In order to design an effective nursing diagnosis it is necessary to analyse the condition of the patient. Here, the patient Mike was a 24 year old male who fell off his motorbike while driving and was transferred to the emergency medical department for treatment. On arrival at the emergency medical ward the patient complained of pain in the lower left leg. Further x-ray confirmed that the patient had fracture in the tibia, fibula. After diagnosis the patient was suggested open reduction and internal fixation (ORIF) of the fracture. Hence, it is important to design nursing priorities for post-operative care of the patient. Therefore, as an effective post-operative care measure the patient had to be provided with pain management medication. Form the patient history and primary survey conducted by the nurse it was analysed that the patient was suffering from severe pain due to fracture in lower limb and had to be provided opoids for effective pain control.

A DRSABCD approach was used for the diagnosis of the patient condition

Danger –

The patient complained of acute pain in his lower left leg indicating fracture  

Response-

The patient was responsive and complained of pain on moving his lower left leg

Send for help –

The patient was moved to the emergency department

Airway-

The breathing was slightly exaggerated in the patient

Breathing-

The patient recorded 22 breaths per minute

Cardiopulmonary resuscitation –

The patient recorded 90 breaths/minute, which was higher than the normal of 72/breaths per minute

Defribrillator-

The patient did not require a defibrillator as he could breather normally

Analysis of acute versus potential risk:

Hence, from the analysis it could be said that the patient was suffering from acute pain owing to left limb fracture. Therefore, pain management was one of the acute nursing interventions, whereas secondary site infection (SSI) has been termed as one of the potential risk factors in post –operative care (Hayes & Gordon, 2015).

Planning goals 

The planning of effective goals serves as one of the important strategies of nursing care. The goals had been developed in correspondence with the nursing priorities. The two such nursing priorities which had been identified over here are effective pain management and infection prevention at the site of wound. Further SMART goals have been developed for the dissemination of the nursing care strategies.

Planning of Pain management 

1. A) Patients shows satisfactory pain control

Specific –

The patient to be out on Paracetamol 1g IV/PO 6 hourly basis for pain control

Measurable-

The  pain to be measured on a ten point scale.

Attainable –

To reduce the  ratings  for pain on  ten pointer scale.

Realistic –

The   pain assessment of the patient to be done on a 6-hourly basis based  upon which  further pain management strategies to be developed (Mann & Carr, 2018)

Time –bound –

The entire process to be executed within next 48 hours.

1. B) Patient shows improved well being such as baseline levels for pulse, BP, respirations

Specific –

The patient to be administered ovoids under 0.2% normal solution, in order to maintain the normal blood plasma concentration.

Measurable –

The viral signs of the patient checked such as blood pressure, respiration rate very three hours

Attainable –

The blood pressure to be effectively regulated though liquid saline injections.

Realistic  –

Based upon the blood pressure monitoring the person to be further continued on particular doses of IVT.

Time-bound-

The patient to be monitored for at most 48 hours.

1. C) Patient shows improvement in coping

 Specific-

Vital signs monitored such as speech, response, awareness of the surroundings

Measurable-

The pain assessment conducted  on a  ten point scale

Attainable-

The patient to be provided with help in the form of counselling

Realistic –

Based upon the vital monitoring sign further medication provided  to the patient

Time-bound –

The entire process to be achieved within 72 hours

Implementation 

The nursing professional needs to administer as well as monitor the doses as well as side effects of analgesics in the patient.  Effective pain management cannot be done without administration of analgesics (Hayes & Gordon, 2015). However, the side effects from analgesics vary due to different degrees of absorption and metabolism in the patients.

In order to access whether the planned outcomes have been met the pain in  the patient could be measured with the help of a Braden scale (Rantala, Kankkunen, Kvist & Hartikainen, 2014).

The nurse should also ensure that no secondary infection develops at the site of infection.  As mentioned by Glowacki (2015), secondary infection at the site of wound could lead to sepsis and resultant organ failure. The patient condition was analysed through the Danger, Response, Airway, Breathing, Circulation, Defibrillation pathway. Hence, the secondary site infection (SSI) was seen as a potential risk factor as the patient had to undergo a surgery in the lower left limb.

Wound prevention at the site of infection

1. A) Patient demonstrates understanding of plan to heal tissue and prevents injury

Specific-

Patient to be administered  basic  wound management education by the nurse

Measurable-

The  healing of the wound site monitored on a regular basis in term of size reduction

Attainable –

The reduction in the wound area

Realistic –

The patient to be given antibiotic  medications for prevention of  recurrence of the infection (Zoëga, Gunnarsdottir, Wilson & Gordon, 2016)

Time-bound-

The  wound size to be effectively  monitored and reduced  within a  week

1. B) Patient’s wound decreases and has increased granulation tissues

Specific –

The size of the patient’s wound size to be monitored on the basis of diameter and reduction it the size of  diameter

Measurable-

The reduction in the wound size  would help in understanding the speed of recovery process of the patient

Attainable – To reduce the number of wounds  which  signifies faster recovery

Realistic – To  provide the patient with sufficient support and aid for self wound management

Time-bound – The  entire process to be achieved  in a week

1. C)  Patient does not report any altered sensation at the site of tissue impairment

Specific – Increased  dose of antibiotics

Measurable- The  pain reduce on 10 point scale

Attainable – Patient  ready to learn effective wound management

Realistic – Patient to be provided with crunches to reduce movement hassles.

Time-bound -To be achieved in a week

 Hydrofibre dressing will be used by the nursing professional instead of traditional gauge dressing to be used for the surgical site healing. As compared to the traditional gauge dressing reduced length of stay of the hydrofibre gauge dressing is associated with less pain, faster healing and improved patient confidence (Rantala, Kankkunen & Hartikainen, 2014).

The evaluation to be performed through checking the reduction in diameter of the wound which will help in accessing the recovery rate.

References

Glowacki, D. (2015). Effective pain management and improvements in patients’ outcomes and satisfaction. Critical care nurse, 35(3), 33-41.

Hayes, K., & Gordon, D. B. (2015). Delivering quality pain management: the challenge for nurses. AORN journal, 101(3), 327-337.

Mann, E., & Carr, E. (2018). Pain management. Foundation Studies for Caring: Using Student-Centred Learning, 259.

Rantala, M., Kankkunen, P., Kvist, T., & Hartikainen, S. (2014). Barriers to postoperative pain management in hip fracture patients with dementia as evaluated by nursing staff. Pain Management Nursing, 15(1), 208-219.

Zoëga, S., Gunnarsdottir, S., Wilson, M. E., & Gordon, D. B. (2016, January). Quality pain management in adult hospitalized patients: a concept evaluation. In Nursing forum(Vol. 51, No. 1, pp. 3-12).