Patient Centred Care

8 August 2016

This essay will engage closely in exploring the case study provided during week one through four. It will deal with various issues such as the difference between type one and type two diabetes, outcomes of poorly managed blood sugar levels, the necessity of pain control during post-operative care for Josie, the implementation of Tanner’s model of clinical Judgement and lastly but not the least, a summary of Josie’s progress note.

Diabetes and blood glucose control As Diabetes Mellitus is closely connected to the insufficient action of insulin in the body, the type one and two diabetic patients suffer mainly from managing their blood sugar levels (Crisp & Taylor, 2009. ). The widely known differences between the two diabetes are that type one diabetes display an inability of the pancreas to create insulin for the body as its cells producing insulin are destroyed.

Type two diabetes do produce insulin, however due to the reduced production of the insulin by the pancreas, the body is unable or resistant to use the insulin appropriately and leads the body to face difficulties in maintaining homoeostatic balance.

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Further differences of type one and type two diabetes could be identified in managing the disease. It is essential for type one diabetic patient to be treated with an external source of insulin, however for type two diabetic patients the treatment could vary simply from controlling their diet and exercising, or injecting insulin into the body to control their blood sugar levels (Barnes, 2004).

Poor function of insulin to control Glucose is the energy source that the cells feed on to survive, therefore poor management of the blood glucose will lead the cells to suffer from insufficient amount of energy to regulate the entire body (Australian Institute of Health and Welfare, 2008). Although the effects may not be immediately life threatening, conditions such as constant exhaustion or hypoglycaemia occurs when there is a low level of glucose in the blood. The patients at such circumstance will experience headaches, dizziness, hunger, seizures and fall into comas at extreme cases.

Other outcomes may occur due to hyperglycaemia, when high blood glucose levels damage the small blood vessels. Blood vessels which supply energy to the cells become affected by the high glucose level which in return causes the blood to be toxic and the formation of blood clots (Zmuida, 2009). This will soon result the nerves and the cells to poorly function and trigger blurry vision, nerve damage, poor circulation, foot infections, cardiovascular complications, kidney infections in the long run. Importance of postoperative pain control

One of the most important purpose to perform a postoperative pain assessment is to manage the risks the patient may face after the operation. By assessing the location, severity, type of pain and the temperature of the pain area, the patient is likely to have lower risks of developing an infection or a disease during recovery (Doherty, 2010). If pain control assessment is absent during a postoperative care for Josie Elliot, Elliot is likely to meet high levels of pain and stress in dealing with the pain.

Such stress is likely to interfere with the other postoperative recovery exercises as it is predictable that Elliot will be physically tensed and unwilling. Furthermore, the consequences of not acknowledging the pain areas for Elliot, could lead to overlooking problems such as swelling or internal bleeding of the operated wrist. Although the problems may be small, they are likely to grow into serious matters such as haemorrhage and amputation. Therefore, for the patients to be less at a risk of becoming susceptible to complications- pain control is the stepping-stone to safety and be considered as a major priority of postoperative care.

Tanner’s Clinical judgement: Noticing In this initial step of clinical judgement the nurse will focus in recognising the current situation of the patient. The nurse will seek to find future discomforts and problems that may occur during the care for the patient (Tanner, 2006). As for Elliot, who had an active life before being submitted into the hospital, the nurse should concentrate in understanding the patients psychological well being. Elliot being in such a contrasting environment to her daily life in the society, she could be expected to experience severe stress.

For example, the nurse could initiating a casual conversation to assess any signs of depression or discomfort that Elliot may be experiencing. Through her voice, expression or gestures, the nurse will be able to notice conditions out of the ordinary. Another way to collect more informations about the patient may be communicating with the family members. Family members are the ones who will know the patient well enough to be concerned with the minor changes the patient shows.

Such way of assessing the patient will help the nurse to accurately point out the changes occurring to the patient and gain deeper understandings of the patient conditions. Interpreting This phase is about digesting the collected information about the patient. For example, Analysing and interpreting the patient’s idea of his or her condition will allow the nurse to prioritise her tasks for the patients health care. Prioritising tasks will help the nurse to initiate the most argent care needed for the patient. This will decrease number of the patient’s risk factors and benefit the patient to be nearer to the risk free zone (Tanner, 2006).

For further example, the nurse could interpret Elliot’s dull and restless behaviours, responses, moods and expressions as a sign of depression. Other objective data such as Elliot’s vitals signs could be interpreted into a certain warning for an occurrence of a diseases. After understanding these informations, the nurse could then prioritise the absorbed informations from the most severe issues to the least (Bradshaw & Lowenstein, 2010). In Elliot’s case it would first be the pain assessment on her fractured wrist and the vital signs to identify and tightly secure Elliot’s overall physical health which is crucial.

The next will be followed by Elliot’s psychological assessment to ensure Elliot will not be harmed by depression. The last task on the list could be the patient shower to benefit Elliot to feel better and comfortable. However being at the end of the list does not indicate that this task is the least important. Responding This phase requires the nurse to be skilful in order to act out and perform the tasks set out in the previous phase of interpreting (Bradshaw & Lowenstein, 2010). At this time of care, the nurse is expected to be insightful, with the attitudes of calmness and confidence to achieve successful outcome of the practice.

For example, the nurse could systematically perform the interpreted and prioritized tasks on Elliot. During each task the nurse should explain the procedures being undertaken and communicate with the patient to be informative and clear. This will bring Elliot to be aware and be assured of the care being provided. This will help her to feel less confused or discomforted by knowing what is going on with her body while receiving the care. This step of clinical judgment will inform and educate the patient which is a crucial part of patient centered care. Reflecting

Reflecting in tanner’s clinical judgment refers to having the knowledge to predict what is expected as an outcome of the care provided. There are two different aspects of reflection which are reflection-in-action and reflection-on-action. Reflection-in-action is when the nurse assesses the patient’s feedback or response in coping with the tasks and the care practiced on the patient. Reflection-on-action is how the nurse learns and gains further knowledge through the patients response to a particular nursing care (Bradshaw & Lowenstein, 2010). During Elliot’s care, the nurse has given the medication to Elliot for pain relief.

The nurse should observe and record Elliot’s responses to the medications. The first response the nurse will be looking for would be the complications occurring Elliot’s health due to the medication, such as a side effects or an allergic reaction. Secondly, the degree of effectiveness of the medication for Elliot to reduce the pain would also be analyzed. After Elliot’s responses have been assessed, the nurse should immediately make an effort to improve the status of the patient, and further promote patient centered care. Fracture in her left wrist from playing soccer. Has a history of Type 1 diabetes, on regular S/C insulin injections . Blood sugar within the average range of 6. 3 mmol/L. Vital signs have been within the normal range: Blood pressure 110/80, Heart rate 61, Oxygen rate 100%, Respiratory rate 17, Pulse rate 100 and Temperature 37. 8. Went to surgery 09/08/10, returned to ward with no complications. Has a cast with fingers exposed.

Post-op requirements 10/08/10 included: indwelling catheter, 6LO2 saturating at 100%, 0. 9 Saline and 5% Glucose at 42mls/hr, PRN analgesia, ceased fluids after commencing oral intake, positioning patient to raise limb and neurovascular observations . Neurovascular observation of colour, capillary return, temperature, pulses, bleeding were within the normal rage. Movement was reduced due to patients pain rated to be 6/10 uncontrolled. Sensation was tingling around the fractured left arm. 11/08/10: Panadeine forte given for management of pain. Pain score reduced to 2/10. patient orally eat and drink.

IDC was removed at 0600. Passed urine at 1100. Has a unoccupied cannula on right arm. Removed Indwelling catheter at 0600. Completed shower and resting comfortably at the time of report. For review by RMO: heeeun Hee-eun Yeo (UTS Nursing student) F. N Florence Nightingale (RN). Conclusion The essay explored the case study provided during week one through four. Focuses were set on; diabetes, issues of controlling the sugar levels, the necessity of pain control during post-operative care and the implementation of Tanner’s model of clinical Judgement on the bases of patient centered care.

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