Assessment item Essay Example

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    1952

Introduction

Eileen Poole is an elderly female patient of 72 years who had been diagnosed with diabetes twelve years ago. She also has high blood pressure, dyslipidaemia and arthritis as well. Poole is undergoing depression after the death of her husband and was admitted after sustaining injuries at her right forearm.

Question 1

Mrs. Poole can be made to be an active participant in the administration of oral medication I many ways. First, she could be vital in knowing the names of the types of drugs she is taking as this will enable ease administration of medication in case there is a hand over process going on within the hospital. This will enable her to always be on the right medication. She will also be involved n the knowledge of the dosage as well as the time intervals in which she is expected to be taking the medication as this will avoid overdosing or under dosing when another health worker will be serving her and is not sure of the dosage that she was taking previously (School of Nursing & Midwifery, 2010).

Question 2

Poole where the site of the pain is, the nature of onset of the pain whether it is insidious in nature or of an acute onset, does the pain radiate to any other part of the body, the aggravating as well as the relieving factors of the pain and the times at which the pain is mostly felt. This will then be followed by a physical exam which will be divided into three phases. the first phase will involve inspection in where the nurse will look at the fingers of Mrs. Poole while comparing bilaterally to the other fingers that are without pain.ht e nurse will look for the presence of any swelling, color changes, and any other features of inflammation such shinny and rubbery skin or any form of soft tissues damage and bleeding. The nurse will also go ahead to look for the presence of features such as pallor and cyanosis on the palmar surfaces of palms (Swash & Glynn, 2011).
The collection of information from Mrs. Poole will involve the asking of questions as well as performing a physical exam. in the asking of the questions there will be need to ask miss

This will be followed by palpation which will involve the palpation of the both hands and feeling for the temperatures, and probably any signs of tenderness while applying some considerable amount of pressure on both upper limbs. The palpation for the pulses will also be done so as to establish if the blood supply is intact and if the supply is of normal character, normal volume. Sensory ability also will have to be examined and this will be aimed at establishing the functioning capabilities of the nerves supplied at the site of the pain if they are intact or not. This will be done by use of a cotton wool and asking the patient whether she can be able to appreciate senses such as that of touch. The limbs will also be tested on power, bulk and tone. The power will either be normal, reduced or decreased and this will be done by asking the patient to apply resistance while pushing the arms of the patient towards his side. The bulk will be assessed by observing whether the muscles are wasted or have normal bulk (Swash & Glynn, 2011).

In this case, the fall made the patient to sustain injuries on the right upper limb. On inspection, the affected limb is noted to exhibit color changes. The limb has a dusky color due to the blood supply to the affected limb being affected as a resulting from blood vessel damage that was secondary to the injury. The injury is also evidenced by the results that were gotten on the examination where the patients affected limb was found to be warm as a result of the inflammatory process that normally occurred after the injury had been sustained. However the limb became cold later on as a result of the inflammatory process coming to a close. The movement was also reduced in the limb affected and this was shown by the movement changing from normal to slight movement being detected (Crisp & Taylor, 2005). Grading of the pain was also done and the pain. The grading was done by both the numerical and the descriptive scales with the patient having a score of eight and severe pain scores respectively (Pain Control Service, 2001). The score of pain basing on visual analogue where the patient is able to point on the scale the corresponding perceptions to pain severity during assessment showed that the pain was more towards unbearable than towards the side with no pain. The pain was attributed to the injury which mad the patient to sustain a colles’ fracture. Poole’s pain was also documented based on the faces scale which established the pain to be hurting a lot and was therefore graded at eight. On palpation, the affected limb was found to be numb and this attributed to the injury causing damage to the nerves hence less sensation was being perceived by the patient. This made the patient to have tingling numb sensations being felt (School of Nursing & Midwifery, 2010).

Question 3

To prevent such risks from occurring in the hospital set up when administering treatment to the patient and uncertainty or any fault is detected, there is need for the nurses to be able to consult in order for the definitive and effective management plan to be achieved. This will involve the use of ISBAR. Like in the case of Poole, there was need to consult over the medication hence the nurse had to call the doctor and introduced herself and went ahead to explain the situation to the doctor which was the concerned about the use of the diabetes drugs. This was later followed by her clearly describing the patient’s background information which included the date of admission, reason for admission, presenting symptoms. The nurse should also go ahead to give information regarding the brief assessment of the patient and finally make a recommendation by being clear about the request. The recommendation in this case was to change the medication of the patient by making the patient take glucophage alone since it already had metformin and hence there was no need to introduce metformin in the medication. ISBAR is thus vital when it comes to facilitating the making of decisions within a hospital set up (School of Nursing & Midwifery, 2010).

Question4

The patient sustained a fall that made her to have a fracture on her right forearm. Miss Poole sustained a fracture as a result of the medication she was taking. She is reported to have been on glucophage which has metformin as one of its components to control the sugars while at the same time she was still on metformin. She was supposed to have stopped metformin while starting to take glucophage since glucophage is to attain the full dose gradually and not as once as when both metformin and glucophage are combined. This made her to become hypoglycemic which eventually resulted in dizziness. She also was on antidepressants she used for instance sertraline to manage the depression that she was under after losing her husband and sedatives such as valerian which she was using due to her being sleepless and this made her dizzy too. All this medication combined made Poole to become dizzy and trip over the cat which normally would not have happened and hence she sustained injury to her right arm. The injury that Mrs. Poole sustained in the arm will certainly affect her day to day performance. The injury would render Mrs. Poole to be totally dependent and would require her to get some assistance in performing some of the activities of daily living activities (School of Nursing & Midwifery, 2010).

Question 5

Mrs. Poole lost her husband due to prostate cancer and she has been very depressed since then. The depression she has will take time to be managed. The management will involve the use of cognitive therapy techniques where Mrs. Poole will be booked for counseling sessions. This will involve the identification of the phase of grief she is in the. The first phase is shock or disbelief, the second being the stage of acute anguish and the final phase is resolution. The counseling will involve the giving of coping techniques to the patient in order to prevent her from going into depression over and over again (Küblar, 2011).

Mrs. Poole is old and so she will have a lot of difficulties in assimilation to begin anew after such a long marriage. Social isolation will also creep in since most of the time she used to share with the dead husband for instance jogging, she now has to stay alone and this makes the situation even harder. Some of the tactics that she would be given to cope with depression need to be employed. This will include the counseling process enabling the bereaved to be able to express their emotions as well as thoughts about the loss and this will include sadness, loneliness, and isolation. Grief counseling will thus be aimed at facilitating resolution in the natural reaction to a loss. Mrs. Poole should therefore be given a lot of comfort and understanding during that trying moment. He should also be helped where necessary so that she might be able to reconstruct her life back to normal even though it will take a long while for her to achieve this. Mrs. Poole will also require to be watched regularly since she might end up not seeing the value of life any more after the loss hence the tendency for her to commit suicides will be high. She will therefore require to be kept involved in the society with things to do and mingle with to her to avoid the thoughts about the loss filling her brains as this will limit the tendencies of her committing murder. Medical management of the depression will involve the use of anti depressants such as sephraline. This will be used to stabilize the moods of the patient. If this will fail, there will be need to use the serotonin releasing inhibitors to help correct the mood disorder. Such patients will also tend to be sleepless hence there will be the need to give them sleep stabilizers as this will enable them to calm down and at least rest their minds from the agony and torment they are going though (Küblar, 2011).

Conclusion

Eileen Poole is a female elderly patient who had a fall as a result of taking of her medication which probably made her to be hypoglycemic and dizzy. The fall made her to injure her right arm at the wrist, and thereby sustained a colles’ fracture. The nurses have been able to identify the cause of her problem after careful scrutiny on how she was taking her medications previously. ISBAR enables the nurses to be able to communicate with the doctor and hence coming up with the definitive medical management of Eileen Poole’s medical condition.

References

Crisp,J & Taylor,C. (2005). Potter & Perry’s Fundamentals of Nursing (2nd ed.) Marrickville: Elsevier

Pain Control Service (2001). Pain Assessment. London:GOSH NHS Trust., 2001).

School of Nursing & Midwifery. (2010). Wiimali:interactive map: Wiimali Hospital: medication assessment and history A and B. , Retrieved from NURS 1201 Blackboard course.

School of Nursing & Midwifery. (2010). Wiimali:interactive map: Wiimali Hospital: Hospital-ipe-isbar-telephone-order, Retrieved from NURS 1201 Blackboard course

Swash & Glynn. (2011). Hutchison’s Clinical Methods, Examination of patient,Elsevier.

kublar R, (2011). Ispiring life, confronting death, retrieved 30th August 30, 2011 from http://www.ekrfoundation.org/