Considering the Health History that you completed with Tina Jones, identify at least 2 diagnoses and justify how you have come to identify them.
Locate and summarize at least 1 scholarly article for each diagnosis. Each article should support your understanding of the diagnosis selected.
Also, locate and summarize at least 2 scholarly articles that address evidence-based practice when treating this patient. Please use the nursing diagnosis of acute pain as the primary and the second nursing diagnosis is Risk for unstable blood glucose levels. Tina Jones can be found on Shadow Health. A 28yo African American female who fell off a stepladder and injured her right foot. Her Glucose:133, HgbA1C:8.7, temperature was 102, WBC:18.6 Hgb:11.1, Pain:7/10
Please cite my book under references. You can look up Tina Jones on the intranet to get a better ideal. 2-3 pages excluding title & reference page
Nursing Theory Unit #2 IP
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Nursing Theory Unit #2 IP
Nurses are directly involved in delivering primary care to patients with different illnesses. To be effective in their role, nurses must demonstrate competence in implementing nursing interventions that will generate positive patient outcomes. It is worthwhile noting that the skill level of a nurse affects the quality of care delivered to patients. For example, highly experienced nurses can handle patients with more complex diseases whereas nurses with less experience can handle patients with mild diseases (Benner, 2009). Nurses are able to advance their skills from novice to expert stages through clinical practice with patients. The purpose of this assignment is to analyze how nurses acquire expertise in practice using Tina Jones as the case study.
Diagnoses
Nurses usually learn to implement the nursing process during their initial years in practice. Patient assessment is a crucial phase of the nursing process because it enables the nurse to identify specific health needs that should be addressed to improve a patient’s quality of life (Bayih et al., 2021). The case study describes a 28-year-old African American female called Tina Jones. From her health history, Tina Jones fell off a stepladder and injured her right foot. Her Glucose1=33, HgbA1C=8.7, temperature=102, WBC=18.6, and Hgb=11.1. She describes the pain on her right foot as throbbing and radiating to the ankle, and constant. She rates her pain at 7/10. Based on Tina Jones’ health data, her primary nursing diagnosis is acute pain and the second nursing diagnosis is the risk for unstable blood glucose levels. These two diagnoses are supported by both subjective and objective data. For example, Tina Jones indicates that she had a scrap on her right foot. This is causing her unbearable pain that is rated at 7/10 on the pain scale. Additionally, Tina Jones has an increased risk for unstable blood glucose levels. This diagnosis is supported by the fact that she has type-2 diabetes but she is non-compliant with prescribed diabetes medication (Metformin). Tina Jones further indicates that she stopped taking the medication without consulting her physician. The information gathered when obtaining her health history supports the identified nursing diagnoses.
Evidence Support
Nurses utilize evidence obtained through research to support their nursing diagnoses and choices of nursing interventions. According to Griffioen et al. (2020), physical injury is the primary cause of physiological pain. When left unmanaged, acute pain can transition to a chronic one. From Tina Jones’ health history, the patient reports that she tripped on a stair at work and twisted her right foot, and sustained a scrape. Her foot is hot, swollen, and red with pus draining. Sudden injuries on any part of the body often cause pain of different levels. In Tina Jones’ case, her pain can be rated at 7/10 on the pain scale. The evidence further supports how the lack of medication adherence among patients with diabetes increases their risk of unmanaged blood glucose levels. According to Polonsky and Henry (2016), poor medication adherence causes inadequate glycemic control in patients with type 2 diabetes. Unmanaged blood glucose increases chances of morbidity and mortality. Severe health complications usually occur in such patients who eventually incur huge hospital costs, record high emergency room visits, and experience prolonged lengths of hospital stay.
Evidence-based Treatment Interventions
The interventions that the nurse implements to treat a patient with acute pain and increased risk of unstable blood glucose levels should be supported by research evidence. The evidence-based intervention for managing acute pain, and that can be considered in Tina Jones’ scenario is the use of opioid analgesics. The healthcare provider should maintain Tramadol given orally at a dose of 50 mg twice daily for two weeks (Motov et al., 2021). A study conducted by Motov et al. (2021) to assess the pain management interventions that are commonly used in the emergency department confirmed the safety and efficacy of opioid analgesics in managing acute pain. The nurse should offer proper guidance to Tina Jones on issues related to the drug’s side effects, overdose prevention, and avoidance of medication abuse.
Patient education is one of the best strategies to promote drug adherence in patients with type-2 diabetes. According to Williams et al. (2022), the use of a personalized approach to treatment can significantly help to improve the health outcomes of patients with type 2 diabetes. Such an approach entails teaching the patient about diabetes, its risk factors, the role of therapy, the importance of medication adherence, and the potential impacts of drug non-adherence. Adequately trained patients often maintain medication adherence, express satisfaction, and have an improved quality of life (Williams et al., 2022). The nurse who is providing care to Tina Jones should maintain current diabetes and pain management medications while also educating the patient to adhere to those drugs.
Conclusion
Exposing nurses to different patient scenarios is a good way to help them transition from one phase of skill acquisition to another. Nurses need to recognize the fact that they will sometimes encounter patients such as Tina Jones with multiple health needs. To remain effective, they should combine critical thinking with the skills already acquired to ensure that their patients receive optimal and quality care.
References
Bayih, W. A., Ayalew, M. Y., Belay, D. M., Alemu, A. Y., Birihane, B. M., Asnakew, S., Endalamaw, A., Demis, A., Kebede, S. D., Abate, B. B., Baih, S. Z., Feleke, D. G., Mekonen, D. K., Aynalem, Y. A., Aytenew, T. M., & Chanie, E. S. (2021). The implementation of nursing process during patient care in Ethiopia: A systematic review and meta-analysis. Heliyon, 7(5), e06933. https://doi.org/10.1016/j.heliyon.2021.e06933
Benner, F.P.P. R., Tanner, F.P.C. R., & Chesla, D.C. R. (2009). Expertise in nursing practice (2nd Edition). Springer Publishing LLC. https://coloradotech.vitalsource.com/books/9780826125453
Griffioen, M. A., Glutting, J., O’Toole, R. V., Starkweather, A. R., Lyon, D., Dorsey, S. G., & Renn, C. L. (2020). Transition from acute to chronic pain in lower extremity fracture patients: A pain phenotyping protocol. Nursing Research, 69(2), 149–156. https://doi.org/10.1097/NNR.0000000000000407
Motov, S. M., Vlasica, K., Middlebrook, I., & LaPietra, A. (2021). Pain management in the emergency department: a clinical review. Clinical and Experimental Emergency Medicine, 8(4), 268–278. https://doi.org/10.15441/ceem.21.161
Polonsky, W. H., & Henry, R. R. (2017). Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Preference and Adherence, 10, 1299–1307. https://doi.org/10.2147/PPA.S106821
Williams, D. M., Jones, H., & Stephens, J. W. (2022). Personalized Type 2 diabetes management: An update on recent advances and recommendations. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 15, 281–295. https://doi.org/10.2147/DMSO.S331654