EBNC – Writing your Care Stud
Introduction
This care study is based on a patient that I met in a community placement. As required by the Nursing and Midwifery Council (NMC2018) the name of patient and other people involved in this case study will not be mentioned. I will use the pseudonym Fiona for the patient, the placement assessor will be called Theresa and the patient’s daughter, as Maria. I have also obtained verbal and written consent as it is vital for nurses and other health care professionals to have a clear and accurate means of communication (Ashelford, Raynsford and Taylor, 2016).
Through undertaking this care study, I aim to produce an analytical approach to nursing care to familiarise myself to my future practice. in discussing this care study, I will use the process of nursing. In my discussion, I will talk about the assessment, planning, implementation and evaluation of Fiona’s care, incorporating the pathophysiology of Fiona’s condition and pharmacology of her medication. I will then conclude this study by reflecting on what I have learnt (Karch, 2010).
Assessment
Fiona,is 76 years old retired school teacher, shehad a past medical history ofrheumatoid arthritis, hypertension and high cholesterol which left he in a stroke and is now will chair bounded. She also suffers from type 2 diabetic mellitus. A year ago, she was diagnosed of Ulcerative Colitis after she reported continues loose stools and blood in her bowels. Her latest diagnose is an exacerbation of her chronic abdominal pain. Due to Fiona’s age and complications doctors and other specialist after a Medical Disciplinary Team meeting, it was agreed she received palliative care which Fiona and her daughter consented. She has been receiving care at home and in the hospice for eleven months. Fiona lives alone but receives help from her daughter who leaves just ten minutes away from her (Lewenson and Truglio-Londrigan, 2015).
Maria called and reported that her mother has been complaining of coeliac abdominal pain. Fiona is going through the end of life therefore the type of pain in this stage may differ from the normal (Banning, 2007) type of pain that other patients experience. Pain measurement at the end of life relies on accurate pain assessment. It is therefore important to question the patient carefully and communication can also be a good means to obtain a full history of the type, area and how long the pain has been going on. Pain in patients suffering from uncreative colitis depends on the severity and the extent of mucosal involvement. The disease is often treated mesalaniine product (five- amino salicylicacid) Steroids and amino salicylates suppress of symptoms and can be subjective only the sufferer knows how it is and where it is. Therefore, in identifying Fiona’s pain the team has used two types of tools (Standing, 2017).
Numerical Pain Systems help in identifying the severity of the patient’s pain and distress using numbers varying from zero to 10. Numerical pain scales may include words or explanations to better identify your symptoms, from the patient feeling no pain to experiencing excruciating pain (Huether and McCance, 2016). For the management of Fiona’s pain, the nurse contacted the doctors in the clinic, and she was advised to administer analgesics like (mg). ibuprofen belongs to a non-steroidal anti-inflammatory drug (NSAID) and suggested that if the pain proceeds to administer morphine. however, ibuprofen can cause abbesses which may further results to fistulas. The doctors therefore advised Maria to stop the insides and prescribed fast-acting painkillers to be administered as the aim for now is to make sure that Fiona’s pain is minimised (Barber and Robertson, 2015).
Planning
Fiona has a past medical history of uncreative colitis. A chronic inflammation in the ulceration of the colonic mucosa is the primary findings of sub epithelial fibrosis and inflammation in the rectal mucosa (Howatson-Jones, Standing and Roberts, 2015). For the past five years, Fiona has been experiencing watery diarrhoea whose mucosa looked normal on proctoscopy. It subsequently introduced the term Ulcerative colitis as a chronic inflammation disease, which causes uncertration+6 of the colonic mucosa and extends proximally from the rectum into the colon. The cause of this disease in still unknown and to be found yet (Henley and Schott, 1999). However, it is known to be common among the white population and Northern Europeans. However, patients from families that have suffered from these diseases are also at great risk. The primary lesions of UC are continuous with no skip lesions are limited to the mucosa and there is impairment of the epithelial barrier (Waugh and Grant, 2018). The rectum is almost always involved the inflammation begins at the crypt. In the large intestine primarily the left colon, inflammation, and release of inflammatory cytokines from neutrophils, lymphocytes, plasma cells microphages, eosinophils and mast cells (Boore and Shepherd, 2016).
Interventions
The golden treatment of uncreative colitis is to decrease inflammation and treat pain.
Management aims to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include five amino salicylic acid drugs, steroids, and immunosuppressant. Some patients can expect colectomy for medically refractory disease or treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is developing, and the number of medicines with new targets will rapidly increase in the coming years (Burns, 2015).
Nurses and other healthcare professionals have a duty of care according to the NMC in assessing the patient who is self-medicating on a continuous bases. They are also responsible for teaching patients to recognise changes and act on them immediately to promote safety. The National Institute for Health and Care Excellence discusses the importance of enhancing the quality of life for patients with long-term conditions. Fiona is wearing that her illness is not curative (Cohen, 2019).
The NMC 2018 requires nurses continuously assess patients who administer their medication themselves. They also have a responsibility to these patients to recognise and act on any changes to their condition and safety. The National Institute for Health and Care Excellence discusses the importance of enhancing quality of life for patients with long-term conditions (Ellis, 2016). Mrs B saw her illness as a personal failure and expressed her gratitude on having her sister around to assist with daily needs, however she also expressed how her illness took a toll on their relationship, as she has bad days. The NMC’s Competency Mental Health Nursing framework says nurses should assess and meet all the required needs of people who come into their care (Cox et al., 2018).
Evaluation
A huge part of the principles of good palliative care requires the health professionals involved to work in accordance with their competency standards. The NMC’s code of conduct explicitly says that all nurses should work within the limits of their competence, and they should make a referral in time if they are any patient concerns as nurses are the patients advocate and have to prioritise the patient, whilst preserving safety, to promote professionalism whilst practising effectively (Day, 2013).
References
Ashelford, S., Raynsford, J. and Taylor, V. (2016) Physiology and Pharmacology for Nursing Students, London: SAGE.
Banning, M. (2007) Medication management in the care of older people, Singapore: Blackwell.
Barber, P. and Robertson, D. (2015) Essentials of pharmacology for nurses, 3rd edition, Maidenhead: Open University Press.
Boore, J.C.N. and Shepherd, A. (2016) Essentials of anatomy and Physiology for Nursing Practice, London: SAGE.
Burns, D. (2015) Foundations of adult nursing, London: SAGE.
Cohen, B. (2019) Memmler’s The Human Body in Health and Disease, Philadelphia: Wolters Kluwer.
Cox, N., Jack, K., Tetley, J. and Witham, G. (2018) Nursing Older People at a glance, Oxford: Wiley Blackwell.
Day, J. (2013) Interprofessional working; an essential guide for health and social care professionals., Hampshire: Cengage Learning.
Ellis, P. (2016) Evidence based practice in nursing, 3rd edition, London: SAGE.
Henley, A. and Schott, J. (1999) Culture, religion and patient care in a multi-ethnic society; A handbook for professionals, London: Age Concern England.
Howatson-Jones, L., Standing, M. and Roberts, S. (2015) Patient Assessment and Care Planning in Nursing, 2nd edition, London: SAGE.
Huether, S.E. and McCance, K.L. (2016) Understanding Pathophysiology, 6th edition, Louis: Elsevier.
Karch, A. (2010) Focus on Nursing Pharmacology, Philadephia : Wolters Kluwer/Lippincott Williams and Wilkins.
Lewenson, S.B. and Truglio-Londrigan, M. (2015) Decision-making in nursing: thoughtful approaches for leadership, 2nd edition, Burlington: MA: Jones & Bartlett Learning.
Standing, M. (2017) Clinical judgement and decision-making for nursing students, 3rd edition, London: SAGE.
Waugh, A. and Grant, A. (2018) Ross and Wilson Anatomy and Physiology in health and illness, 13th edition, China: Elsevier.
