Clinical Scenario Essay Example
The patient in this case study is Eileen Poole, an elderly female patient 72 years of age having been diagnosed with diabetes twelve years ago. In addition, she also has high blood pressure, dyslipidaemia, arthritis and she also is on depression that began soon after the death of her husband. She was admitted in hospital after sustaining injuries at her right forearm when she tripped over her dog and fell down. The fall sustained in this case can be attributed to the medication which Mrs. Poole was put on in the management of diabetes, depression together with sleeplessness. The medication made the patient to become dizzy and hypoglycemic hence she tripped and sustained the injuries on the right upper limb.
Involvement of Mrs. Poole as a participant in the administration of the medication will begin by informing her why she needs the prescribed medication and the names of the medications she will be put on. This will assist the other health workers serving her who are not very sure on her mediation to get information about what she was put on. The manes of the medication will also limit the possibility of her being put on the wrong medication. Mrs. Poole also needs to be informed on the dosages of the medication for this will enable the administration of the medication to be done at correct intervals and trimmings by the health workers. For instance, she will be able to remind the health workers in case she was to take medication at a particular time and the right dosages will also at the same time be administered. Mrs. Poole will also be informed on the mode of administration of the drug and this will go a long way to assist the health workers as well as the nursing students in this case to always use the correct mode of administration of the drugs to the patient. Information on the side effects of the drugs should also be given to Mrs. Poole. Information on the side effects to the patient will go a long way to enable the identification of adverse reactions on time and stop the use of the drugs if the drug reactions are severe or not giving the intended result and outcomes. It will be of importance that Mrs. Poole has knowledge of the medications which should be taken together at a given particular time. This will avoid the accident that occurred in the case study where she was taking two medications with the same effect that resulted to the patient being hypoglycemic and dizzy and there after sustaining a fall injuring his right arm (School of Nursing & Midwifery, 2010).
Collection of information from Mrs. Poole will involve the asking of questions and carrying out a physical examination on Mrs. Poole. The question that will be put across to Mrs. Poole in this case will be based on the chief complains which was the inability to use the right upper limb. Questions relating to the history of the presenting complain will also be posed to Mrs. Poole. In this case, Mrs. Poole will be asked questions relating to what she was doing before sustaining the fall, what she thinks made her sustain the fall and her health condition at the time of sustaining the fall. There will also be the relevance to ask questions on the site of the pain, the onset of the pain whether it was as acute or insidious in nature, the aggravating and relieving factors, whether the pain was radiating or non radiating and the durations the pain was most felt. Physical examination on the other hand will involve inspection which will be done on the upper limbs while comparing both upper limbs simultaneously. Inspection will be done to identify any forms of deformities, bleeding and also color changes and features of inflammation on the upper limbs. Inspection will also be useful in the checking for cyanosis and pallor (Swash & Glynn, 2011).
Palpation will thereafter be carried out. This will involve the palpation of both upper limbs with an aim of feeling the temperatures, and also to check signs for tenderness while applying pressure on the sites injured. Palpation of 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. Capillary refill will also be assessed by applying some pressure on the nails and checking the time interval it takes for the blood to refill. The sensory ability will be examined in order to establish functioning capabilities of the nerves that supply the site where the injury was sustained if they are intact or not and this will be done using the hair brush in the patella hammer. The brush will be moved along the affected limb while asking the patient whether she can be able to appreciate senses such as that of touch. Assessment of the power, bulk and tone or the limbs will also be done. Grading of power will either be normal, reduced or decreased. Grading of power will be done after asking the patient to apply resistance while pushing the arms of the patient towards his side. Assessment of muscle bulk will be achieved by observing whether the muscles are wasted or have normal bulk (Swash & Glynn, 2011).
In the case study, Mrs. Poole is reported to have sustained injuries to the right arm after falling. On inspection, the affected the right upper limb exhibited color changes. The affected right limb was noted to be dusky color when inspection was conducted. This might have resulted from the blood supply to the affected limb being affected secondary to damage of the blood vessel damage after the injury. Mrs. Poole’s right upper limb was also found to be warm as a result of the inflammatory process that occurred after the injury had been sustained. It is reported that the limb became cold later on which could have resulted from the inflammatory process coming to a halt. Movement of the affected right upper limb was reduced and this is evidenced by the changes in the movement from normal to slight movement being appreciated (Crisp & Taylor, 2005). The pain that Mrs. Poole had was graded. Grading was done using by both the numerical and descriptive scales with the patient having a score of eight and severe pain scores respectively (Pain Control Service, 2001). Scoring of the pain based on visual analogue was also conducted after assessment of the patient was done. The score was achieved by the patient pointing on the scale for the corresponding perceptions to the severity of the pain severity and the pain was found to be more towards unbearable than the side with no pain. In this case, the pain was attributed to the injury which made the patient to sustain a colles’ fracture. Documentation of the pain was based on the faces scale which established the pain to be hurting a lot and was therefore graded at eight. The affected limbs was found to be numb on palpation and this could be attributed to the damage of nerves sustained as a result of the injury hence the patient was able to perceive loss of sensations (School of Nursing & Midwifery, 2010).
Before administering paracetamol to Mrs. Poole, I would go ahead to ask her the medication she has been put on. This will be aimed at identifying if she is on any other pain reliever apart from paracetamol. I would also ask her the dosage she takes and possibly take a look at her medication and check for the indicated dosage. I would also go ahead to inquire if she has already taken the medication or not on that day. This will be aimed at preventing overdose of the patient. Due to adherence to medication being of importance, I will then ensure that Mrs. Poole takes the medication while under my supervision. I would then inform her when she will be expected to take her next medication. Using ISBAR to inform the junior medical officer on Mrs. Poole’s condition, will introduce myself and then go ahead to inform the junior medical practitioner on the back ground information of the patient which will include the patient’s name, the date of admission, the chief complains and the main reasons for admission. I will also go ahead to state any complains that the patient has currently. This will be followed by mentioning any other medical conditions the patient is having and the medication that he has been put on. I will then inform the junior medical practitioner on the medication that I have given the patient and the dosage of the medication. I would then ask the junior medical officer for any additional information or task to be undertaken in relation to the management of Mrs. Poole. ISBAR will be vital in the facilitation of consultations to be made with the junior medical officer in the circumstances where decision have to be made when he or she is not presently near the patient that is being attended to by the nurse (School of Nursing & Midwifery, 2010).
Mrs. Poole was admitted to hospital after sustaining falling and sustaining injuries on her right upper limb. This injury was sustained as a result of Mrs. Poole changed her diabetic medication. Previously Mrs. Poole is reported to have been on metformin but is introduced to glucophage which still had metformin as one of its components. During the change of her medication however, she was taking both drugs. She was however not told to stop taking metformin after being given glucophage. Glucophage was to attain the full dose gradually when taken alone. However when both metformin and glucophage are combined, the full dose is attained rapidly hence resulting in Mrs. Poole becoming hypoglycemic and dizzy. Mrs. Poole was also on antidepressants. She is reported to have been on sertraline in the management depression after losing her husband. Due to being sleepless, she was also put on sedatives in this case valerian was used. The sedatives together with the antidepressant medication combined made Mrs. Poole to become dizzy. With Mrs. Poole being dizzy and hypoglycemic, Mrs. Poole tripped over the cat sustaining injury to her right arm. The assessment for the risk of Mrs. Poole having sustained injuries after a fall will begin with the inquiry of the chief complains that Mrs. Poole presented with which in this case would was the inability to use the right upper limb and pain. The history of the prevailing illness will also be established and this will seek to identify the cause of the injury. In this case, the condition of the patient before having the chief complains. This will seek to identify the cause of the injury and how the injury was sustained. In this case the injury resulted from tripping over the cat after the patient feeling dizzy and weak. The history of medication she was on will also go further to elucidate the reasons for her sustaining the fall. Since the injury renders Mrs. Poole to be dependant hence the nursing intervention would include the use of the plaster of Paris cast being put on the right upper limb to help immobilize the site of the injury and facilitate healing of the fracture sustained. This would mean the patient is assisted in carrying out various activities such as lifting to enable healing to be achieved. Since Mrs. Poole is dependent, she will also require assistance with activities of daily living such as dressing, bathing and feeding among others (School of Nursing & Midwifery, 2010).
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.
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