Clinical Reasoning Cycle And Nursing Care For Miss Jane Green

patient situation

Subjective data

Miss Jane Green is a 30-year-old female who was hit by a car that ran a red light while she was crossing at a pedestrian crossing.  The impact caused Jane to be thrown into the kerb resulting in an apparent left lower leg fracture.  She has just arrived on your ward from the emergency department.  She winces visibly but answers that she is worried about her mother who is in the early stages of dementia and for whom she is the sole carer.  Upon clinical assessment, the nurse release that she has a bad graze on her left shoulder. The time is 0800.

Collect Cues

OBJECTIVE DATA

patient assessment : Miss Green information:

Vital signs

BP: 155/90

Pulse: 107bpm

RR: 22

Sa02: 97%

Temp: 36.6

Other data

GCS: 15

Pain score: 9/10 on movement. 8/10 on rest

Patient is becoming anxious in regards to her mother’s welfare.

Neurovascular assessment

Capillary refill rate of >3 seconds.

Complaining of tingling in the toes of the left leg

Increased pain at rest and upon passive movement of the affected limb

Left leg appears paler than right leg

Process Information

Interpret:

normal/abnormal

Normal

Abnormal

Bp, pulse rate, RR, saturation 02, temperature, capillary refill rate

GCS: 15, and pain score, patient becoming anxious regarding the mother’s welfare, complaining of tingling in the toes of the left leg, increased pain at rest and upon passive movement of an affected limb, left leg appears paler than the right leg.

abnormal findings to the underlying physiology/pathophysiology

It is evident Jane has both chronic pain and anxiety due to high pain score. For the caregivers to accurately evaluate and manage a patient with chronic pain and simultaneous mood disorder; it essential to apprehend the similar pathophysiological process underlying the conditions. Chronic pain is explained as pain that persists beyond the projected course of normal healing. Chronic pain and mood disorder such as anxiety usually cohabit due to the pathophysiological matches connecting to neurotransmitter in the CNS (Taylor 2014, pp.48). Evaluation of pain in patients with the anxiety is done broadly taking into account numerous aspects such as social, emotional, and psychological matters. Patients can be hard to cure due to a variance in view of pain and negative handling skills. Treatment of prolonged pain in patients with anxiety is excellently done by a pain managing team that concentrate on the patient’s obligation to enthusiastically take part in the therapy process (Taylor 2014, pp.48). For the Jane to reach her goals, it is crucial to ensure she is adequately well-versed of the state, and genuine expectation of pain controls is set.  Dispensing chemist can play a vital role ranging from inpatient to ambulatory setting and health to the psychiatric surrounding. The incidence of the anxiety and chronic patient due to the fracture of the bone in hospice is high, and pain is correlated with the cognitive impairment (Cooper et al. 2012, pp.98).  Since the anxiety accompanies the patient with chronic pain due to the rupture of the bone, health care provider should comprehend that and offer psychological interposition such as cognitive behavioural healing as well as anti-depressants or anti-anxiety treatment at the early phases. Health care group should admit that pain is one of the most prominent factors aggravating mood illnesses, and should pay particular consideration to pain controlling.

Predict:

What may happen to Jane if NO action taken and why?

Some fractures need not to be cured as they can be left to mend without the support of the medical interference. Medical professional may resolve it is the best option specifically when small bones are cracked such as in the case Jane (Department of Health 2012).  Another scenario is where medical professional makes a mistake during the x-ray examination.  If the fissure is not handled correctly, it can possibly lead to some problems such as infections specifically of the bone or bone marrow. It can also grow into a persistent contagion called osteomyelitis; eternal nerve injury; distortion where bone heals in the wrong site; splitting of muscle or ligament’ blood clotting; finally avascular necrosis where the bone loses blood supply (Brukner 2012, pp.20).

Identify the Problem/s

 Three key nursing problems

Risk of infection

Self-care deficit

Constipation

Establish Goals & Take Action

nursing problems, goals, related actions, and rationale

 To  

Evaluate outcomes & Reflect on new learning

Evaluation

Bone fracture among adults is significant health care concerns globally (Sale et al. 2011, pp.2067).  In the present clinical surrounding of care for the rupture actions, health care providers often disregard the patient risk for the imminent fractures, and therefore they need to speak the threat. The evaluation of after fracture management and patients awareness is essential to prevent future rupture, but, not sufficient. The occurrence of bone breakage in adults needs to be related with the post-fracture evaluation to prevent secondary fractures (Song X et al. 2011, pp.828). But, prosperous secondary preclusion measures rely not only on examination and commencement of the cure but to the upkeep of treatment: loyalty and acquiescence, which poses extra concerns. A range of execution challenges and investigation concerns lie onward.  Beginning with health structures embracing continues expansion in various environment and sharing the experience