The case study is about a patient named Jolene

The case study is about a patient named Jolene

Assignment- Case study

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Introduction

The case study is about a patient named Jolene. The patient is having a past medical history of Asthma and Grave’s disease. Her current history involved, meeting with a road traffic accident, in which bared multiple compound fracture to the tibia and fibula. She also met with a head injury during her accident. She was admitted to the emergency care department for the management of the same. She underwent surgical corrections for her injuries. After being discharged from the setting the patient was again admitted to the emergency care unit pertaining to an episodic event of developing angina and dyspnea. She was diagnosed with DVT and pulmonary embolus. Nine months post-surgery, she also had an episodic event of tonic-clonic seizures for which she was admitted to the emergency care department. The patient has had a very slow recovery since the time she met with the motorbike accident and has been under prolonged treatment for the same. This has led her to develop a depressive attitude. The case study will help in evaluating the pathophysiology, nursing interventions as well as various drugs that are being administered to the patient and their effects on her.

Pathophysiology

The patient is having multiple diagnosis in the case study and each of the condition is somehow related to each other. Pain post-surgery is a very common finding. As the patient was subjected to a major accident, she sustained multiple injuries (Gilron 2019, pp.36-43). The surgery she underwent also was a complicated one, therefore a lot of time is needed in the healing process. The patient was managed surgical by the help of fixing plates and screws at the site of fracture. Such complicated procedures require prolong bed rest. This is important from the point of view of promoting enhanced healing and helping the patient in recovering with a faster pace. However, due to prolonged bed rest there are multiple complications that might arise from it. Some of the common complications include, development of bed sores, reduced blood circulation, muscle fatigue and so on (Santos 2017, pp.1-12). As the patient in our case study is quite young and also does not have any history of overweight, she is not subjected to a risk of developing pressure sores. There is however, a lack of physical activity due to prolonged bed rest required in this case. Lack of physical activity can lead to hampered blood circulation to the body and can cause muscle fatigue or generalized muscle weakness as well. The patient must have developed clots in her lower extremities due to poor circulation (Song 2016, pp.1459-1464). These clots are observed to move through the major arteries of the body during any movement and they can get clogged in other main arteries responsible for blood flow and pumping of blood to other parts. The common site for deposition of these clots is usually cerebral artery and pulmonary artery. Similar situation might have been with our case study and the same led to her developing pulmonary thrombus (Seo 2018, pp. 72-75). The clot post deposition in the lung cavity might have hampered with the blood pumping and reducing the adequate supply of oxygenated blood to the various parts of the body. Situations like this forces the heart to compensate for the respiratory loss and thus, putting an additional stress on the heart. These symptoms were reflected in the patient in the form of chest pain or angina. The prevalence of patients having seizures in head injury cases is also found to be high. Tonic-clonic seizures are also found to be existing in patients who have a history of trauma to the head (Salas 2019, pp.135-139). As the patient in our case study had a head injury during her accident, she might have developed these seizures pertaining to the same. The reason for the patient having traumatic epilepsy can also be associated with the same. Patient is also suffering from depression. The depression is mainly due to prolonged treatment. This is usually seen in post-operative patients as they tend to lose hope of getting better with the passing time (Jones 2018, pp.1238-1246). The recovery time in our case study for the patient has been too long for now and therefore, pertaining to that she has developed depression. Depressive state of mind can however, be easily treated in these patients.

Medications considerations

The patient is being managed on anti-coagulant therapy. These are the first choice of drug to help in preventing the formation of blood clots in individual. The patient had developed deep vein thrombosis which has led her to develop pulmonary embolus. This condition can be very fatal if it goes untreated. The anti-coagulant drugs helps in blood thinning and thus, help in reducing the risk of developing clot by multiple folds (Larsen 2016, pp.72-78). It is also useful for the purpose of preventing the re-occurrence of the symptoms in the patient and thus, helping in reducing the comorbidity and mortality rate in the patients. The anti-coagulant therapy can however be fatal in the case of Jolene as she is pregnant. However, looking at the risk factor of deep vein thrombosis, she can be prescribed the therapy through heparin. This drug can be given in pregnant females as it does not cross overs through placenta and is thus, helpful in reducing the risk considerably (James 2018, pp.228-234). The patient has had only one episodic event of tonic-clonic seizures. However, after undermining the risk associated with the same the patient can be helped with anti-epileptic drug therapy as well. These medications are based on deactivating the neurotransmitters causing the action potential to spike and bring about an epileptic event in the patient. These medication are although not apt to be given in our case study, application of anti-epileptic drugs can be harmful for pregnant females as they can cause neural tube defects in the unborn child (Nie 2016, pp. 2400-2404). These risks are also anticipated highly in early stages of pregnancy as in Jolene’s case, who is only in her first trimester. As patient had only one event post her accident, she can be regularly scanned for any symptoms, rather than being treated by the medication means. The patient is also suffering from asthma so she can be given few doses of salbutamol. This will be helpful in later stages of pregnancy, when she might be experiencing respiratory deficit, due to inability of full lungs expansion. The patient is also having a depressive state of mind. Patient having a prolonged period of recovery phase tend to go into depressive state of mind. The patient given in our case study is however, not having any severe signs of depression at present. She can be easily managed with the help of anti-depressant drugs and counselling. However, many pregnant females are prescribed these drugs to manage their depression and there are no side effects observed in the individuals prescribed with these drugs. Although, some of the anti-depressant drugs are found to bring about birth defects in pregnant females (Cantarutti 2017, pp.1100-1108). These are anti-psychotic medications. So to be on safer side the patient can be preferred to be treated with counselling sessions rather than prescribing her drugs.

Nursing Interventions

There are many nursing interventions that are suitable for the patient case study in order to help her with her current symptoms and key areas of concerns. This is inclusive of considering for providing her with the required care for her pregnancy status as well. The nursing interventions that can be applied in our case study as inclusive of as follow:

1. Treating for pain management-The patient can be encouraged for increasing her physical activity status. She can also be provided with the help of physical therapist, who can ensure that she has a step wise exercise protocol to be followed. This protocol should be based on enhancing her muscle strength and range of motion. This will also help in promoting blood circulation through the body and will help in reducing formation of blood clot and reducing the underlying risk factors as well. Apart from physical activity the patient can also be provided to keep heat pads or ice packs at the surgical scar site, for providing her with symptomatic relief of pain (Wylde 2017, pp.1293-1306).
2. Managing her diet- This can be done with the help of a dietician. Dietician can work along with the nurse and the patient, to provide her with a balanced diet plan. This can be inclusive of good supply of natural vitamins and mineral. This is crucial from the point of view of promoting healthy eating habit, while providing the unborn child with the required nutrient supply for healthy growth purpose (Chatzi 2017, pp. 47-56).The diet can also be helpful to the patient in reducing the cardiovascular and other risks associated with her current clinical status. Healthy diet pattern can also be helpful in cutting down on multiple medications, the patient is being prescribed at present.
3. Counselling- The depression of the patient can be reduced with the help of counselling sessions. These sessions will aid the patient in speaking up her mind freely as to what all she been going through. It is also important from the point of view of promoting a healthy and robust state of mind as it will be directly impacting her physical health. This will allow the patient to have sense of calmness and re-assurance of being her to and will also be beneficial for her pregnancy (Proctor 2017, pp.417-426). Counselling for pregnancy can also be provided to the patient to help her with all of her concerns and doubts. She can also be provided details about various other healthcare programs, she can enroll herself into. This will be helpful for her in managing her pregnancy along with her medical limitations.
4. Medicine reconciliation- The patient is having multiple conditions for which she is being managed with medications. The medication management is also being done for most of her condition. With her pregnant status, there is a dire need of reconciliation of medication so that any error in medicine management can be averted (Rose 2017, pp. 2057-2058). The medications posing a threat to her pregnancy status should also be reconsidered at all times and should be prescribed with alternative solutions for the same. It is also important from the point view of keeping a close monitoring on her vitals to continue, increase, and decrease or to discontinue any of her medications.
5. Family education- She is currently having a lack of support from her family. Family plays a crucial role in helping in smooth transition of care. The patient along with her family can be educated about the various conditions she is having and what all threats these condition pose to her current clinical status (Nisar 2017, pp. 103-115). They can also be taught for multiple treatment options and services available in place to ensure smooth facilitation of care services to the patient.
6. Financial support- The patient is also having financial constrains in managing her condition. The medication and the treatment cost incurred in the process can be very expensive for the patient. The nurses can also help in providing the patient with information of community based services that can be helpful in providing the patient with the required financial support to manage her health in a holistic manner (Grant 2019, pp. 325-330). Nurses can also take help of a local liaison officer in getting Jolene a job which will be helpful in keeping her mind engaged and will also help her in providing with a source of income.

Conclusion

Nursing care plan is an important part of the patient care plan. These interventions are necessary for identifying the main key points related to the case study and examining the same for formulation of holistic patient-centered approach that can be provided to the patient. Nurses work in collaboration with other healthcare professionals to provide them with the multidisciplinary team approach to treat their condition. It is very crucial from the point of view of attaining improved healthcare outcomes from the patient and thus, improving his quality of life largely. This is also vital for providing the patient with the motivation to perform independently in his daily routine of life.

References

Cantarutti, A., Merlino, L., Giaquinto, C. and Corrao, G. 2017. Use of antidepressant medication in pregnancy and adverse neonatal outcomes: A population?based investigation. Pharmacoepidemiology and Drug Safety, 26(9), pp.1100-1108.

Chatzi, L., Rifas?Shiman, S.L., Georgiou, V., Joung, K.E., Koinaki, S., Chalkiadaki, G., Margioris, A., Sarri, K., Vassilaki, M., Vafeiadi, M. and Kogevinas, M. 2017. Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood. Pediatric Obesity, 12, pp.47-56.

Gilron, I., Kehlet, H. and Pogatzki-Zahn, E. 2019. Current status and future directions of pain-related outcome measures for post-surgical pain trials. Canadian Journal of Pain, 3(2), pp.36-43.

Grant, S.M. and Johnson, B.H. 2019. Advancing the Practice of Patient-and Family-Centered Care: The Central Role of Nursing Leadership. Nurse Leader, 17(4), pp.325-330.

James, A.H. 2018. Prevention and management of thromboembolism in pregnancy when heparins are not an option. Clinical Obstetrics and Gynecology, 61(2), pp.228-234.

Jones, A.R., Al-Naseer, S., Bodger, O., James, E.T.R. and Davies, A.P. 2018. Does pre-operative anxiety and/or depression affect patient outcome after primary knee replacement arthroplasty?. The Knee, 25(6), pp.1238-1246.

Larsen, T.B., Lip, G.Y. and Gorst-Rasmussen, A. 2016. Anticoagulant therapy after venous thromboembolism and 10-year mortality. International Journal of Cardiology, 208, pp.72-78.

Nie, Q., Su, B. and Wei, J. 2016. Neurological teratogenic effects of antiepileptic drugs during pregnancy. Experimental and Therapeutic Medicine, 12(4), pp.2400-2404.

Nisar, S., Talib, A., Naqvi, I.H. and Lal, J. 2017. The Effectiveness or Efficacy of Modified Nursing Interventions Classification (NIC) in Reducing the Severity of Depression among Patients with Myocardial Infarction. Open Journal of Psychiatry, 7(02), p.103-115.

Proctor, G. and Hayes, C. 2017. Counselling for Depression: a response to counselling education in the twenty-first century. Ethical conflicts for a counselling approach operating within a medicalised bureaucratic health service. British Journal of Guidance & Counselling, 45(4), pp.417-426.

Rose, A.J., Fischer, S.H. and Paasche-Orlow, M.K. 2017. Beyond medication reconciliation: the correct medication list. Jama, 317(20), pp.2057-2058.

Salas-Puig, X., Iniesta, M., Abraira, L., Puig, J. and QUIN-GTC study group 2019. Accidental injuries in patients with generalized tonic–clonic seizures. A multicenter, observational, cross-sectional study (QUIN-GTC study). Epilepsy & Behavior, 92, pp.135-139.

Santos, P.M.R., Ricci, N.A., Suster, É.A., Paisani, D.M. and Chiavegato, L.D. 2017. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy, 103(1), pp.1-12.

Seo, I., Oh, C.W., Kim, J.W. and Park, K.H. 2018. Pulmonary Thromboembolism during acetabular fracture operation. Journal of Trauma and Injury, 31(2), pp.72-75.

Song, K., Yao, Y., Rong, Z., Shen, Y., Zheng, M. and Jiang, Q. 2016. The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures. Archives of Orthopaedic and Trauma Surgery, 136(10), pp.1459-1464.

Wylde, V., Dennis, J., Beswick, A.D., Bruce, J., Eccleston, C., Howells, N., Peters, T.J. and Gooberman?Hill, R. 2017. Systematic review of management of chronic pain after surgery. British Journal of Surgery, 104(10), pp.1293-1306.

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