NUR 4153-Deliverable 4-Make the Best Choice for the Right Situation What is the best action to perform a third of the six actions identified as part of planned client care for this client? Input consult for pain management into the electronic order system

Notice: The physician has placed an order to decrease the PCA pump and to have a pain management consult with the

Interpret: We need to have a plan developed for pain management for the patient as the PCA pump is being discontinued. Since we are potentially placing an order for the patient’s Nicotine Patch and writing a communication note for the patient’s chart, we can quickly add these changes to the patient.’

Respond: Place the orders for a pain management consult and then disconnect the PCA pump.

Reflect: As the patient has just received a dose of Morphine for breakthrough pain, the patient should have controlled pain long enough for pain management to come and consult with him. Having a pain management consult will help determine the medication that would most benefit the patient in his recovery, as well as determine the severity of the patient’s acute and chronic pain needs. Establishing pain management now will decrease the time the patient will be without assistance during his recovery (Walid, 2008).

What is the best action to perform fourth of the six actions identified as part of planned client care for this client?

Administer tetanus immunization

Notice: The patient was in a motor vehicle accident with a rollover, which caused multiple abrasions, rib fractures, and a right femur fracture (Tetanus vaccines: WHO position paper 2017).

Interpret: We need to administer the tetanus shot to the patient to prevent the development of tetanus infection, which could lead to muscle pain, contractions, and weakness, and if left untreated, could lead to respiratory complications and death.

Respond: Educate the patient on the need for tetanus immunization, explaining why the doctor has ordered it, what it prevents, symptoms and outcomes of tetanus if the patient becomes infected, mortality rate, and how the medication is administered, obtaining consent to the injection as well. Once consent is obtained, administer the shot.

Reflect: The administration of the tetanus vaccine is important due to the amount of external to internal injuries this patient has. Coming into contact with multiple materials during a motor vehicle accident, as well as surgical sites that, are all points of entry for tetanus. If not prevented by immunization or booster, infection could lead to muscle aches and cramps and contractions in the neck and jaw and eventually affect breathing, potentially leading to death. The patient is at a lower risk of acquiring tetanus if given the vaccine. Currently, tetanus has no cure, and is care of the infection is focused on managing the symptoms. However, the vaccine is the easiest way to prevent infection (Johnston, L. 2011).

What is the incorrect action for this client?

Decrease O2 to 2L Nasal Cannula and continue Sp02

The patient has an oxygen saturation of 94% while on oxygen at 4L nasal cannula. If we decrease his oxygen to 2L at this time, his oxygen saturation will fall and will not stay at the guideline of 92%. Maintaining proper oxygen flow and monitoring Sp02 levels, we can also monitor the patient’s remaining ABGs. Currently, the patient is in respiratory acidosis uncompensated, so if we decrease his oxygen before monitoring and ensuring the patient has within normal limits or stable ABGs, we are increasing the risk of the patient maintaining respiratory acidosis, which could lead to respiratory failure, poor organ function, and shock. Education on smoking cessation and materials on where to get assistance in smoking cessation should be provided to the patient. The use of oxygen should be titrated down slowly to assess oxygen saturation without dropping the patients’ oxygen levels too quickly while maintaining ABG levels within normal parameters. If we are able to decrease the patients’ pain, we can provide deep breathing techniques not only for pain relief measures but for increasing oxygen saturation levels as well (Grensemann, J., 2018).

References

Bender, D., Jefferson-Keil, T., Biglari, B., Swing, T., Schmidmaier, G., & Moghaddam, A. (2014). Cigarette smoking and its impact on fracture healing. Trauma, 16(1), 18–22. https://doi.org/10.1177/1460408613504064