Introduction of the patient
The present study is about a 6 years and 5 months old patient who was brought in ER because of Road Traffic Accident. The patient also got multiple injuries on head and neck region. After reaching into the stage of stabilization, the patient was taken to Operation Theatre Disectomy and Anterior Epidural Heamatoma was also carried out. Afterwards, the patient got shifted into PICU and is also attached to mechanical ventilator with tracheostomy tube. At this stage, supportive medical care is
Brief summary of the patient (medical history and acute care episode)
As per the diagnosis, the patient is involved in Road Traffic Accident and is also on mechanical ventilation. Tracheostomy, Quadriplegia and Disectomy are also identified while analysing the situation of the patient. In addition to the same, breathing is also irregular which leads to unconscious state in the patient. Medication such as Lactulose, Fusidic Acid, Nitrofurantoin and Multi-vitamins are given to the patient. Prior, admitting the patient in the hospital, requirement of acute care episode is conducted to lead for better and quality services. The condition of the patient is getting worst; hence appropriate attention is required to be given at the same time.
Why this patient is considered as complex
In the present case, the patient is termed as complex because several health problems are occurring in the patient at a time. In order to improve health conditions of the patient, it is essential for the care providers to ensure that suitable services are being delivered. Thus, relating to the present case, patient has been experiencing complex issues because of road and traffic accident. Moreover, according to patient’s medical history, certain changes are arising in the present health status.
Two core acute care nursing concepts
According to primary assessment, there are two core acute nursing concepts that needs to be given much importance so that health status of the patient can be managed suitably. Thus, according to ABCDE concept, suitable approaches are required to be considered so as to manage nursing intervention in suitable manner. Therefore, focus will be laid on such things:
Under this dimension, respiratory rate will be checked on frequent basis so that patient’s capacity of inhaling oxygen can be ascertained. Moreover, in this context increase in chest effort will also be ascertained at the same time. Since, the patient has tachypnea and because of that the issue of bleeding is increasing which can further lead to anemia. Therefore, this may enhance other health issues in the patients.
It is the final component of the primary assessment in which entire assessment of the body is included. Thus, in this respect cervical spine precaution is required to be maintained due to serious injuries. At the time of having any serious injury, it is essential for the nurses to conduct a stern conduct so that affected area can be ascertained accordingly. All the conditions of patient is required to be ascertained suitably so that to avoid hypothermia.
Nursing management of the patient
As per the current assessment, the patient has severe head injury; therefore it is essential for the practitioners and nurses to give all such medications through which such issue may not get raised. At the same time, it can also be said that along with proper medication, patient should also get support in diverse contexts. For instance- nurses should maintain a patent airway because it assist with endotracheal intubation. Assistance can also be taken through using side rails which could protect the patient from further injury. Nurses should also ensure to assist the patient by giving walking aid. Nurses can also insert an indwelling urinary catheter. Additionally, when the patient gets unconscious, nurses can also insert a nasogastric tube for the purpose of preventing aspiration.
Henceforth, according to the same, it is essential for nurses to monitor patient’s intake and output in suitable manner for the purpose of maintaining a normovolemic state. Along with head injury, focus shall also be laid on other injuries which can cause severe impact on the health dimension. It is also crucial for the nurses to observe the patient regarding issues related to dizziness, irritability and anxiety (McNamee, 2016). This is also crucial for the purpose of monitoring fluid and electrolyte levels that replaces the blood level as prescribed. Focus shall also be given on CSF leakage as then only appropriate care can be delivered. In the same way, the patient should be asked to return to the hospital if he experiences persistent worsening headache along with blurred vision.
According to the health diagnosis, it can be said that the patient is having issue because of irregular berating which is also affecting the lungs and eventually it is inhibiting breathing capacity of the person. Moreover, in this context nurses are required to conduct nursing diagnosis so as to analyse if there is any decrease in the lung expansion. Along with the same, focus shall also be laid on pain and anxiety aspects which brings more changes in the health conditions. Therefore, it is crucial to have appropriate analysis about inflammatory process because accidents must have affected the patient’s internal body parts. The nurse should also involve the patient in treatment process so that suitable changes can be made accordingly.
Changes also needs to be carried out in airway; hence for that nurses should stabilize the C-spine with in-line immobilisation (Kawai and et.al., 2016). There must be proper analysing about health disability as well as then only patient’s internal and external capability can be ascertained. This is also essential for the purpose of protecting airway from aspiration; thus in such consideration bag-valve mask is required to be used to assist the process of ventilation. The inflow and outflow of air should be adhered accordingly so that further issues of the patient can be resolved appropriately. Nurses should adopt all such intervention through which breathing process can be strengthened as per the determined pattern.
Justification of the nursing management
The above mentioned nursing intervention are being selected as the patient is having several injuries due to road accident. Along with head injury, the patient is experiencing different issues as well; therefore it can be said that chief emphasis should be laid on removing the level of pain that exist in the patient (Bernard, Loeslie and Rabatin, 2016). Due to this health state, the state of unconsciousness usually appears and as a result patient get weaker. Due to road traffic accident, head injury is caused to the patient; therefore chief focus shall be laid on managing internal functioning of the brain. Since, brain is entitled to manage all the functions of the body; therefore it is essential for the nurses to ensure that suitable remedies are being given to the patient. In addition to the same, patient is also having other injuries; therefore suitable care should be given accordingly.
Along with the same, it is vital for the nurses and care practitioners to ensure that proper airway management is being conducted as the patient is on mechanical ventilator. Furthermore, in this regards, it is evident that while shifting the patient in PICU, proper diagnosis is being carried out as then only supportive medical care can be delivered. Therefore, under acute care concept, focus will be laid on airway to manage berating exposure and along with this, chest movement will also be managed accordingly. Similar to this, it will also aid in reducing berating related issues; hence air movement will be managed suitably. Chest expansion is one of the symptoms that could arise in the present case; therefore in this respect proper emphasis should be laid on breathing.
Since, focus will also be laid on exposure; therefore considering the same proper physical examination will be carried out accordingly. The patient might be having diverse injuries along with head injury; therefore considering the same prominent preventive methods should be adapted accordingly. The issues of hypothermia can be avoided in the same way in which it is crucial for the nurses to conduct direct analysis about the exact situation. Physical examination is necessary so that overall health prospects can be ascertained and this is also imperative in terms of protecting the patients from other injuries . While on the other hand, skin bruises because of road accident shall also be analysed as that may impact the health dimensions of patient. The chances of trauma also exist in the present case because of head injury; henceforth all the associated health issues are required to be analysed accordingly.
Acute Care Nursing Concept
Typically, Acute care Nursing stream provides assistance in clinical practice in which nurses are delegated diverse cases especially when they have knowledge about advanced nursing practices. In this process, focus shall be laid on exploring emerging treatment for the patient so that health issues can be managed. Thus, according to the defined health status, it is essential for the nurses to ensure that all the practices related to patient service is managed in the best possible manner. Moreover, it can also be said that with the help of acute care nursing, chief focus should be given in injuries which could affect the health of patient for longer period. Head injuries are common reason for which patients usually visit to emergency department and at the same time, it requires suitable treatment as well.
In the present study, the patient is 6 years old; therefore it is vital to conduct early diagnosis as late diagnosis and intervention is a major factor that could influence the decision to adopt a clinical strategy (Kim and et.al., 2016). Therefore, according to the health aspects for head injury, it is essential for the nurses to adopt consistent approach so that suitable services can be delivered accordingly. This is also vital in analysing the long term consequences of head injury. In this respect, proper emphasis should be given on physical attributes of a child’s skull as that showcases the exact situation of the brain. Fractures and other issues could also arise accordingly; hence suitable analysis is required to be conducted accordingly.
Strengths and weaknesses of the nursing management process
In the above section, two different nursing management processes are being defined wherein one is focusing on head injury and the other one is emphasising on breathing issues. Therefore, both are major health issues prevailing in the patient. In order to manage such issues prominently, it is vital for the nurses and care providers to adopt quality measures so that suitable services can be rendered accordingly. Focus on airway will also aid in managing oxygen capacity and meanwhile it can change the health prospects.
Furthermore, in the same dimension, it is clear that issues related to breathing also needs suitable consideration as that might hamper functioning of liver and lungs both. However, chief focus should be given on controlling and monitoring so that areas of improvements can be identified accordingly. This is also suitable in terms of adopting effective measures for health dimensions. Therefore, in this respect it can be said that according to the nursing intervention, nurses are required to consider various things into account to treat the patient in the best possible manner.
Current workplace system for nursing management of patient
Analysing the current workplace system, it can be said that at present, only a few services are available at the care home; therefore improvements and modifications are essential in the same way. Moreover, in a few areas, nurses should get training as well so that they can deliver suitable and quality associated services to the 6 years old patient (McNamee, 2016). Moving on to safety and security aspects, it can also be said that nurses should develop safe and secure environment. Similarly, this can also aid in reducing other issues prevailing at the workplace. Nurses should also give consideration towards availability of tools and techniques so that suitable services can be delivered. Therefore, prior delivering any health care service, it is essential for the nurses to ensure that staff members have the information to deal with all tools and equipment. In this way, suitable care amenities can be delivered to 6 years old patient. Therefore, it can be said that suitable changes are also required in the same dimension so that value of services can be underpinned accordingly.
Best practice guidelines for current workplace systems
There are varied dimensions and aspects that are required to be considered during management of workplace system. In this respect, focus should be laid on health and safety dimensions so as to avoid the chances of accidents and uncertainties. Patient’s safety and quality of care is crucial; hence according to National Safety and Quality Health Service Standards, nurses are ought to promote education and training among the colleagues. This way support can be delivered to others in different ways. As per Australian Commission on Safety and Quality in Health Care, it can be said that there must be suitable emphasis on risks and for that specific procedure is required to be followed. Moreover, in the same context, this will also assist in maintaining patient’s safety and security aspects.
It is the duty of the health care practitioners to ensure that safe and secure culture is being developed at the workplace; henceforth performance should be reviewed accordingly. This is also essential for managing diversified changes in health care services. Nonetheless, all the defined protocols and policies should be adhered accordingly so as to prevent legal aspects of the health care entity. The guidelines also states at workplace, clinical governance framework should be adopted accordingly so that risks and challenges can be avoided. There must be proper reporting of the issues prevailing in the organisation as that can only aid in ensuring that proper actions are taken to minimize and eradicate such challenges. Therefore, according to the performance changes, it is essential for the nurses and care practitioners to implement new and diverse ways of delivery services.
Areas of improvement in nursing management of patient
The above mentioned nursing management is for patient who has severe injuries because of road accident; therefore in this context it can be said that several aspects needs to be considered on appropriate basis. Nurses must have to focus on quality dimensions so that patient can get recovered as soon as possible. Moreover, in this respect it is also crucial for the nurses to conduct monitoring and continuous evaluation so that changes can be made to the health dimensions. As mentioned in the above section, focus has been laid on two basic aspects of acute care such as- culture in practice and clinical specialization. Thus, in both the aspects, it is evident that there must be suitable assessment of health condition of the patient so that proper remedies can be adopted accordingly. Culture in practice states that nurses must adopt suitable culture while delivering the services as then only best interest of the patient can be maintained.
At the same time, it is also vital for the nurse to ensure that family members of the patient are being involved in decision making process as they possess the right to be informed. Suitably, this can aid in developing better understanding among patient and nurse. Moreover, it can also underpin service delivery aspects. Along with the same, it is also crucial for nurses to focus on clinical specialization because that aids in managing health aspects in suitable manner. Further, this can also encourage health professionals to encourage the health dimensions in the society. Thus, in terms of areas of improvement, it can be said that along with professionalism, ethical and legal prospects are also required to be considered at the same time. This is also useful in supporting care provisions.
Conclude the analysis with some recommendations for future practice
Thus, summing up the entire nursing process, it can be said that because of suitable nursing care, the patient can be protected from other injuries and health issues. In every care provision, it is essential for the nurses to consider safety and quality in health aspects as then only, valuable services to the patients can be delivered (Thackeray and et.al., 2016). Thus, according to legal prospects, it is significant to consider that patients and carers have an important role to play in the safe delivery of health care.
In addition to the same, it is also essential for the clinical workforce to deliver high quality health care services. However, in the present case all the important dimensions of service delivery process are being considered; still there are many areas which needs improvement for betterment of the services. Therefore, in this context it can be said that health care can be improved when patients and carers comply with all the legal aspects in suitable manner. Henceforth, several things are required to be considered in this respect which can also underpin health care needs of the patients. There should be proper recording of each and every event so that suitable care services can be delivered accordingly.
- Bernard, S., Loeslie, V. and Rabatin, J., 2016. Use of a Modified Frazier Water Protocol in Critical Illness Survivors With Pulmonary Compromise and Dysphagia: A Pilot Study. American Journal of Occupational Therapy.
- Bogert, J. N. and et.al., 2017. Resuscitative endovascular balloon occlusion of the aorta with a low profile, wire free device: A game changer?. Trauma Case Reports.
- Bragge, P. and et.al., 2016. A state-of-the-science overview of randomized controlled trials evaluating acute management of moderate-to-severe traumatic brain injury. Journal of neurotrauma.
- Davies, S. and Doyle, M. P., 2016. Major self-mutilation leading to complete amputation of the hand during an acute psychotic episode.
- Hubbard, J. L. and et.al., 2016. Use of endotracheal tubes with subglottic secretion drainage reduces ventilator-associated pneumonia in trauma patients. Journal of Trauma and Acute Care Surgery.
- Kawai, Y. and et.al., 2016. A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing. Pediatrics