NURS2004 Gwendolyn Harris Case Study Sample

Health Assessment

Question 1: Nursing Process – Assessment

This is the case of Gwendolyn Harris, who was 86 years old lady and got scratched from her cat on her right leg. Her wound healed and there was an increase in pain. For this, her leg was elevated so that it can give relief up to some degree. She used to apply crape bandages on that scratch to reduce exudate soiling of her clothes. She was having a medical history of Diabetes Mellitus due to which her wound was not getting healed. In the assessment process, the signs such as fever and WBC count will be investigated to know the level of infection and its spread. WBC count will help in detecting the level of infection. WBC cell’s role is to fight against infection, and they are essential for the health and well-being of a person. The ranges of WBC’s are:

• Low: Below 4500
• Normal: 4500 – 11000
• High: Above 11000

If the WBC count will be reflected as risen from investigations, they will indicate that there is a high level of infection in a patient's body (Franks et al, 2016). Though, she had a history of Diabetes Mellitus also. In this disease, the wound does not get healed quickly and proper care is required by the healthcare professionals as well as from the patient's side. In the cases of infection, the temperature of the body also raises, this means fever is also needed to be assessed to know the patient's condition.

Question 2: Nursing Process – Diagnosis

The diagnosis process will involve the role of a doctor in suspecting an infection based on physical examinations, risk factors, and a person's symptoms. The doctor will confirm that the patient is having an infection or not. If after the investigations the person gets detected that he/ she has an infection, then the laboratory tests will help in identifying microorganisms. This will be done from a sample of urine, saliva, plasma, other fluid, or soft tissue from the body. The tests will be tainted and analyzed under a microscope. Culturing will help in finding the circumstances that promote the development of microorganisms. Analysis for antibodies will cover molecules that are manufactured by the person’s impervious system in reaction to the microorganism. Microorganisms test will discover an antigen that means the molecules from microorganisms that cause an impervious reaction in the human being body (European Association for the Study of the Liver, 2017). The doctor will choose the test based on illness because the test will not help them in the detection of microorganisms that they think are most likely to cause infection.

Question 3: Nursing Process – Planning

The planning to treat an infected patient will cover:

• Maintaining or teaching asepsis for dressing changes and wound care, catheter care, central venous management, and handling.
• Hand washing and teaching patients before contact with the patient and between procedures with patients. The time to wash hands are:
• Wearing gloves before and after touching patients
• Before and after touching a patient before handling an invasive device
• Before handling medications.
• Encouragement of patients for taking a protein-rich diet.

The multidisciplinary team includes the involvement of general practitioners, nutritionists, endocrinologists, and nursing professionals. The general practitioner will conduct the assessment for the detection of microorganisms, the nutritionist will advise the diet plan according to illness, and the endocrinologist will look after the diabetic complications because they are playing a major role in the spread of infection. Nursing professionals will do all the care activities for patient’s health recovery and betterment.

The ethical and legal considerations will include compliance with all nursing procedures as per NMBA standards, maintenance of hand hygiene, dressing according to protocols, following aseptic measures, and maintaining the confidentiality of patient records (Carbone et al., 2015). Here, the informed consent would be taken from the patient if any invasive procedure would need to be conducted. The registered nurse will follow NMBA standards that include six standards namely

Standard 1 – Thinks critically and analyses nursing practice

Standard 2 – Engages in therapeutic and professional relationships

Standard 3 – Maintains the capability for practice

Standard 4 – Comprehensive conducts assessments

Standard 5 – Develops a plan for nursing practice

Standard 6 – Provides safe, appropriate, and responsive quality nursing practice

Standard 7 – Evaluates outcomes to inform nursing practice

Question 4: Nursing Process – Implementation

The plans will be implemented by following these steps:

• Pathways should be followed by urgently or emergent treatment of infection.
• Hospitalization of patient
• Involvement of surgeons also they should have complete expertise and concern in treating patients.
• Avoidance from further complications
• Clinical examination and identification of risk factors such as failure of consciousness or any other.
• Involvement of multidisciplinary team
• Assigning members based on their expertise for incorporating expert’s opinion when a lack of evidence is felt.
• Physicians, nurses, and surgeons will play their effective role in the management of patients along with screening and management staff.
• Following guidelines and checklists to ensure appropriate care provider to patient.
• Urgent consultation at the time of need.
• Appropriate post-hospitalization monitoring to reduce the risk of infection
• Optimal correction and control measures should be taken to manage fluid and electrolyte disturbances (Grever et al., 2017).

Question 5: Nursing Process – Evaluation

The evaluation will be done by:

• Monitoring vitals such as blood pressure, fever, pulse, and heart rate
• Regular monitoring of blood glucose levels.
• Lab inspections to keep a track on WBC count
• Pain score management
• Healing of wound
• Proper grading or staging of the wound using a proven classification system that records intensity and presence of infection.
• Compliance systems with checklists, guidelines, and pathways.
• Recovery status of the patient
• The average length of stay of the patient
• Readmission of patient
• Adverse events
• The satisfaction of patient from hospital staff (Hallek et al., 2018)

These points will help in evaluating the condition of the patient and detecting whether the patient got recovered from the care provided by the hospital staff or not. The knowledge of experts in case handling at different levels will also be judged that will lead to the incorporation of new roles and interventions in the care plan. The patient satisfaction score will reflect that whether the patient is satisfied with the hospital services or not. Based on that, the revision of guidelines and procedures could be done.

References for Gwendolyn Harris Case Study

Carbone, A., Vaccher, E., Gloghini, A., Pantanowitz, L., Abayomi, A., De Paoli, P., & Franceschi, S. (2015). Diagnosis and management of lymphomas and other cancers in HIV-infected patients. Nature Reviews Clinical oncology, 11(4), 223. DOI: 10.1038/nrclinonc.2014.31

European Association for the Study of the Liver. (2017). EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. Journal of Hepatology, 67(1), 145-172. DOI: 10.1016/j.jhep.2017.03.022

Franks, P. J., Barker, J., Collier, M., Gethin, G., Haesler, E., Jawien, A., & Weller, C. (2016). Management of patients with venous leg ulcers: challenges and current best practice. Journal of Wound Care, 25(Sup6), S1-S67. DOI: 10.12968/jowc.2016.25.Sup6.S1.

Grever, M. R., Abdel-Wahab, O., Andritsos, L. A., Banerji, V., Barrientos, J., Blachly, J. S., & Else, M. (2017). Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood, The Journal of the American Society of Hematology, 129(5), 553-560. DOI: https://dx.doi.org/10.1182%2Fblood-2016-01-689422

Hallek, M., Cheson, B. D., Catovsky, D., Caligaris-Cappio, F., Dighiero, G., Döhner, H., & Stilgenbauer, S. (2018). I will guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood, 131(25), 2745-2760. DOI: 10.1182/blood-2017-09-806398.

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