Question

On Sunday at 1000hrs, you are assigned to admit a new client to your ward.

Fei Hong is a 70-year-old female who was admitted to your ward this morning following a fall at home. On admission, her daughter Yu Yan is in attendance. Fei Hong has sustained significant bruising and swelling to her right hip and shoulder with a large skin tear to her right forearm. She did not sustain any fractures. She is admitted for pain relief, dressings to her forearm and a physiotherapy review.

On assessment of Fei Hong, you note that she has bony prominences on her hips and pelvis, and is at risk of developing pressure areas.

Yu Yan has requested an interview with the doctor to determine if her mother needs any extra care at home, as Fei Hong is beginning to show signs of dementia according to her daughter. Fei Hong generally eats a small, but nutritious diet at home that includes all food groups, and is predominantly Asian cuisine.

Fei Hong has reported no urinary issues and takes Metamucil daily to prevent chronic constipation. She can shower and dress independently but requires supervision and prompting at times due to early signs of dementia. She had been mobilising independently prior to this fall.

She will need to be assessed by a physiotherapist for a walking aid. Medically, Fei Hong has some hearing and sight impairment, and wears glasses and bilateral hearing aids, but is on no regular medications.

Socially, she lives with her daughter Yu Yan, son-in-law George and their children – three-year old twins – and Yu Yan’s 17-year-old son Jason from a previous relationship.

Yu Yan cares for her mother and her three (3) children and has no community support for her mother. Fei Hong has no other extended family as she immigrated to Australia 16 years ago to help her daughter raise her son. She speaks little English and is Buddhist. She states that her strong faith and her daughter help her cope with her ageing process.

Fei Hong’s observations on admission are:

• Temp 36.1

• BP 105/68

• Respirations 18

• HR 64

• Height: 156cm

• Weight: 46kg.

• BMI of 19

Question1

Another nurse has drafted a plan of care for Fei Hong. Respond to the questions below based on your scope of practice as an enrolled nurse. Use 20 words for each to explain:

a) How you would confirm that this plan reflects the needs of Fei Hong and her family

b) If the care plan seems to conflict with the client’s needs and requirements, who you would speak with and how you would justify your assumption

c) If Fei Hong’s situation deteriorated after admission, who you would communicate this to, and when and how that should be done

Nursing diagnosis Planning (Nursing intervention) Expected Outcome

• Pain to hip and shoulder due to bruising and swelling following fall • Monitor pain levels with regular pain assessments, may need to use Abbey pain scale due to limited English.

• Minimise pain by administering regular analgesia as prescribed.

• Apply ice pack to reduce swelling as required. • Pain assessment scales reflect reduced pain levels after interventions.

• Reduced mobility following fall • Provide a safe environment for Fei Hong to mobilise

• Follow physiotherapy recommendations. • Fei Hong is able to mobilise with a frame and supervision.

• Potential pressure area formation; related to limited ability to move. • Provide regular pressure area care and assist with 2-4 hourly repositioning.

• Use air mattress to reduce pressure areas. • Skin integrity remains intact.

• Potential infection due to laceration/skin tear to arm • Keep wound clean, change dressings as prescribed.

• Review site for signs of infection such as redness, swelling, discharge.

• Monitor temperature 4th hourly

• Report any concerns to RN. • Optimal wound healing without infection.

• Potential decline in emotional state, related to lack of support in practising her religious faith and limited communication due to speaking little English • Allow time/support for Fei Hong to practice her faith as a coping mechanism.

• Use pictograms to assist with communication, and daughter/ interpreter to interpret on admission and throughout the hospital stay. • Optimal emotional state and Fei Hong able to maintain basic communication strategies.

• Hearing and sight impairment related to ageing. • Assist Fei Hong to apply her glasses and hearing aids.

• Ensure limited background noise when speaking to client.

• Do not shout at client, speak in a clear voice in good light facing her. • Fei Hong is able to see clearly and hear while in hospital.

Response: ??

Question2

Yu Yan and Fei Hong have a complex family. Fei Hong lives with her daughter and her family and Yu Yan is very involved in the care of her mother. In 50 words, explain why it is important to include Yu Yan in the planning of her mother’s care and describe two (2) techniques nurses can use to increase a family’s involvement in the care of their loved one during hospitalisation.

Response

Answer 1

1.To confirm that this plan reflects the needs of Fei Hong and her family the following plan should be implemented

• Knowing whether the plan is culturally competent
• Ensuring there is no linguistic barrier
• Age specific care and treating the patient with due respect and dignity
• Involvement of family in the care and providing a patient centered care.

b. If the care plan conflicts with the clients needs and requirements it is best to approach the incharge nurse to discuss about it. It can be justified by rationalising the needs based on the requirements.

c. In case if the patient condition detoriates it is best to inform the concerned provider and get the appropriate change of orders and implement it at the earliest to prevent complications .This has to be done immediately with no delay because of the risk of slow recovery process in old-age .

2.It is important for her daughter to involve in care because this can make the patient feel stronger and confidence that family members are there to care at this age. It can also improve the patient to adhere to the treatment .There can be continuous supervision of her daughter and ensure to provide a safe environment and recover healthily and quickly .

The strategies which can be followed to involve family in the care are by

• Involving them in the decision making process of the treatment .
• Gathering information from the family members regarding the needs of the patient and working towards to meet the goal