Comprehensive care plan

Kevin Johnson’s Comprehensive care plan

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In this assignment one is required to develop a comprehensive plan of care using the
scenario Kevin Johnson, which needs to include rationales and evidence to support care
decisions. The plan of care should cover the following nursing diagnosis in relation to
Kevin; Acute pain, Risk for peripheral Neurovascular Dysfunction (or risk of same; related
to oedema or immobilization following fracture), Risk for impaired skin integrity (related
to presence of immobilization device bandages, cast), Fear, Constipation (occurring with
prolonged immobilization), Spiritual distress (related to chronic illness, life change or
disturbances in belief and value system that give meaning and a sense of hope), Interrupted
family processes (related to patient’s illness). What are some of the
assessment/interventions behind these diagnosis and their rationales.

Introduction
Patients with healthcare needs, their relatives, physicians and community benefits
adequately from a comprehensive written medical summary including emergency treatment plan
are provided. Comprehensive care plan refers to the combined report of medical summary,
emergency care plan and the working treatment plan is provided. Before completing the
necessary effective interventions, it is important to identify issues which need attention. Patient’s
commitment to healthcare should also be analyzed because it determines their extent of

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involvement in performing negotiations on the approaches where important care plan issues are
prioritized (Papastavrou, 2012).
This case study aims at developing care plan for Kevin Johnson’s. He is 15 years of age
and of Aboriginal Australian. He lives with his mother and four siblings. He was rushed at the
ED after automobile crash, which gave him multiple injuries. He had no protective gear at the
time of the accident. His head was hit he got a fractured leg and broken mandible. Additionally,
his socio-cultural beliefs and values were identified as the main barriers to healthcare provision.
In this context, this paper evaluates the symptomatology risks including risks to developing
peripheral Neurovascular Dysfunction, impaired skin and spiritual distress due to interruption of
family’s processes. The assessment and interventions behind these diagnosis and rationale will
be evaluated (Ramont, Niedringhaus, & Towle, 2012).
Nursing diagnosis
Subjective: Kevin had a fractured knee which was rectified using seven stitches. His mandible
was fractured which was treated. Additionally, his right arm had lacerations. Lacerations were
also observed on his right knee and thigh. Kevin verbalized excruciating pain in his right knee,
left leg and face, reported pain scale of 7/10.
Objective: BP 120/65; HR 90beats; RR 18 beats; SaO2 99%, GCS 1; L. leg pain is 6/10 and right
leg 3/10
Social history: Kevin is an extrovert and like taking risks. Being of adolescent age, curiosity
bolsters his desire to engage in risky activities such as riding motor bikes at high speed without
wearing any protective gear.
Medical history: His past medical history indicated that he suffers from Type 2 diabetes. He is
currently taking Metformin 500mg TDS. He reports that he is allergic to penicillin.

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Plan: Kevin had a fractured knee which was rectified using seven stitches. His mandible was
fractured which was treated. Additionally, his right arm had lacerations which were treated using
wound dressing. Lacerations were also observed on his right knee and thigh which were dressed.
Diagnostic imaging and laboratory testing was conducted to evaluate if there was internal
bleeding.
Critical analyses of care plan
There is need for patient care analysis to be critically addressed. This is normally
accomplished by empowering the patient and integrating them in managing their condition.
Additionally, the health care provider should assess on how well the patient care is being
managed basing arguments on what the patient told them, and the medical indicators must be
highlighted. Reaching a complete negotiation between the two parties’ would result to
conclusive reports. The lacerations were treated by wound dressing. The patient had concerns
that the presence of immobilized bandages would put pressure, friction shear, causing harm to
the skin integrity (Oeffner, Aker, Brillhart, & Natale, 2011). This concern is valid bearing in
mind that the skin is one of the largest body organs. This is extremely important because of the
skins vital role of protecting the body from injury. Impaired skin integrity is a common threat to
individuals with restricted mobility such as Kevin’s situation. To control the incidence, the
nurses involved should conduct regular skin surveillances and use tropical treatments where
necessary. The expected outcomes include enhancing/ promoting skin health integrity (Morris,
2012).
Peripheral neurovascular dysfunction is also observed. The nurses had difficult time in
getting pulse in Kevin’s left leg. This is attributable to Trauma and excessive pressure on the
nerves and circulatory vessels. This is characterized if the refill toes time is less than 3 seconds,

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presence of numbness or tingling in foot and toes. To manage this concern, the burses used ice
packs to the injured knee 48 hours after surgical operation, to reduce edema and bleeding.
Patency in the drainage system of the wound is maintained with the aim of reducing edema. The
injured leg is positions in a way that the knee immobilizers, the CPM apparatus do not cause
excessive pressure (Obuekwe & Etetafia, 2009).
Kevin is also suffering from mental distress. His fears include that prolonged
immobilization and hospital stay would affect his peer relations and interrupt the family relation
purposes. In this case, families have critical role to play in prioritizing the patient’s needs. This
will ensure that the patient feels appreciated; thereby enhancing their sense of hope. Family
hope could in terms of providing home care nurse once he is dismissed from the hospital. It is
extremely important for the family members to recognize that the patient is still under
medication to avoid manhandling them. These interventions will adequately address the the
distress experienced by Kevin (Neir, 2013).
Kevin cultural and religious beliefs pose barrier to the healthcare. He believes that he
cannot be served by a female nurse and the nurse should not address him when looking into the
eyes. Several incidence of Kevin’s noncompliance have been reported. He felt that his rights as a
person were violated. This calls for social and cultural competencies from the healthcare facility.
Long term and short term care management goals
Kevin’s health condition is described by increased pain (scale 7/10). The short term goal
is to assess the pain within 24 hours after admission. A licensed nurse will perform pain
assessment using tools which are designed for evaluation of cognitive impaired as soon as
admission is done. Specific guidelines on how to manage the risks such as protocols, policies and
other relevant procedures will be done to assess and identify the causes of pain. Secondly, the

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risk factors which relate to pain and risk of having pain will also be evaluated, this will ensure
that appropriate diagnoses and other conditions could contribute to the predisposition of pain.
This will be evaluated using the QI protocol to assess the cognitive impaired function effectively.
The long term goals include the identification of pain management goals. This will
require collaboration between the relevant healthcare inter-professional team in order to identify
the most relevant interventions which will effectively manage the condition. The interventions
will stretch to include the factors which will result to total pain reliever (Rockwood, Green, &
Bucholz, 2010). Periodical reassessment of the pain will be done to check the patient response
and to evaluate the degree of comfort. Where the response is inadequate to the interventions
selected, the approaches will need to be adjusted; and if necessary, alternative approaches will be
applied. Lastly, the significant effects will be evaluated even after hospital discharge through
clinical follow ups. This will facilitate the identification of problems which arise due to
medication reactions and manifest themselves as infections or other causes. If the medication
proves to be effective, it should be continued; if not it must not be used as it would worsen the
conditions (Lowe, & Friedlaender, 2013).
Main inter-professional teams
Health care delivery system is a complex and demands good co-ordination between the
APNs, RNs, physicians and other allied healthcare professionals. The hospital administrators
such as the pharmacists, department managers and chief nursing officers are charged in ensuring
that Kevin’s health is restored by developing strategic plans, structures, and procedures which
will bring forth positive outcomes. The healthcare executives should ensure that effective
communication pattern is enhanced especially when resolving common healthcare challenges
(Guglielmi, 2013).

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Kevin’s case calls for multidisciplinary collaborations between various health care teams.
These include the physicist, clinical nurses, and pharmacists. The interdependent nursing
intervention will be conducted. Well co-ordination and collaboration of the relevant healthcare
professionals will enhance the potential of ensuring that a comprehensive care is achieved, one
which is patient based and cost effective for Kevin (Tabloski, 2010). The healthcare team work
will emphasize on health promotion and infection prevention on the Kevin’s bruises and injuries
(Humphrey, 2008). These efforts are aimed at meeting any unanticipated health care challenges.
The importance of the team work and inter-professional collaboration is that it will ensure that
complex problems on Kevin’s case are addressed thereby improving quality of life in Kevin.
According to Kevin’s case study, it is evident that Kevin requires wide range of healthcare needs
including physiotherapy, psychotherapy and the general medication to ease the pain and to
promote his health. Kevin requires to be empowered by these services, which implies that a
collaborative inter-professional team will enhance faster healing process (Taylor, 2011). For
healthcare professionals, inter-professional healthcare will increase their professional
satisfaction, through the increased collaborations, new innovations will be made. The inter-
personal collaboration will foster mutual understanding across the relevant disciplines. This
practice will ensure effective delivery of care. Resources and facilities used in healthcare system.
Kevin’s burden on acute delivery will be considerably reduced, and thus continuous quality of
care services will be done (Kerig, & Alexander, 2012)
Nurses Role in Kevin’s care
In this context, the nurses are one of the inter-professional teams role in Kevin’s care.
For a long period of time, the nurses have been valued as doctor’s handmaidens. Their training
was focused on task and technical based duties. However, modern nurse are armed with better

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education on how to focus on coordinated patient care and will involve critical thinking ability.
For this reason, Kevin’s care will be best managed by the care patients. This is because Kevin
will spend sometime in the hospital care and he requires a lot of technological care. One role of
the nurse during Kevin’s care is to ensure safety for the patient (Grigoryan, Javedan, & Rudolph,
2014). They will work round the clock, they will ensure that no medication errors occurs and the
patient is provided with the correct therapy putting in consideration the associated risks such as
skin breakdowns and falls. The nurse is also aware of healthcare systems which would either
delay or make it work faster. They will work towards minimizing inefficiencies which would
reduce quality of care. Additionally, nurse’s roles are often generalized (Readdick, 2008). They
work collaboratively with other multiple healthcare team members in order to provide a wide
range of quality care in order to achieve the patient goals. The nurse’s roles also include
advocating for patient rights. The nurse interact with the patients more often than other
healthcare team works and are at a position to recognize the potential harmful issues which can
be advocated by the patient (Frondini, & Lunardelli, 2013).
These briefly described roles will enable the nurse to assess the patients and families
status of health, in order to ensure that the patient physical, psychological and social demands are
addressed. The nurse is also responsible to monitor Kevin’s health status and his response to
treatment and the ability for Kevin to provide self-care in daily activities. The nurse will ensure
that Kevin’s care is coordinated with the family, healthcare staff and other professionals by
developing individualized care plans (Grigoryan, Javedan, & Rudolph, 2014). The nurse will
also implement various interventions to design and to manage Kevin’s pain, improve his
functionality, empower the patient and to eventually strengthen the coping strategies. In some
cases, the nurse will also be involved in administration and monitoring roles played by the family

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members and patient’s lifestyle, and where necessary; the nurse will be required to provide
educational care. The nurse will also be involved in the evaluation of treatment outcomes and
where necessary, revise the action plans to fit Kevin’s needs and demands. All these practices
will be carried out as evidence based practice ad research, in an effort to improve the quality of
the healthcare being provided (Navalta, 2009).
Ethical, legal and professional concerns
The nurses designated to work on Kevin’s care must autonomously remain responsible
and accountable for Kevin’s safety, and must perform all the tasks using a patient centered and
evidence based practice which respects, upholds patient’s dignity and above all, observes the
patient human rights. The nurses are required to exhibit professionalism in their work as
recognized the ethical and legal frameworks. The nurses are required to work under partnership
with the other professional teams, service users and their relatives. This will ensure that the
decision making processes are shared (Lowe, & Friedlaender, 2013).
Excellent communication must be observed which will enhance interpersonal skills. The
communication must remain compassionate and respectful at all times. Each time a new strategic
intervention is made, the nurses will use effective communication skills to make reasonable
adjustments which will ensure that health is promoted. When it comes to decision making
processes, the nurse taking care of Kevin is required to be assessing the wide range of physical
and mental needs of people within the healthcare. The nurses must be in a position to provide
safe and quality care where necessary; irrespective the fields of care (Ginsberg, Adunsky, &
Rasooly, 2013). All actions must be observed to meet a complex and co-existence of patients
demands. The decision making process must be shared amongst the care givers, patient and the
patient relative; the choice made should be full range of possible interventions including an

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updated technology knowhow. Of importance in this case is that all nurses must understand the
factors which influence the patient lifestyles including the cultural contexts, social economic
aspects among other factors in Kevin’s care provision. When making these decisions, the person
must take into account the ethical standards. It requires nurses who have high understandings of
law and nursing ethics (Conradi& Wilson, 2010).
For instance, Kevin’s comes from a culture which does not permit him to be taken care of
by a female nurse. The culture where looking direct in to his eyes when giving instructions or
making some practices is not allowed. His request to change nurse who will provide care for him
should have offended some nurses, but putting into considerations that a nurse needs to be
culturally competent, Candice requested the nurse manager to assign a male RN to take up the
task. There are need to address the spiritual and social distress experienced by the patient and the
family. This is not an easy task and the nurse could experience a moral anguish when faced with
such like dilemmas which concerns patients care. In this case, when making ethical decision,
there are three vital resources which must be put into account including; a) The ANA code of
ethics; b) comprehension of ethical principles and c) establishing the ethics of caring (Brown,
McCauley & Saxe, 2013).
The nurse must understand the principle of nonmaleficence which entails the principle of
providing care without harming others. Secondly, the nurses must understand the principle of
beneficence which focuses in bringing quality healthcare to the the patient which meets the
standards and care of patients. The other four principles includes the principle of self-
determination and autonomy, principle of fairness, equitability and remaining truthful and that of
fidelity. These principles have been indicated by evidence based practice to guide a nurse in
making ethical decisions. When it comes to legal issue, the nurse offering g healthcare serviced

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must be licensed by the state federal, which will provide framework where nurses are expected to
follow. In areas where the nurse scores below the acceptable standards of competence, the nurse
can be litigated. This includes negligence, failure to provide the necessary and essential level of
care among other malpractices (Frondini, & Lunardelli, 2013; Riewpaiboon Et al., 2008).
Conclusion
Therefore, nurses have important role in providing healthcare. They are at the front line
to ensure that a patient receives care according to the standards of healthcare. They should
respond confidently and more autonomously when delivering care, even in uncertain situations
and manage themselves and the events accordingly. Additionally, nurses must understand that
there are decisions influence many aspects of life. The patient must be empowered to ensure that
they are able to make decisions effectively, and to make them understand that they are special
part of the processes which are essential and integral in the healthcare systems.
Again, there is need for involved inter-professional team to work in partnership. There
are also needs to value the client’s autonomy and dignity. Lastly, the healthcare environment
must be enhanced to ensure that patient’s privacy and dignity is bestowed. This will make the
patient to feel more comfortable, and to make sure that their health outcomes is achieved. Lack
of these described hospital environs and care will threaten the patient’s dignity, which could lead
to complex mental and psychosocial disorders.

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References
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