for eight hours before the
procedure. If need be i will provide sedative medicine to the patient before the procedure so
as to relax the patient.
Further after the patient has gone to operating procedure, there is need to prepare the
patient beds, this can be facilitated using Balkan frame with trapeze on the bed frame. This is
meant to allow the patient to move after operation. Then rigorously make the bed using a
comfort device and ensure clean lines to minimise infections. And then finally preventing and
elimination additional movement of the patient on her bed on her post anaesthesia bed care
unit through preparing the bed and transporting it to the operating room, (Auyong et al.,
2015).
Thus the nursing preoperative Assesment procedure is defining patients’ vulnerabilities
and risk factors associated with poor surgical outcomes. Hence the patient vulnerabilities
need to be assessed and managed so as to ensure critical care for the patient.
Immediate nursing interventions
The immediate nursing interventions are to take the patient to recovery room for
observation purposes. And then the vitals needs to be taken and measured each and every
time, this include pressure, pulse and breathing are stable and alert. Arthroplasty surgery
needs critical care process, (Schroeder et al 2016).
Nursing interventions and goals are to maintain bed rest for the patient in the affected
region using sling and ensuring proper positioning of the affected leg for the patient. Further
as a nurse the assistance for ensuring that the patient shift positions after every 2 hours while
the patient is on bed rest, (Zhu et al 2017).
Further it is important to take moving the new joint after surgery. Thus coordinating for
physical; therapists for the patient is critical in ensuring that the patient receives the needed
care and ensure that rehabilitation program for the patient is ensured. This will ensure that the
pain is controlled for the [patient. Providing the patient with an exercises plan in hospital
after surgery process is essential for care management. Thus as a nurse there is need to ensure
that support of physiotherapist helps for the muscles and legs to regain strength and muscle
for good motion range.
Post operative care process
The rehabilitation exercises have general time frames which the patient needs to be
aware. They ensure reference to the individual patient, however different patients progress at
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different rates. Knowing specific time frames, restrictions and precautions are essential in
ensuring that specific healing tissues and surgical constructions are adhered to al., 2013,
(Wittig-Wells et).
Post operative process begins at preoperative evaluation and initial pot cooperative
exercises which involve isometric and active range of exercises. This is geared towards
facilitating normal walking process. Thus, counselling the patient on the possibility of using
the crutches while walking is essential in order for her to recover faster to her normalcy,
(Maslakpak & Raiesi, 2014).
Further i would counsel the patient on the possibility of the rehabilitation process
commencing faster. Thus the rehabilitation services will be provided faster to them. Thus the
patient needs to be aware the kind of care they are going to be given as this will facilitate
faster healing process.
Discharge planning process
Discharge plan for patient Audrey is crucial in that after the post operative process, they
will be done at home and at the rehab facility. Patient Audrey needs more help especially at
her age, a lot of care and assistance is needed. This services incorporate services of skilled
nursing care and adequate rehabilitative care for the patient, (Grodnin et al., 2014).
In the rehab facility, the patient will be continued with the rehabilitation program and
the medical needs of the patient are needed to be adhered to. The therapy sessions should
focus on building strength, enabling endurance and building self care skills. Thus as a matter
of planning process, the rehab facility should be patient friendly, where she can be
comfortable and have the rehab services.
Conclusion
The role of nurses in enabling a caring environment for the patients is critical towards
offering the needed care and attention. Patient Audrey is in critical state after foot injury and
with her current age status, she needs careful nursing skills and practice. Thus nursing care
should be geared towards patient centeredness. Her preoperative and post operative phase
needs to be carefully planned and drug regime should be of key concern. The post operative
care is critical in ensuring that the patient is well and nursing care being facilitated for the
benefit of the patient. Adequate preparations should be geared towards her post operative care
in the rehab facility. Thus for effective care multidimensional health approach should be
advanced for the patient to achieve successful healing process.
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