Nursing theories are essential in all medical settings, including patients' and health-care institutions'. In today's medical world, safe nursing care is critical. A framework for all medical care is offered based on nursing practice theories. Theories that guide the nursing discipline are vital for ensuring professionalism and ethics in all nursing care. Holistic care is critical, especially when it adheres to the protocol outlined in a care plan.
Care plans serve as a road map for providing excellent and professional care, particularly when dealing with client-specific problems (Cosnes, 2013). Having a good care plan during the nursing practice is crucial because it helps the practitioner to efficiently deal with all situations like the case in hand. This analysis reveals the health state of Linda who is clearly old and suffers from venous insufficiency, diabetes and instances of poor memory. A clear assessment framework and principles will enable quality and safe nursing practice on the patient in question.
1. Assessment Framework.
From Linda’s’ case (who is the patient), the presented information about her health condition would form a good basis for both health and physical assessment on the patient. Additionally, from the prescription by the patients’ general practitioner (G.P), it is possible to obtain the clinical history of the patient. This will be useful when developing the substantial assessment for the patient to be ascertained of the reliable care pathway (Charles & Howard 2014).
The systematic assesment framework would include client’s health and environment as well as medication assessment to be able to make the meaningful conclusions of the patient’s health assessment (Cosnes, 2013). From experience, professional judgment and nursing practice guidelines, it will be possible to deliver accurate nursing care to the patient.
a. Health and Physical Assessment.
Linda suffers from diabetes. The poorly controlled diabetes led to an influx in the amount of blood-sugar level. This influx of sugar level in blood is the ultimate cause of the leg ulcer. Additionally, the Linda’s G.P has prescribed some medications for her, which clearly shows her health status of the. He has prescribed 25 mg of Metoprolol and notes dosage for Atorvastatin, which is used to treat cardiovascular disease. The patient suffers an elevated blood pressure. From the medication, provided by the G.P it is clear that he understood that the patient suffers from venous insufficiency, which is caused by poor blood flow to the heart (Cosnes, 2013). Venous insufficiency worsens the state of the ulcer, which is therefore treated by the use of the two medications.
Additionally, from the physical assessment of the patient and learning experience; it is clear that the patient suffers from mid-stage senile dementia. This is shown by her physical presence and her actions (Bernal & Wendon, 2013). Her relatives state that the patient has developed a state of poor reminiscence when compared to the past few months. This clearly shows that she was at the early stages of dementia, but it has traversed to the next state demonstrated by her inability to get names in the right manner and forgetfulness (Bernal & Wendon, 2013).
Another sign which reveal that she had senile dementia is that it was almost difficult for her to perform certain chores, which she used to like easy preparation of a cup of tea (Bernal & Wendon, 2013). Furthermore, she is seen caught her foot on the throw rug when she moved from the kitchen, which means that her judgment and thinking is most likely compromised by the condition. She did not understand her medications and had poorly organized her medications. Poor organization is evident from the fact that she had mixed her medication with that of the other people (Bernal & Wendon, 2013). Additionally, the fact that she sauntered and leaned on furniture on every stop she made in the house clearly shows that she was suffering from mild cognitive impairment and gout. This mild cognitive impairment is a warning sign of senile dementia (Bates, 2012). This assessment would aid in ensuring that the patient would receive good nursing care.
2. Medication administration Safety.
The concept of safety in medication is critical to ensure that the health status of the patient is professionally attended to. This idea helps in preventing any possible deterioration of the health status of the patient, which may subject the life of the patient at subtle peril (Bernal & Wendon, 2013). Safe medication ensures that any potential error by the nurse or the patient is eschewed. Medication harm may be detrimental to the patient. This means that perfect nurse care service should follow all the necessary guidelines to ensure that there are no medication errors or cases of flawed dispensing systems.
For this patient, high accuracy of all medical procedures is paramount. This is because; the patient did not suffer from a single disease but several. She used several cardiovascular disease treatments drugs hence; high accuracy was not an option. A proficient nurse should, therefore, be versant with all prescription, transcription, verification, dispensing, administering and monitoring procedures. In this case, the G.P had already prescribed the right medications for the patient.
a. Dispensing and administration.
During the visit to the patient, the G.P had ordered administration of ampicillin intravenously. The administration of the drugs should be based on the route of administration of the drug. Ampicillin, Lantus and Novo mix was to be administered intravenously while Metoprolol, Atorvastatin, Allopurinol, and Omeprazole were to be administered orally in their right doses as prescribed by the G.P.
i. Insertion of Peripheral Intravenous Cannula.
This procedure was ordered by the G.P as a requirement to intravenously administer the antibiotic dosage. The whole process would be effective if professional and aseptic techniques were followed to ensure the safety of both the patient and the nurse.
Before beginning the procedure, the nurse should make sure that she has all the necessary equipment like disposable sterile gloves, right size cannula and needle gauge (thick for the elderly), sterile dressing materials, which are not made of micro pore, Ampicillin Fluid In IV bag tourniquet and sterilizing agents (Bates, 2012). Before, commencing the whole procedure, the nurse should seek permission from the patient and assure the importance of the entire process (McGovern, 2010). In the case of anxiety and nervousness from the patient, the nurses should ensure that the patient is comfortable and relaxed about the procedure to avoid cases of vasoconstriction (McGovern, 2010).
To mark the start of the procedure, the nurse should set the ampicillin fluid in an elevated position. The IV tubing should be connected after ensuring that it has no air bubbles inside to prevent any case of embolism (McGovern, 2010). Look for the most prominent and accessible vein on the upper arm closer to the joint, the nurse should avoid places where recent IV was done and places where there is swelling or irritation (Bates, 2012) and use the tourniquet on the chosen site of IV to have an aculeate view of the vein; disinfect the whole site. Into the sterile cannula bevel, insert the needle facing up with the cannula in place (McGovern, 2010).
The needle should be un-plunged leaving the cannula inside the venous entry. The needle should be discarded and advance the cannula into the vein slowly to ensure it is perfect inside the vein (McGovern, 2010). Tourniquet should be removed and place a sterile dressing material without using any form of micropore since the patient is allergic to the micropore. Uncover the end of the IV tubing and insert into the hub of the cannula (McGovern, 2010). Lock up the hub, open the IV roller clamp and let the IV fluid infuse into the vein dropwise. Note the time and date of insertion of the Intravenous peripheral cannula
ii. Summary of Webster Pack Medication.
The patient should also receive an injection of Novo mix 30 titrated to biosafety levels and dosed into three times a day. This will help to control the diabetes type condition of the patient. Additionally, the patient should receive 300 mg of allopurinol. Allopurinol will be effective in reducing the level of uric acid in blood hence useful in treating any signs and symptoms of gout as shown by the patient.
The G.P had also ordered 5 mg of perindopril on a daily basis as well as 25 mg of the Metoprolol twice a day. These two drugs were to be administered orally to help in treatment of the venous insufficiency condition of the patient. At night-time, the patient was to receive 35 units of Lantus which to be administered by subcutaneous injection to help in controlling the diabetes mellitus and also receive 40 mg of atorvastatin to help in the treatment of venous insufficiency. The nurse should be keen to note the patient’s response to medication. Any serious adverse effects of the drugs should note, and possible measures are taken to avoid the contingencies of these effects on the patients
iii. Wound care.
It is essential to note the allergy history of the patient. With the case in hand, the patient had an allergic response for micropore tape. Therefore, dressing of the wound should be conducted with care and avoid any contact with micropore tapes. While caring for the wound on the leg, the nurse should sanitize her hands use and use sterile gloves to avoid introduction of germs into the wounds as well as to prevent body contact with the fluids from the patient. Ulcer wounds, especially the ones brought about by diabetic condition, remain unhealed for a long time (Cosnes, 2013). Therefore, their susceptibility to germ infection is high. This explains why the G.P prescribed the ampicillin dosage to kill any bacterial life forms on the wound and prevent entry of any bacterial microorganisms (Cosnes, 2013). The wound should also be, cleaned and any unnecessary movement by the patient, which may cause muscle extension on the wounded part; causing a delay in healing, should be avoided.
Since the patient suffered a memory problem, proper home nursing was crucial. Available relatives should be given the responsibility to ensure that all daily medication from the patient is provided in correct doses and right time (Cosnes, 2013). The relatives should be informed by the nurse on how to ensure that the wound of the patient is aseptically cared for and cleaned a fast healing.
3. Legal and Ethical Requirements.
In all healthcare services, the patient is usually the center of interest. Therefore, nursing care should be provided in a manner, which upholds professionalism and ethics. Nursing and caring are generally intertwined since nursing is the extension of care to the patient. The concept that the well-being of a patient is the core of all nursing practice obliges any nurse to ensure that all Medicaid services rendered to the patient follow the legal and ethical requirements (Cosnes, 2013). From the cases studies ethics provide the framework upon which quality care for the patient in hand should follow. Following these requirements will ultimately ensure that the nursing service standards are reached.
In caring for this patient, the nurse is legally obliged by law to ensure that the patient’s information is kept private and confidential. In this case, she is not to disclose Linda’s health information to any third party. Any disclosure should actually be after a being given consent by the patient to do so (Charles & Howard 2014). In this context, the third party should be the patient’s most trusted and available relative(s). They are to be informed of the patient’s condition since they are the only ones who are allowed to provide any home care services to the patient i question.
Secondly, before provision of any care service on the patient, be it, care of the wound, washing, and administration of medication, the nurse should seek permission from the conscious patient (Charles & Howard 2014). In case the patient does not consent any activity to be done on her, the nurse is expected to respect the decision. The nurse should not, therefore, use any personal judgment about the patient's refusal to receive nursing services since it may compromise the service delivery and care to the patient t(Charles & Howard 2014). Respect of patient’s opinion should be the guideline in care provided to the patient.
It is also an ethical requirement on the nurse to have a clear comprehension of the patient’s health and clinical history (Charles & Howard 2014). This will form basic guidelines to the nurse on how the patient has been able to deal with home nursing situations. It is from health history assessment where that nurse can understand the patient’s response to certain medications to avoid tension, which arises when a patient responds opposite to nurse’s expectations (Charles & Howard 2014). Furthermore, the nurse is obliged to ethically conduct a heritage assessment on the patient. This helps him or her to avoid any misunderstanding with the relatives in case certain culturally unapproved practices are done on the patient. Cultural consultations also boost the patient’s confidence on the nurse in charge (Charles & Howard 2014).
The nurse also should avoid any personal danger when dealing with the patient. Several forms of uncertainty include physical violence from the patient, communicable infections or sexual molestation. According to the Workers Compensation Act, the employer of the nurse should not assign the Nurse to perilous situations (Charles & Howard 2014). In the case of misunderstanding between the care provider and the patient, friends or relatives, the nurse should professionally shun situations, which can lead to physical abuse (Charles & Howard 2014).
Lastly, the nurse should only opt to provide the type of care, which she is competent in. Additionally, affirmation should always be availed to the patient on why certain procedures are conducted on him/her (Charles & Howard 2014). For example, Linda should be made to understand intravenous cannulation is important when administering ampicillin. Such information is relevant to the patient since it fosters a sense of confidence in the patient and shows that the nurse is competent in her work.
Conclusion
Competence in nursing care is vital. It forms the basis for quality care services to patients. It also fosters an augmented belief that it is actually possible to efficiently handle certain chronic disease situations through proper nursing practices. Therefore, for Linda’s case, care pathways should be developed. These care pathways should be guided by the learned theories and should exclusively be incorporated into practicability. Reliable care pathways should include health assessment of the patient, physical assessment, medication and all safe nursing practice. This will ensure that quality nursing services are availed to Linda.
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