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Complex Patient Plan Of Care Question: Discuss about the Complex Patient Plan of Care.     Answer: Complex Patient Plan Of Care        Patient/Nursing Problem Patient Assessment Data Optimal Patient Outcome/Goal Pain related to bone fracture, soft tissue injury, muscle spasms, traction/immobility devices, anxiety and movement of bone fragments (Brown 2017). As evidenced by patient verbalizations of pain scale of 4/10, guarding, facial mask of pain, alteration in the tone of muscles and distractions. Patient should verbalize pain relief, rest and sleep appropriately. Patient should demonstrate relaxation techniques and diversional activities (Gordon, 2014).  Risk for infection related to open and dirty wounds due to broken skin, damaged skin tissues, compromised blood circulation and invasive surgical procedure (Gordon, 2014).  Open and dirty wounds on the skin that are filled with sand from the scene Exposed body tissues Compromised flow of blood to the foot due to the fracture Patient to remain free of infection as evidenced by vital signs which are within normal ranges. Patient demonstrates meticulous techniques of handwashing and preventing infection (Brown et al, 2017).  Impaired physical mobility related to restrictive therapies such as limb immobilization, discomfort, pain and muscular skeletal impairment. As evidenced by reduced muscle control and strength, limited range of movements, imposed surgical restrictions and inability to purposely move within his physical environment. Patient regains and maintains mobility and demonstrates tactics of enabling resumption of normal activities. Patient maintains his position of functioning and shows increased strength and control of the compensatory and affected body parts. Impaired tissue/skin integrity related to compound fracture, altered level of circulation, puncture injuries, physical immobilization, surgical interventions and insertion of wires, pins and screws during traction (Brown et al, 2017). As evidenced by reports of pain by the patient, skin surface disruption, destruction of skin tissues and layers and invasion of structures into the body. Patient verbalizes relieved discomfort and demonstrates techniques and behaviors of preventing breakdown of skin to facilitate faster healing. Achievement of timely healing of lesions and wounds (Gordon, 2014).   Risk for falls and trauma related to weakness, movement of fragments of bone and loss of the integrity of body skeleton due to fractures. Bone fractures and dislocations Displaced fragments of bones   Limited movements due to the bone injuries   Maintain alignment and stabilization of fractures. Display formation of callus and bone union as expected. Patient demonstrates body mechanics aimed at promoting fracture site stability (Gordon, 2014).  Patient Background Mr.Ben Casey is a male patient aged 38 years. He was brought to the UTS Emergency Department this morning by an ambulance with injuries secondary to MVA. X-rays at ED showed Left femoral Fracture and Left tibia open-displaced fracture. Ben was then scheduled for an urgent surgery for reduction and fixation of the noted fractures. The surgery went for 3 hours and was uneventful. Estimated blood loss during the surgical procedure was 750mls and 750-1000mls during the scene. Ben’s major complaint was pain. He had been given 25mg of Intravenous Morphine but he reports that the pain is tolerable at a score of 4/10.The dressing on the left thigh is intact and dry with slight oozing. The Glasgow Coma Scale was 15/15. Based on the last observations done, there were no major variations and patient reported improved pain with a score of 7/10.   Pain This was an unpleasant emotional and sensory experience for the patient which arose from bone fractures, skin and tissue damage following the scene. Assessment data for this problem was patient verbalization of pain at a score of 4/10, discomfort, distractions and alteration in the tone of muscles. This data was both subjective and objective. It was identified by a collaborative team of nurses and physicians. Based on this problem, the expected outcome was that patient should report relived pain, display relaxed manner, relaxation and ability to sleep and rest comfortably (Trentz, 2014). The A-G style of physical assessment was applied to obtain and organize data from the patient to plan for care. Regarding nursing interventions, all affected areas were maintained immobile using tractions, cast and bed rest was encouraged in order to relieve the level of pain and avoid displacement of the bones and extension of tissue/skin injury (Trentz , 2014).The injured extremity was supported and elevated to promote venous return, reduce pain and edema. Evaluation and documentation of reports on discomfort and pain was done noting the intensity at a scale of 0-10, aggravating and relieving factors. All the non-verbal cues of pain such as vital signs, behaviors and emotions were noted. All this was meant to evaluate the effectiveness of the nursing interventions implemented (Resick, 2014). Nurse encouraged Ben to discuss problems which were related to his injury in order to alleviate the level of anxiety as it relieved the experience of the accident. All procedures were fully explained to the patient and consented to allow him prepare him psychologically and enable him cope with the level of discomfort associated with the procedures (Resick, 2014). Emotional support was fully offered and the patient was encouraged on use of techniques of managing stress such as deep-breathing exercise and visualization imagery to refocus his attention and promote sense of control which enhance his abilities of coping with stress associated with the traumatic scene which led to the pain (Gandhi et al, 2012). When on pain, the patient was given stat doses of analgesics to relieve pain. Performance and supervision of exercises on active and passive Range of Movements was carried out to maintain mobility and strength of the unaffected muscle to enhance resolution of inflammation in injured body tissues. To evaluate on the outcome of the nursing intervention implemented, the patient was re-assessed. Patient reported reduced pain and he displayed relaxed manner. The patient could sleep and rest comfortably without any form of distractions. The two outcomes were achieved because patient verbalized relieved pain and demonstrated relaxed manner and could sleep comfortably (Gandhi et al, 2012). Risk Of Infection Ben had risk of infection associated with inadequate primary defense which was caused by tissue/skin damage and broken skin integrity due to the traumatic scene that happened. This was also associated with the invasive procedures performed on him during the reduction and fixation of the fractures. On assessment, Ben had open wounds which were filled with dust from the scene, therefore this led to identification of the problem that he had an increased risk of contracting infections (Eiff, Hatch and Higgins, 2012).  Based on Ben’s scenario, our goal was to ensure that he remained infection-free despite the increased risk. Nursing care also aimed at ensuring that Ben developed meticulous techniques of washing hands before and after everything he did. To achieve these outcomes, various nursing interventions were implemented. Teaching on maintenance of asepsis in wound care, change of dressings, peripheral IV and catheter management. Aseptic technique decreased the chances of spread and transmission of microorganisms to Mr.Ben during nursing care. Transmission of infection was effectively prevented since the chain of infection was interrupted (Gordon, 2014). All health care workers were enlightened on importance of washing their hands before and after contact with the patient especially when conducting a procedure that involved the exposed skin areas. Hand washing was done before  and after gloving, touching the patient, dealing with an invasive device, coming into contact with body fluids of the patient and when moving from a contaminated to a sterile area (Perry et al, 2013).  Running water and friction when washing hands was meant to effectively reduce transmission of pathogens from one procedure to another. Health care providers washed their hands with plenty of water and antiseptic soap for at least 10-15 seconds and an alcohol rub as an antiseptic to kill microorganisms which could lead to increased risk of infection to Mr.Ben (Gulanick and Myers, 2013).  Patient was provided with diet-rich in proteins to support the responsiveness of the immune system. Adequate fluid intake of about 2000-3100mls of water every day was encouraged to promote formation of diluted urine and increase the frequency of bladder emptying and reduce the chance of urinary tract infection associated with irritation of urinary bladder by concentrated urine. The number of visitors was restricted to two people per patient to reduce the chances of transmission of pathogens (Morton et al, 2017). Visitors were fully enlightened on covering their nose and mouth when sneezing or coughing to help in reducing the risk of infection. Protective garments were used by health care providers when dressing wounds (Masters, 2013).  Masks were used in protection of the mucous membranes of the mouth, eyes and nose during procedures that involved direct contact with the patient that may generate fluids or splashes hence leading to infections to the patient.  Additionally, patient was fully encouraged on importance of adhering to the prescribed medications (Hung et al, 2012). Generally, aseptic techniques were fully implemented. To evaluate the applicability of the nursing interventions, patient was assessed for sign of infections and all the vitals were within normal range (Neuman et al, 2014). Secondly, the patient, health care professionals and visitors demonstrated meticulous techniques of hand washing. Patient had no infections and he reported improvements of his complaints regarding his traumatic scenario (Masters, 2013). Conclusion Ben’s case was handled using multidisciplinary and multidimensional approach to ensure achievement of the set goals of nursing care. The priority nursing diagnoses for Ben’s care were impaired physical mobility, pain, risk for infection, impaired skin or tissue integrity and risk of falls. Nursing goals, interventions, implementation and evaluation of nursing care were all carried out based on the priority nursing diagnoses. Pain was managed using techniques such as psychological support, breathing exercises, ensuring minimal movements and medical management. To prevent the risk of infection to Ben, the health care professional were fully enlightened on aseptic techniques such as washing hands and use of protective garments when handling patients. The visitors and the patient himself were also educated on all measures of preventing infection spread from one place to another in the health care setting.   References Brown, D., Edwards, H., Seaton, L. and Buckley, T., 2017. Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences. Eiff, M.P., Hatch, R. and Higgins, M.K., 2012. Fracture management for primary care. Saunders/Elsevier. Gandhi, K., Baratta, J.L., Heitz, J.W., Schwenk, E.S., Vaghari, B. and Viscusi, E.R., 2012. Acute pain management in the postanesthesia care unit. Anesthesiology clinics, 30(3), pp.e1-e15. Gordon, M., 2014. Manual of nursing diagnosis. Jones & Bartlett Publishers. Gulanick, M. and Myers, J.L., 2013. Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences. Hung, W.W., Egol, K.A., Zuckerman, J.D. and Siu, A.L., 2012. Hip fracture management: tailoring care for the older patient. Jama, 307(20), pp.2185-2194. Masters, K., 2013. Nursing Practice. Role Development in Professional Nursing Practice, p.235. Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins. Neuman, M.D., Silber, J.H., Magaziner, J.S., Passarella, M.A., Mehta, S. and Werner, R.M., 2014. Survival and functional outcomes after hip fracture among nursing home residents. JAMA internal medicine, 174(8), pp.1273-1280. Perry, A.G., Potter, P.A. and Ostendorf, W., 2013. Clinical Nursing Skills and Techniques8: Clinical Nursing Skills and Techniques. Elsevier Health Sciences. Resick, P.A., 2014. Stress and trauma. Psychology Press. Trentz, O., 2014. Polytrauma: pathophysiology, priorities, and management. In General Trauma Care and Related Aspects(pp. 69-76). Springer, Berlin, Heidelberg.

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