Part 1:

1.1 Identification and summarization of the family and social history of the patient

The patient is a 68 years old female, named as Mrs. Jane, she is restricted in a suburban area in which she lives with her daughter and two grandchildren. She is 72 years old, a retired school teacher and has lived on her own since the death of her husband some twenty years ago. Nowadays, because of health complications, her daughter has been living with her to assist her in most of her needs.

As for social contact she is only active during family events and from time to time with a circle of several friends. Jane exercises and has volunteered in any frequency of activities within the society since she has been sick and no one should have the thought of her as a sickly person. Nevertheless, she still has her community that is still part of her social networks. From a cultural perspective the primary value that Jane cherishes is autonomy; therefore, she experiences frustration and emotional stress while witnessing a slow regression of her independence. [Analysis based on the case study].

1.2 Identification of the acute presenting issues and the reason of nursing care

Jane was also hospitalized for a severe fall at home in which she sustained a hip fracture. It is important to distinguish between the acute issues that required her need for care in the first place, which was the immobilization that came along with a fracture; other chronic diseases included osteoarthritis and diabetes (Rasmussen et al., 2019). She needed active medical attention which includes pain control for her discomforts, regular blood sugar checks, and physic to help with her mobility.

1.3 Influences of stereotyping

First of all, Jane is an elderly patient and this puts her in a vulnerable category and exposes her to such stereotypes as being frail or suffering from some form of dementia. These stereotypes may determine the kind of treatment she gets. For instance, when admitting her, some of the healthcare workers may think that owing to her old age, her mental health is not very good, and this may impact on how they involve her or talk to her (Low & Purwaningrum, 2020). This erodes her self-autonomy feature, which she holds in high esteem, and thus she does not get what she wants.

Besides, Janes physical weakness after the fall may make people think that she cannot prove that she can get back to her feet, and this can determine her rehabilitation plan. Some common perceptions regarding aging are that elders are slow in healing and therefore the doctors and nurses may expect her to take a long time in recovery from the respective injuriesr (Kontos et al., 2018).

1.4 Comorbidity 1 its impact on patient functional health status

For the past 15 years Jane has been suffering from diabetes mellitus type 2 diseases. This has affected her functional health in relation to physical energy in a very dramatic way. Its causes include variations in her blood sugar levels which result in instances of fatigue and weakness hence being unable to do the daily activities (Srikanth et al., 2020). Emotionally, diabetes is a persistent source of stress because it influences what she eats, how she manages her diabetes to prevent such complications like hypoglycemia.

1.5 Comorbidity 2 and its impact on patient functional health status

Jane has another disease which is diabetes, and she also has osteoarthritis affecting her knee and lower back. This condition greatly restricts her movement and results in constant pain, which played a part in the fall. She had a condition that greatly restricted her movements and which caused her severe pain. The pain increases with activity hence limiting her mobility and cannot participate in physical rehabilitation after surgery (Swain et al., 2019). Also, osteoarthritis impacts her emotionally as she can be frustrated, and at times suffers from depression owing to the physical constraint and the pain it brings.

1.6 Associated risk factors

1.6.1 Risk factor 1

One of the social histories related risk factors for Jane are; reduced physical activity because of osteoarthritis and recently received surgery. Sedentary lifestyle is also disadvantageous because it contributes to muscle weakness and balance problems which may lead to future falls (iestad et al., 2022). Inability to move around results in other associated issues including formation of pressure ulcers as well as formation of deep vein thrombosis which would also add to her recovery period and the amount of nursing care she would need.

1.6.2 Risk factor 2

Osteoarthritis and diabetes are diseases related to diet, but unfortunately, Jane failed to adhere to proper diets. Due to her osteoarthritis disease, and stress to manage diabetes she has lost appetite resulting in irregular meals. This poor consumption increases her problems of diabetes and has led to hypoglycemic episodes. Moreover, the woman may lose a lot of weight, lack the necessary vitamins as well as have a lowered immune system, which makes a possible infection inevitable and a longer recovery period necessary (DellIsola et al., 2021). It will also compromise her bone nutrition needs especially when she has a hip fracture which is essential in the healing process.

Part 2: Care plan report

2.1 Identification of the acute presentation of your patient

It is important that the reason for admission was a hip fracture which occurred due to fall in home of Mrs. Jane. Some of the manifestations include immobilization, post-surgical pain, and restricted mobility as the result of fracture. The two diseases that Jane had include diabetes and osteoarthritis making it hard for her to overcome COVID- 19. Due to diabetes individual cannot easily recover from wounds and skin afflictions while osteoarthritis is a condition where a patient suffering from it experiences severe and unbearable pain, restricted motor movement. Taking into consideration all these aspects, one can conclude that the patient needs the best nursing care in her post-operative management of her long-standing medical conditions to reduce a possibility of a poor prognosis [Analysis based on the case study].

2.2 Justification of three nursing care priorities

2.2.1 Pain management

Managing pain after the hip fracture surgery is one of the essential nursing care plans because the failure to ensure adequate pain control contributes to further complications, prolongs the healing process and hinders mobility (Brooke & Cronin, 2021). Chronic pain has to be addressed to allow for rehabilitation which will in turn help to correct Janes mobility status and her overall quality of life.

2.2.2 Wound care and infection prevention

Being a diabetic, there is a higher possibility of slow wound healing incisions and complications in the surgical area. Proper wound care and timely reduction of infection rate is highly important to have a successful recovery and to minimize the chances of developing complications like diabetic foot ulcers and sepsis (Singh et al., 2020).

2.2.3 Mobility and fall prevention

To achieve mobility rehabilitation is important because the inability to move leads to the possibility of falling prone to DVT formation, and development of pressure ulcers. Due to her osteoarthritis and the recent fracture she also has higher chances of falling thus mobility and preventing fall is another nursing consideration for Jane (Hunter et al., 2019).

2.3 Evidence based nursing intervention

• Pain Management

In regards to pain that occurs after the interventions, it is advised to follow the principles of multimodal analgesia. This involves the use of mild pain relieving medications that do not include opioids, moderate pain relievers which include opioids to be administered depending on the intensity of pain in Jane in the short term use only. Techniques like positioning and cold therapy that is used at the postoperative period (Vadivelu et al., 2021). This intervention will be given according to Janes pain assessment, for example using NRS so that her pain can be controlled without adding reliance on opioids.

• Wound Care and Infection Prevention

For wound care, since there is an evidence-based practice, the patients wound will be cleaned on a daily basis and its dressing changed as per the new protocol and hydrocolloids will also be used. Also, the bad glycemic control is essential to improve the wounds healing process and avoid the development of infection. Target blood glucose level will be maintained by the use of a glucose meter and adjustment of Janes insulin as deemed necessary. Prophylactic antibiotic use may also be recommended if infection has been deemed to be manifesting its signs (Edwards et al., 2017).

• Mobility and Fall prevention

Rehabilitation with a physiotherapy program, a structured program will be developed for Jane to enhance mobility after the surgery. Saris' mobility with direction by a registered physical therapist quickly strengthens the muscles and minimizes the deleterious effects including DVT. Besides, to reduce the risk of falls, information regarding preventive measures will have to be passed to Jane and her family including (Cameron et al., 2018).

2.4 Evidence based evaluation strategies

• Pain Management Evaluation

Before and after the application of the pain relief interventions the patients pain level will be measured using the Numeric Rating Scale (NRS). The NRS enables Jane to quantify her pain on a scale of zero to ten with the actual flag representing no pain and the top flag representing the most severe pain that one can endure (Ferreira-Valente et al., 2011). It will be expected that after the intervention, the patients pain has remained at 3 or below on the 10-point scale as a sign of well managed pain and increased ability to engage in rehabilitation exercises.

• Wound Care and Infection Prevention Evaluation

This will be assessed by the Pressure Ulcer Scale for Healing (PUSH), where surface area of the wound, amount of exudate and type of the tissue in the wound will be used to check the healing status (Stotts et al., 2013). Wound assessments for other signs of infection will be done on daily basis, which may include redness, heat, and even discharge. Also, pre- and postprandial blood glucose will be determined with the target of 80130 mg/dL (American Diabetes Association, 2022). Wound size decreases and blood glucose will be controlled at an optimal level; these will be the signs that show that the wound has received adequate care.

• Mobility & fall prevention assessment

To evaluate Janes mobility and her fall risk the Timed Up and Go (TUG) test will be conducted. The TUG test is applied to assess the time a patient has been given to rise from a chair, walk a distance of three meters, turn around and sit back on the chair (Shumway-Cook et al. 2000). This test will be done in the course of a weekly exercise programmer all through her rehabilitation period. Besides, decreased incidence of falls or near falls will indicate toward successful implementation of prevention measures.

Are you struggling to keep up with the demands of your academic journey? Don't worry, we've got your back!
Exam Question Bank is your trusted partner in achieving academic excellence for all kind of technical and non-technical subjects. Our comprehensive range of academic services is designed to cater to students at every level. Whether you're a high school student, a college undergraduate, or pursuing advanced studies, we have the expertise and resources to support you.

To connect with expert and ask your query click here Exam Question Bank