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Nursing

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Nov 24, 2024

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1 Carla Stevens Case Study Student Course

2 Carla Stevens Case Study Part A: Assessment and Problem Identification Acute Pain related to Intertrochanteric Fracture Carla Stevens, a 45-year-old woman, is dealing with severe Pain in her right hip due to an intertrochanteric femur fracture following a low-impact fall where she landed on her right side ("Case Study"). She rates her pain level at 8/10 on a numeric pain scale, signifying the intensity of her Pain. This high level of Pain significantly impacts her behavior and activities, making it a crucial issue that necessitates immediate nursing intervention. Assessment Data: Objective Data: o Pain level: 8/10. o X-ray confirms the fracture. o Altered vital signs indicative of Pain. o Non-verbal signs of Pain (facial grimacing, guarding the hip). Additional Information Needed:  Past experiences with pain management and medication efficacy.  Allergies or adverse reactions to pain medications.  Detailed pain history. Anxiety related to Loss of Function, Unknown Outcome of Surgery, and Unfamiliar Surroundings In addition to the acute Pain, Carla is battling anxiety stemming from various sources, adding a layer of complexity to her situation. Firstly, the impending surgery to address the

3 fractured hip has triggered fear and uncertainty regarding the surgical outcome and potential loss of function. The fear of the unknown outcome is a formidable source of anxiety. Secondly, the unfamiliar hospital surroundings and the surgery prospect contribute to her anxiety. Addressing her concern is essential for a successful pre-operative phase. Assessment Data:  Subjective Data: o Expresses fear and uncertainty about surgery and potential loss of function. o Indicates anxiety about the unfamiliar hospital surroundings. Additional Information Needed:  Detailed psychological history and coping mechanisms.  Previous surgical experiences and related anxieties. Alterations in Vital Signs and Behavior The fall and subsequent fracture have resulted in severe Pain and altered Carla's vital signs and behavior ("Case Study"). Her vital signs, such as heart rate, respiratory rate, and blood pressure, have been impacted, highlighting the physiological stress she is enduring. Additionally, she is tearful, anxious, and looks pale, indicating significant emotional distress. Monitoring and managing these alterations are crucial for her overall well-being. Assessment Data:  Objective Data: o Deviations in vital signs (elevated heart rate, blood pressure). o Behavioral changes (tearfulness, anxiety, paleness).

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4 Substance Use and Its Effects on Pain Management Carla's history of alcohol consumption and smoking is a critical issue influencing her pain management ("Case Study"). Her alcohol consumption, reported at several bottles per week, can interfere with the effectiveness of pain medications and might pose challenges in achieving optimal pain relief. Addressing substance use and considering its impact on pain management is essential for formulating an effective care plan. Assessment Data:  Subjective Data: o History of alcohol consumption (several bottles per week) and smoking. Part C: Concept of Caring The Concept of Caring framework is pivotal in Carla's case, integrating empathy, respect, and understanding of her needs and concerns (Ventura et al, 2021). Carla's experience encompasses the physical trauma she is facing due to the fracture and the emotional distress stemming from the unfamiliar hospital environment and the imminent surgical intervention. As a nurse, applying this framework involves actively listening to Carla's fears and worries, acknowledging her anxiety, and addressing it compassionately. Providing comprehensive information about the surgical procedure and expected outcomes and involving her in decision-making are fundamental aspects of this approach. Also, demonstrating empathy and support during this stressful period significantly improved Carla's comfort and overall well- being. By integrating the Concept of Caring framework into practice, we ensure that Carla's physical and emotional needs are effectively met, resulting in a more positive and holistic healthcare experience. This framework underscores the essence of person-centered care,

5 emphasizing the ailment and the individual experiencing it. It reinforces the notion that genuine care transcends the clinical aspects of healthcare, encompassing emotional support and understanding the patient's unique perspective and concerns ( Lê Van et al., 2023 p6) . In doing so, we heal the body and provide solace to the mind, acknowledging that true healing encompasses physical and emotional well-being.

6 References Lê Van, K., Arditi, C., Terrier, L., Ninane, F., Savoie, A., Rochat, S., ... & Schaad, B. (2023). The Lausanne Hospitality Model: a model integrating hospitality into supportive care. Supportive Care in Cancer , 31 (5), 1-7. Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2021). Nursing care in mental health: Human rights and ethical issues. Nursing ethics , 28 (4), 463-480.

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