Nursing Practice in Context

Case scenario: Nursing Practice in Context 4
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1] Current problem
Both Type 2 Diabetes, hypertension increase the risk of fractures, and in the case of hypertensive older patients, care should be exercised to ensure that they do not worsen the situation. According to (Solomon et al., 2011), antihypertensive may affect the bone metabolism in cases where there is decreased calcium absorption. Since hypertension likely affects the bone mineral density (BMD), and fracture risk, there is a need to understand how hypertension and type 2 diabetes. However, there are mixed results on the impact of antihypertensive drug exposure and fracture risk. For instance, thiazide diuretics and Angiotensin-receptor blockers have lower risk of fractures unlike calcium channel blockers, but other agents seem to have to impact on the fracture risk (Solomon et al., 2011).
Patients with increased body weight have high bone density, but some studies show that there is likely no association between type 2 diabetes and risk of bone fracture. The stress of operation may exacerbate diabetes, and there is a need to address the stressors and look at the behavioral responses to them (Lloyd, Smith & Weinger, 2005). Social and psychological support might improve the chance of Jensen coping with the situation, but his children and ex wife and live out of state. Hypertension and type 2 diabetes are comorbidities, since they are likely to take medications that may decrease the BMD or increase risk of falling (Lipscombe et al., 2007). Jensen is 65 years old.
Even though, the fractures were caused by the fall, there are various factors that may worsen the situation. After having undergone the operation, there is risk that without power management of diabetes, there may be more complications. This is because stress can cause a rise in blood sugar levels, as stress hormones increase blood sugar levels including cortisol and epinephrine. There are both pharmacologic and non-pharmacologic interventions that address the risk factors of further structures. The pathophysiology of fractures are mostly related to the bone strength including age, one quality, bone mass, and the nature of injuries (Melton et al., 2008). Understanding the risk factors to the fractures is the basis for identifying the most effective interventions.
To highlight the gravity of the problem is that as severity diabetes increases so does the risk of non traumatic(fragility) fracture, while the current prediction tools to detect the risk of fractures are not necessarily robust when dealing with diabetic patients (Fraser et al., 2013). To further compound the problem is that Mr. Jensen smokes 20 roll-up cigarettes per day, increasing the risk of hypertension. Since the blood pressure is 155/100, focusing on the benefits of healthy eating during and after recovery would minimize further complications from diabetes and hypertension. Brown & Edwards (2015), highlight that patients ought to taught to manage the BP levels and maintaining the goals as this makes it easier to use interventions.
Patients with diabetes mellitus are at a higher risk of complications after suffering fractures regardless of whether they are treated surgically or not (Craft et al., 2015). Fracture repair starts with inflammation that allows recruitment of mesenchymal stem cells, before there is cartilage formation, cartilage resorptiom and the secondary bone formation (Graves et al., 2011). However, for patients suffering from diabetes the condition affects wound healing for both soft and hard tissues, since there is accelerated loss of cartilage, the tissue level changes and there is risk if reduced cartilage formation (Graves et al., 2011).
Impaired fracture healing is a concern in patients with hypertension and diabetes since there is delayed union. There is also a risk of more complications in the quest to identify the best combination of medications, given the need to manage the fracture, hypertension and diabetes all at the same time. For the non diabetic patients open fracture of the right tibia and fibula can heal without complications, but the patient suffers from diabetes and hypertension, while the intervention will ensure that Jensen resumes proper functioning of his leg, while also tackling the stress levels.
2] Jensen’s physical assessment physical examination
In the assessment, the diagnosis will first be corroborated to determine how the swellings are localized and the tenderness of the surrounding areas. The rationale for this is that the wounds surrounding the tibia and fibula will provide clues on the risk of further injuries. As such, the X-rays are important to show the extent of the injury and associated injuries around the knee. Additionally, the CT scans may not provide all the information to assess the injuries resulting from the proximal tibial fractures. The early symptoms indicate serous oozing and swellings of the patient’s right leg.
The vital assigns assessment was performed focusing on the blood pressure, heart rate and capillary refill give clues on the interventions to be undertaken. There is concern since the blood pressure was still not manageable, and the heart rate is still elevated at 110 meaning that the hypertension might complicate the healing process. The primary assessment also identified airway, breathing and circulation mainly focusing on the distal pulse to the site of the injury. This was conducted since capillary refill affects circulation status, and for the injuries to heal properly care should be exercised to ensure there are no risks to proper circulation. Inadequate pain control may worsen the hypertension, highlighting the need to monitor the blood pressure.
Assessment of the tibia focused on the medial and larger bone of the bone area while the fibula is the smaller bone of the lower leg. Since Jensen suffered an open fracture, the open skin around the site of injury is likely to be infected, and the physical examination did not identify extensive damage to the tissue around the site of injury. The musculoskeletal assessment extends to checking the extent of swelling, tenderness and pain at the site of fracture. Mr. Jensen’s post operative vital signs showed a score of 7 on a scale of 1 to 10. Diabetes is a risk factor for the development of musculoskeletal conditions such as osteoporosis (Lewis & Foley, 2011).
Treating lower leg injuries including tibia and fibula focus on the neurovascular assessment, pain management and reduction of swelling. Neurovascular assessment focused on distal PMS (pulse-motor-sensor) and the checks determine the distal PMS functions were still function after the operation. Jensen did not experience severe pain, after the operation but careful monitoring of the neurovascular status focusing on the pulse, strength and sensation. The nurse plays a crucial role in minimizing the risk of compartment syndrome for patients with, whereby there is buildup of pressure in the muscle compartment and compromises circulation (Judge, 2007).
3] Priority problems
Managing hypertension is a top priority since, there is decreased cardiac output, and the use of antihypertensive might be affected by using new interventions. Comparing the pressures is consistent with the need to establish how the risk factors influence elevation of the blood pressure. There is deficient knowledge related to information to manage hypertension and diabetes and how they influence healing delay following the fracture and injuries. Maintaining the blood pressure within the acceptable levels means that. The patient ought then to be informed on the treatment regimen.
For patients with type 2 diabetes, addressing blood glucose levels is crucial to the long-term management of the condition (Lewis & Foley, 2011). Jensen is already under medication, to manage both conditions and the antihypertensive reduce the risk of cardiovascular events. Considering the risk factors including smoking using a risk tool, is undertaken with the objective of combining interventions to manage the co- morbidities. This includes drug therapy and lifestyle modification where possible, while offering support to ensure there is improved adherence (Thongsai & Youjaiyen, 2013). There is a risk that the patient many not persist with all the treatments, when left alone to self-manage.
Since there is a need to ensure there is strength, motor movement and proper sensory of the affected right foot, there is a need to prioritize management of the injury, taking into account the likely complications. Having assessed the vital signs, and identified the fluid balance, assessing the extremity, then diagnosis of the fracture is related to the need to improve mobility while reducing pain. The presence of wounds increases the risk of infection, with evaluation after interaction with the patient meant to reduce risk of infection, while ensuring there is timely wound healing.
Despite the patient being old, knowledge needs are still relevant to ensure better ...