Arthur Charleston is a 72-year-old Aboriginal Wiradjuri man. Birth date 7/04/1950. MRN  1020304.
Mr Charleston presented to the Emergency Department today following a fall at his home. Mr Charleston has a contusion above his left eye and shows some disorientation to person, place and time; he currently has a GCS of 14. Pupils are equal and reactive to light and motor function is equal on both sides in his legs and arms. Mr Charleston has a history of Type 2 Diabetes Mellitus, Hypertension, IHD, and COPD. He wears glasses for reading and hearing aids. Mr Charleston lives on his own and smokes 20 cigarettes a day. Mr Charleston consumes 6 cans of full-strength beer per day, and he states that he eats very little and enjoys take away meals most days. He is allergic to shell fish and Penicillin. Vital signs 170/80, HR 92, RR 20, SpO2 99%, Temp 36.5, BGL 12.4 mmol, Weight: 110kg Height: 190cm.

Mr. Charleston has expressed increased pain in his left hip when mobilising. The RN has informed you that you need to ensure that Mr Charleston has strict rest in bed until review by the doctor later that day.
a)    Considering the previous care plan, outline which nursing diagnosis will need to be updated to reflect this change in Mr Charleston care.
b)    Update the care plan according to the change you have identified for the following nursing diagnosis -Strict rest in bed, include in your response –
1.    What actual or potential impact will this have on the patient?
2.    Two (2) examples of nursing interventions that you would provide.
3.    What are the expected outcomes?
4.    Give two (2) strategies that you could implement to reduce risk (within your EN scope of practice).
5.    Provide one (1) more example of a nursing diagnosis, impact, intervention, expected outcome and safety consideration for Mr Charleston.

ANSWER

Updating Mr. Charleston’s Care Plan: Addressing Increased Pain and Strict Rest in Bed

Updating Nursing Diagnosis

One nursing diagnosis that needs to be updated in Mr. Charleston’s care plan is “Impaired Physical Mobility related to pain and hip injury.”

Updated Care Plan: Impaired Physical Mobility – Strict Rest in Bed

Impact on the Patient:
Strict rest in bed may lead to potential complications such as muscle atrophy, decreased joint mobility, increased risk of deep vein thrombosis (DVT), and respiratory complications due to immobility.

Nursing Interventions

Positioning: Place pillows to support Mr. Charleston’s left hip, ensuring proper alignment and reducing pressure on the affected area.
Range of Motion Exercises: Perform passive range of motion exercises for Mr. Charleston’s unaffected limbs to maintain joint flexibility and prevent muscle atrophy.

Expected Outcomes

Mr. Charleston will report decreased pain and discomfort in the left hip.
Mr. Charleston’s joint mobility and muscle strength will be maintained to prevent further complications.

Risk Reduction Strategies (within EN scope of practice)

Encourage Deep Breathing: Teach Mr. Charleston deep breathing exercises to prevent respiratory complications and maintain lung function during rest.
Promote Hydration: Ensure Mr. Charleston remains adequately hydrated to reduce the risk of DVT formation.

Additional Nursing Diagnosis: Risk for Impaired Skin Integrity related to limited mobility and pressure points.
Impact: Prolonged bed rest can lead to skin breakdown and pressure ulcers due to reduced circulation and pressure on bony prominences.
Intervention: Reposition Mr. Charleston every 2 hours, provide skin care, and use pressure-relieving devices.
Expected Outcome: Mr. Charleston’s skin integrity will remain intact, with no signs of pressure ulcers.
Safety Consideration: Use appropriate lifting and transfer techniques to prevent friction and shearing during repositioning.

In conclusion, updating Mr. Charleston’s care plan to address his increased pain and the need for strict rest in bed is crucial for preventing complications associated with immobility. By implementing tailored interventions and considering potential risks, nurses can provide safe and effective care to promote his recovery and overall well-being.