Nursing Assessment: Person-Centered Care Plan for Mr. Davis' Condition

This case study delves into the principles of person-centered care, contrasting it with traditional medical models where patients are passive recipients. The analysis identifies two primary health concerns for a patient named Mr. Davis: sinus tachycardia and oliguria (low urine output), both of which require immediate attention to prevent further health deterioration. The study proposes specific nursing interventions to address these issues, including the administration of beta-blockers and placing the patient in a supine position to manage tachycardia, and administering furosemide along with oral rehydration therapy to combat oliguria. These interventions align with registered nurse standards of practice, emphasizing evidence-based strategies, careful planning, and continuous monitoring to ensure effective treatment and patient recovery. The conclusion reinforces the importance of person-centered care in achieving positive health outcomes.

Running head: NURSING
Nursing practice
Name of the Student
Name of the University
Author Note

1NURSING
Introduction- Person centred care refers to the process of delivering care services in a
manner that the patients are provided the opportunity to actively participate in their clinical
treatment, in close association with the responsible healthcare professionals. In clear contrast to
conventional medical treatment modalities, implementation of person centred care model
facilitates inclusion of patient and family members in clinical decision making and also helps the
healthcare professionals to reach a point of mutual agreement, for the intended medical plan and
interventions (Eaton, Roberts & Turner, 2015). This case study will identify to actual or potential
nursing priorities for a patient Mr. Davis who had been admitted the previous evening to the
hospital following a motor vehicle accident, and information related to his health have been
provided during handover.
Priority nursing problem- The first priority nursing problem that has been identified after
conducting a thorough and comprehensive analysis of this case study is the presence of sinus
tachycardia, as manifested by the ECG results of the patient. Commonly referred to as sinus
tachy, the condition encompasses sinus rhythm that is characterized by an elevation in rate of
heart impulses that are greater than 100 beats per minute, in an average adult being. While the
normal heart rate in resting stage of average male ranges from 60-100 beats/minute, Mr. Davis
had a pulse of 105 beats/minute, thereby providing evidence for the presence of sinus
tachycardia (Baruscotti, Bianco, Bucchi & DiFrancesco, 2016). Although the priority problem
often occurs in the form of response to normal physiological circumstances, some instances like
pain, fever, dehydration, and heart failure also increase the likelihood of a person to suffer from
the condition. It can be suggested that, following the motor vehicle accident the patient was in
pain, which might have triggered an enhanced release of catecholamines. Pain has been found to
bring about elevation of pulse rate by stimulating the sympathetic nervous system through

2NURSING
electrical signals. The neuroanatomical changes in the brain that might have occurred with
persistent pain are also capable of bringing about continuous sympathetic discharge of
catecholamine, thereby signalling the pituitary and hypothalamus to release the hormone ACTH,
hence elevating the heart rate (Olshansky & Sullivan, 2018). Thus, the accident resulted in a
persistent elevation in the resting heart rate of the patient, which in turn manifested in the form of
an exaggerated response to the trauma.
An analysis of the case study also facilitated identification of the second priority problem
that is low urine output or oliguria. Also referred to as hypouresis, the condition refers to low
production of urine, specifically less than 400 ml/day and more than 80 ml/day. On assessing the
information that had been received during handover, it has been observed that although Mr.
Davis had been admitted to the healthcare setting at 1900 hours, the previous evening, his urine
output since admission has been only 500ml, thus providing adequate evidence for the presence
of oliguria. It has often been found that low output of urine occurs due to failure of the kidney, or
during the presence of urinary obstruction that make the renal system lose their capability of
regulating balance between electrolytes and fluids, and also hinder appropriate removal of waste
products from the body (Schetz & Hoste, 2017). Time and again it has been established that
victims of motorcycle accident and car collisions typically develop symptoms of retinal problems
such as, painful urination, lower abdominal pain, problem in empty the bladder, decreased urine
output, and urinary retention due to presence of blood clot that blocks the urethra (Grigorian, de
Virgilio & Kim, 2015). Thus, low urine output might also have been manifested under
circumstances when there was a reduced blood supply to the excretory system during excessive
blood loss and/or dehydration. If left untreated, the condition can lead to severe acute renal
injury and mortality.

3NURSING
Smart Care plan- The care plan for addressing tachycardia is provided below:
 S- Patient will demonstrate adequate cardiac output
 M- Restoration of pulse rate
 A- Patient will demonstrate a pulse rate within 80-100 beats/minute
 R- There will be no symptoms of syncope, dyspnoea, and chest pain
 T- Enhancement in patient health status within 24 hours
The care plan for addressing low urine output is provided below:
 S- Patient will eliminate adequate amount of urine
 M- Increase in urine output
 A- Patient will demonstrate urine output from 800-2000 ml/day
 R- Patient will be able to maintain clear and odour free urine
 T- Enhancement in patient health status within 36 hours
Interventions and justification- With the aim of addressing the priority problem of sinus
tachycardia, the first nursing intervention would be based on administration of beta blockers that
refer to a class of drugs, predominantly administered for managing abnormal heart rhythm.
These medications will help in protecting the patient from suffering myocardial infarction and
will also act in the form of competitive antagonist by blocking receptor locations for the
endogenous catecholamine, norepinephrine and epinephrine. This inhibitory action will be
exerted on the adrenergic nervous receptors that are present in the sympathetic nervous system,
and responsible for mediating fight or flight response in the body (Fiuzat et al., 2016). The drug
will also bring about a decrease in secretion of rennin that will lower oxygen demand of the
heart, thereby decreasing extracellular volume and elevating blood’s oxygen carrying capacity,

4NURSING
thus reversing the effects of sinus tachycardia (Lumbers et al., 2017). Moreover, sinus
tachycardia characteristically comprises of an increased activity of catecholamine on the heart,
which in turn is responsible for numerous deleterious impacts, including an increase in oxygen
demand, abnormal remodelling of cardiac tissue, and inflammatory mediators propagation, all of
which have been found to reduce deficiency related to cardiac contraction, and significantly
contributed to poor ejection fraction. Hence, administration of beta blockers will help in
countering the improperly increased sympathetic activity on the patient, by eventually bringing
about an improvement in ejection fraction (Bavishi, Chatterjee, Ather, Patel & Messerli, 2015).
The second intervention would be based on placing the patient in supine position. There is
mounting evidence for the fact that assisting a patient to remain in supine position helps in
increasing when venous return that refers to rate of blood flow to the heart (Maeder et al., 2016).
Moreover, it will also help in increasing urination in the patient (diuresis), by restoring
homeostatic mechanism of the body in maintaining fluid and electrolyte balance.
In order to address the second priority problem of low urine output or oliguria, the primary
intervention would be based on administration of the medication furosemide that is commonly
used for the treatment of fluid accumulation, or build up in the body due to renal disease, liver
scaring or heart failure. The patient will be subjected to intravenous administration of this
medicine that will act like loop diuretics and inhibit the NA-K-Cl transporters, located in the
thick ascending limb of loop of Henle. Mechanism of action of the drug comprises of binding of
the medication to chloride transport channels present in loop of Henle, which brings about a loss
of sodium, potassium, and chloride ions in urine (Kikura, Nishino, Suzuki & Uraoka, 2019).
Taking into consideration the fact that furosemide will act in the form of a non-competitive
blocker of GAB-A receptor, it will help in increasing the output of urine from the body. The

5NURSING
second intervention would be based on subjecting Mr. Davis to oral rehydration therapy, a type
of fluid replacement therapy that will help in preventing dehydration in the body, and would
require him to drink modest amount of water, containing salt and sugar, specifically potassium
and sodium (Guarino, Bruzzese & Vecchio, 2018). This therapy will help in absorption of water
from gastrointestinal tract, and will also increase urine output, owing to the action of glucose that
will elevate sodium uptake by the intestine. The aforementioned interventions are in accordance
with the registered nurse standards of practice, since standard 1 requires all nurses to use several
thinking strategies and best available evidences, while providing quality and safety nursing
practice to patients (NMBA, 2016). Furthermore, the strategies are also congruent with standard
5 that expects all nurses to be accountable for appropriate planning of nursing practice, based on
correct documentation, evaluation, and modification of plans, in order to meet achievable
outcomes. Following administration of the interventions, the progress of the patient will also be
continuously monitored, to determine effectiveness of the treatment, in accordance to the
standard 7.
Conclusion- To conclude, the domain of person centred care is different from traditional
treatment based models that consider patient as passive receivers or acceptors of different
clinical interventions. On analysing the patient information that had been received during
handover, the two actual health problems, which if left untreated could result in deterioration in
the health and well-being of Mr. Davis were presence of sinus tachycardia and extremely low
urine output. Hence, implementation of the discussed interventions would help him recovery
easily.

6NURSING
References
Baruscotti, M., Bianco, E., Bucchi, A., & DiFrancesco, D. (2016). Current understanding of the
pathophysiological mechanisms responsible for inappropriate sinus tachycardia: role of
the I f “funny” current. Journal of Interventional Cardiac Electrophysiology, 46(1), 19-
28. https://doi.org/10.1007/s10840-015-0097-y
Bavishi, C., Chatterjee, S., Ather, S., Patel, D., & Messerli, F. H. (2015). Beta-blockers in heart
failure with preserved ejection fraction: a meta-analysis. Heart failure reviews, 20(2),
193-201. https://doi.org/10.1007/s10741-014-9453-8
Eaton, S., Roberts, S., & Turner, B. (2015). Delivering person centred care in long term
conditions. Bmj, 350, h181. https://doi.org/10.1136/bmj.h181
Fiuzat, M., Wojdyla, D., Pina, I., Adams, K., Whellan, D., & O’Connor, C. M. (2016). Heart rate
or beta-blocker dose? Association with outcomes in ambulatory heart failure patients
with systolic dysfunction: results from the HF-ACTION Trial. JACC: Heart
Failure, 4(2), 109-115. DOI: 10.1016/j.jchf.2015.09.002
Grigorian, A., de Virgilio, C., & Kim, D. Y. (2015). Abdominal Pain Following Motor Vehicle
Accident. In Surgery (pp. 415-424). Springer, New York, NY.
https://doi.org/10.1007/978-1-4939-1726-6_41
Guarino, A., Bruzzese, E., & Vecchio, A. L. (2018). Oral Rehydration Solution—An Essential
Therapy for Childhood Gastroenteritis. JAMA pediatrics, 172(10), 991-991.
doi:10.1001/jamapediatrics.2018.2622

7NURSING
Kikura, M., Nishino, J., Suzuki, Y., & Uraoka, M. (2019). Effect of Furosemide under
Hyperchloremic Acidosis on Intraoperative Oliguria and Acute Kidney Injury in Patients
with Normal Renal Function. Nephron, 1-8. https://doi.org/10.1159/000499938
Lumbers, R. T., Martin, N., Manoharan, K., Nyong, J., Thomas, J., Casas, J. P., & Davies, C.
(2017). Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for
chronic heart failure with preserved ejection fraction. Cochrane Database of Systematic
Reviews, 2017(7). DOI 10.1002/14651858.CD012721
Maeder, M. T., Zurek, M., Rickli, H., Tobler, D., Kiencke, S., Suter, T., ... & TIME‐CHF
Investigators. (2016). Prognostic value of the change in heart rate from the supine to the
upright position in patients with chronic heart failure. Journal of the American Heart
Association, 5(8), e003524. https://doi.org/10.1161/JAHA.116.003524
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice.
Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Olshansky, B., & Sullivan, R. M. (2018). Inappropriate sinus tachycardia. Ep Europace, 21(2),
194-207. https://doi.org/10.1093/europace/euy128
Schetz, M., & Hoste, E. (2017). Understanding oliguria in the critically ill. Intensive care
medicine, 43(6), 914-916. https://doi.org/10.1007/s00134-016-4537-7