This assignment aims to implement a hypothetical nursing care plan for a patient that I been involved with recently whist on clinical placement. I have used a published nursing model in order for me to apply an appropriate nursing care plan for my chosen patient. I will explain my reasoning for the purposed care, whilst also including an explanation of how pathophysiology contributes to the patient experience. In accordance with the Nursing and Midwifery Council (NMC 2008) and the Data Protection Act (1998), all names and locations have been changed in order to maintain confidentiality.
The Patient Thelma is a 75-year-old female who had fallen from a chair when changing a light bulb. Her husband was out walking the dog at the time, and found her on the floor on his return. He called an ambulance and she was admitted to the accident and emergency department (A&E). After an X-ray in A&E it was discovered that Thelma had fractured the neck of her right femur. The diagnosis of a fracture is based on history, symptoms and on radiographic studies (Schoen 2000).
The general opinion is that two views at right angles, are the minimum number required to evaluate a suspected fracture and that the X-rays should include the joints above and below (Kunkler 2002). Following the X-ray, Thelma was then admitted onto an orthopedic ward. For the purpose of this assignment I have chosen a time frame of an 8 hour shift looking specifically at Thelma’s care post-operatively. As defined by The Royal College of Physicians (RCP, 2001), there are two types of fractured neck of femur.
Firstly, those occurring within the capsule of the hip joint between the head of the femur and the pelvic acetubum, making it intracapsular. Secondly, those occurring outside the hip joint capsule making it extracapsular. Walsh and Crumbie (2007a) also state that fractures of the femur neck are generally divided into two categories, intracapsular or extracapusular. Intracapsular fractures occur through the capsule at the base of the femur head. Extracapsular fractures pass through either of the trochanters or the intertrochanteric area.
Fractures to the intracapsular region are likely to damage the blood vessels supplying that region, therefore causing avascular necrosis (Schoen 2000a). When this is the case hemiarthroplasty is the chosen surgical intervention (Santy 2005a). With extracapsular fractures however, the viability of the blood supply to the femur head is not usually at issue (Walsh and Crumbie 2007b) and the choice of fixation is either dynamic hip screw or an intrameddullary nail (Kunkler 2002).
In her fall Thelma sustained a closed and undisplaced intertrochanteric fracture of the proximal femur therefore making her fracture extracapsular. Because of the nature of her fracture it was decided that a dynamic hip screw under general anesthetic would be the choice of surgical intervention. Specifically a four hole 135 DHS plate with an 85mm DHS lag screw. The wound was closed with 3/0 Monocryl and dressed with steripad. No drains were inserted. A dynamic hip screw is the implant of choice for stable trochanteric fractures (Harrington, et al 2002, Lorich, Geller and Nielson 2004).
This is considered to be particularly so in the elderly (Koval and Zuckerman 1998). Fractured neck of femur most commonly occurs in older women who have osteoporosis, following a fall (Gordon 2005). Osteoporosis is defined as the reduction in bone mass that increases the susceptibility to fracture (Leppert and Peipert 2003). Nursing Model For this assignment I have chosen to use the Roper Logan Tierney Model of Nursing based on Activities of Living (2002) to create an effective care plan for my patient.
The model looks at 12 activities of living that a person carries out each day. The nursing model is based on the theory that people are best understood by the activities of their lives (Aggleton and Chalmers 2000), biological, social and cultural. Some activities are essential and primarily biological in nature, while others are non-essential but enhance quality of life. According to Holland et al (2008) the model incorporates physical, psychological, socio-cultural, environmental and politico-economic aspects.
I looked at a variety of nursing models such as Orem’s General theory of Nursing, Henderson’s Definition of Nursing and Roy’s Adaptation Model. However, the Roper Logan Tierney Model uses a holistic and individualistic approach, whilst also incorporating a life span continuum, where the individual passes from fully dependent at birth, to fully independent in the midlife, and returns to fully dependent in their old age. Other models didn’t include this life span, nor did they include the process of dying. The Roper, Logan and Tierney model is a good all ound general purpose nursing model, suitable for adaptation and modification within variable clinical settings. The model is patient focused and allows the patient to participate in the management of their care. Bos (2008) states that by allowing the patient to be actively involved in the planning of their care, this empowers the patient. The model is relevent to my chosen patient scenario as it recognises how injury can affect the patient’s self-care ability (Santy 2005b) on top of the many serious medical complications.