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Nursing Assignment: Case Of Medical Intervention For Better Health Management



This nursing assignment is based on the case scenario of patient, Mr Z. Mr Z has been admitted to your ward following an unwitnessed fall at home earlier this morning; he has sustained a (R) # NOF and is scheduled for theatre tomorrow morning for a (R) ORIF. And you are the nurse allocated to provide pre-operative person-centred care. Based on the subjective and objective data provided (appendix 1), identify three (3) actual or potential nursing problem statements relating to Mr Z’s pre-operative care. Nursing problem statements should be 3-part statements e.g. Problem related to aetiology (cause) as evidenced by signs & symptoms. Each of these nursing problem statements must be supported by the cues and data from the case scenario and supported with credible, current and relevant literature.

Assignment guidelines

  • Identify three (3) actual or potential nursing problem statements based on the subjective and objective data provided pertaining to Mr Z’s current admission. Each of these nursing problem statements must be supported by the cues and data from the scenario and justified (referenced) using current and relevant nursing literature. Nursing problem statements should be 3- part statements e.g. Problem related to aetiology (cause) as evidenced by signs & symptoms.
  • Using evidence-based practice, discuss how literature supports each nursing problem statement pertaining to Mr Z’s pre-operative care. The literature needs to be credible, current and relevant.
  • nursing-assignment-11


    The main concern of this nursing assignment is hip fracture which is the most common cause of emergency in the older population (Bell et al., 2021). Roughly, 70,000 hip fractures occur at the cost of £2bn to the healthcare facilities. Most patients with hip fractures have a range of co-existing health problems with functional deterioration, enhancing the need to practice pre-operative care (Bell et al., 2021). The assignment aims to understand the nursing intervention undertaken for better health management outcomes.

    Mr. Z is commonly given inability to stroll after low speed fall. In light of the sort of break, some portability might be conceivable, yet the outcome will be excruciating. The aggravation is confined in the upper external crotch or thigh area. Also, if the break is uprooted, the impacted appendage might seem turned or abbreviated.

    Foremost back pelvic and sidelong hip X-beams are needed if there should arise an occurrence of suspected hip breaks (Mohammad, 2018). On the off chance that the presumed hip break isn't apparent on the X-beam, attractive reverberation imaging is utilized to affirm the analysis. In the event that this is contraindicated because of the presence of a pacemaker, figured tomography is recommended (Ferrell et al., 2020).

    Discussion related to nursing intervention during preoperative stages
    Fast track triage system should be in place as most of these patients are referred via the emergency department. This will allow early clinical recognition of hip fracture with early diagnosis and radiography, allowing chances of rapid admissions (Boži? et al., 2019). The implementation of care pathway pro forma ensures basic quality standards that help to meet the care requirements. The following intervention should be undertaken for better management of the condition:

    Provision of pain relief: The patient should be offered analgesic medication. As influenced by Sivanandapanicker et al., (2018) use of nerve block medication helps in managing pain. Normal paracetamol should be prescribed on a regular basis; however, opioids should be used with relevant caution. The use of medication is the first step undertaken to ensure that the patient is prepared for the surgery. However, nurses are not often allowed to use medication, in such cases a better posture can help in reducing pain. The use of support and pillows to provide the expected support, with a neutral posture can help. The patient should refrain from unnecessary movement which may further disrupt the alignment. Proper use of pillows can prevent deformities due to pressure. Nurses can further use traction to maintain integrity (Billings et al., 2021). Traction allows pulling of the fractured bone, while allowing the body to overcome muscle tension. The use of skeletal traction pins allows greater weight for traction pull reducing the possible chances of pain.

    Intravenous fluid therapy: Patients with hip fracture are seen to suffer from fluid depletion upon arrival. However, the assessment of hydration is difficult in older patients as Mr. Z, as he may not exhibit typical physiological responses such as hypotension or tachycardia. In case of fluid depletion, patients like Mr. Z have poor tolerance to hypovolemia, leading to cardiovascular instability and even possible chances of organ hypoperfusion. Hence, as a nurse it is important to document and assess the fluid status of Mr Z, while administering IV fluids as per requirements. As influenced by Segevall, Söderberg & Randström (2019), preoperative use of colloid solution before hip fracture surgery does not improve outcomes, as opposed to conventional intravenous fluid regime using crystalloid solution. A relevant research literature supports the use of blood resuscitation among older patients (more than 65 years old) who have been within 24hours of sustaining hip fracture with colloid or crystalloid resuscitation did not provide significant data (Bell et al., 2021).

    Investigation of the vital signs: Full blood count, with ECG, urea and electrolyte is a prime intervention undertaken for patients in the preoperative stage. Anaemia is a common instance among older patients such as Mr. Z and a lower threshold for blood transfusion can be considered among patients with the stated age group. Mr Z must have a ventricular rate which is less than 100/minute (Mpanda et al., 2018). Reversible causes such as imbalance of electrolyte and hypovolemia should be corrected if the patient enters tachycardia phase.

    International normalized ratio for anticoagulation should be less than 2 for the event of surgery. Patients under medications are expected to have problems related to blood clotting and loss. It is for the same reason, platelets should not be administered prophylactically without consulting haematologists (WU et al., 2021).

    Hip fracture is often associated with severe incidents of pain and effective analgesic Poor pain control may result in post-operative delirium and Mr. Z, clearly exhibits signs and symptoms of delirium. Patients with delirium may receive inadequate analgesic. However, the incident of hip fracture triggers muscle weakness and loss of mobility, while increasing the possible chances of fall, while resulting in impaired chances of mobility (Mpanda et al., 2018).

    Nursing diagnosis based on subjective and objective data 

    Risk factors 

    Desired outcomes 

    Intervention and rationale 

    Risk for falls 

    Loss of skeletal and muscular integrity 

    Weakness and failure to get up without any assistance

    Mr.Z will maintain alignment and stabilization of fracture 

    Client may exhibit display of callus formation

    Demonstrate body mechanics promoting stability 

    Assess integrity and external fixation device: 

    Use of support using weights to align the fractured area

    Review and follow-up with x-rays: 

    Provides visual evidence about the location of the fracture and the therapy needs 

    Nursing diagnosis based on subjective and objective data

    Possibly related to

    Evidenced by 

    Nursing assessment and rationale 

    Impaired mobility

    Skeletal and neuro-muscular impairment causing discomfort and pain

    Psychological immobility

    Not familiar with the use of mobility devices

    Mr. Z will regain and maintain mobility 

    Client demonstrating a high level of body mechanics that induces a sense of stability at the site of fracture. 

    Maintain high level of rest

    Nutritional assessment

    High level of malnutrition

    Possible chances of calcium deficiency leading to weak bones 

    The fall suggests that bone structure for Mr. Z has weakened in significant manner leading to the fracture 

    Proper nutritional intake with fluid intake can help in enhancing the level of nutrition. Offering nutritional supplements can help in providing the expected results. 

    Table 1: Nursing intervention based on subjective and objective

    (Source: self made)

    Patients with low healthful stores as Mr Z, might be helpless to disease and set aside a great deal of effort to arrive at their recovery potential. The utilization of unhealthiness screening apparatuses will distinguish the degree of lack of healthy sustenance. Decrease obstructions to Mr. Z eating admirably. For example, at current occurrence, Mr. Z has restricted portability and thinks that it is amazingly hard to arrive at food and beverages, consequently the medical caretakers should assist him with the situation to sit appropriately during suppers. Skin trustworthiness and hazard identified with pressure ulcer ought to be evaluated on confirmation and expanded danger of strain harm because of immobilization (Mpanda et al., 2018). The appraisal ought to think about any potential possibilities of distress and torment by the patient. The attendants should search for skin trustworthiness for better norms of care. As numerous patients like Me. Z experience the ill effects of fall, think about the scope of mental effect on them. The dread of falling is a critical indicator of helpless life quality, thus, medical caretakers should take imperative mediation for lessening the dread and working on the personal satisfaction. Break at the femur neck, trailed by a low power of injury is regularly caused because of hidden pathology like osteoporosis. The medical attendants should take imperative mediation pointed toward lessening avoidance of delicacy as an essential piece of care, which ought to incorporate administration and evaluation of osteoporosis.

    Fracture liaison services recognize patients who supported a delicacy break are at tremendous danger of osteoporosis are suitable for additional evaluation. Pertinent examination writing proposes, for each 1000 patients with issues relating to delicacy crack evaluated by resulting break contact benefits, extra investment funds were caused (Sivanandapanicker et al., 2018). Notwithstanding, patients with episodes of osteoporosis might request pharmacological mediation to build bone thickness. This ought to additionally be joined by changes in way of life and in general strength of the bone.

    Hip fracture is one of the most well-known purposes behind crises in the more established populace. Patients are frequently exposed to different comorbidities, which expands the danger identified with mortality. An all-encompassing and multi-disciplinary methodology is expected to give effective consideration during the stage before activity. Nursing staff play an excellent part in overseeing and evaluating patients like Mr. Z and lessening the potential dangers and risks related with hunger and fixed status.

    Reference list
    Bell, J. J., Geirsdóttir, Ó. G., Hertz, K., Santy-Tomlinson, J., Skúladóttir, S. S., Eleuteri, S., & Johansen, A. (2021). Nutritional care of the older patient with fragility fracture: opportunities for systematised, interdisciplinary approaches across acute care, rehabilitation and secondary prevention settings. Orthogeriatrics, 311-329. Retrieved from: [Retrieved on: 16th November, 2021]

    Billings, J. D., Khan, A. D., Clement, L. P., Douville, A. A., Brown, E. W., & Schroeppel, T. J. (2021). A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients. Journal of Trauma and Acute Care Surgery, 90(5), 769-775. Retrieved from: [Retrieved on: 16th November, 2021]

    Boži?, A., Brestova?ki-Svitlica, B., Karadeglija, M., & Koledin, S. (2019). Parents satisfaction with nursing care in children with supracondylar fracture of the humerus. Sestrinska re?, 22(78), 15-18. Retrieved from: [Retrieved on: 16th November, 2021]

    Ferrell, J., Bowden, D., Tong, C., Etter, K., & Bruce, R. (2020). Implementation of a Comprehensive Hip Fracture Care Program in a Community Hospital Setting. J Surg, 5, 1303. Retrieved from: [Retrieved on: 16th November, 2021]

    Mohammad, E. E. H. (2018). Intensive care unit nurses’ performance regarding caring patients with head injury: an educational intervention. International Journal of Studies in Nursing, 3(3), 141. Retrieved from: [Retrieved on: 16th November, 2021]

    Mpanda, R. S., Liang, Q., Xu, L., Lin, Q., & Shi, J. (2018, July). Investigation on various antenna design techniques for vital signs monitoring. In 2018 Cross Strait Quad-Regional Radio Science and Wireless Technology Conference (CSQRWC) (pp. 1-3). IEEE. Retrieved from: [Retrieved on: 16th November, 2021]

    Retrieved from: [Retrieved on: 16th November, 2021]

    Segevall, C., Söderberg, S., & Randström, K. B. (2019). The journey toward taking the day for granted again: the experiences of rural older people's recovery from hip fracture surgery. Nursing assignment Orthopaedic Nursing, 38(6), 359-366. Retrieved from: [Retrieved on: 16th November, 2021]

    Sivanandapanicker, J., Nagar, M., Kutty, R., Sunilkumar, B. S., Peethambaran, A., Rajmohan, B. P., ... & Sharma, S. (2018). Analysis and clinical importance of skull base fractures in adult patients with traumatic brain injury. Journal of neurosciences in rural practice, 9(03), 370-375.

    WU, H., Van Mierlo, R., McLauchlan, G., Challen, K., Mitra, S., Dhaygude, A. P., & Nixon, A. C. (2021). POS-348 Predicting difficulties with direct home discharge following hip fracture for patients living with CKD: Insights from a 6-year prospective study. Kidney International Reports, 6(4), S151-S152. Retrieved from: [Retrieved on: 16th November, 2021]


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