Roper Logan Tierney Model Activities Of Daily Living

Roper Logan Tierney Model Activities Of Daily LivingINTRODUCTIONIn this assignment I will present a long-suffering I see supervised for during one shift on my placement ward. employ the Holland et al (2008) Roper Logan Tierney model of tutelage which focuses on the activities of daily living a description of c atomic number 18fulness received by the tolerant will be outlined. Any reference made to the unhurried is down the stairs pseudonym and referred to as Mrs Oni to protect the diligent confidentiality consort NMC Code of conduct (2008). To comply with campaignlines erect out by De sparkment of Health (2009) full verbal take was first obtained from the patient of before whatsoever information was used in this assignment.My placement was in group AB and orthopaedics functional ward were patients were routinely admitted from accident and emergency and prepared for mathematical lick and admitted after surgery. I feature chosen a 33 year old female patient admitte d to accident and emergency department and hence to the ward with acute freeze off group AB distract and later had non elective surgery for appendicitis.It was my duty under the supervision of my mentor, during this shift to monitor and maintain internal and safe surround, exit and encourage patient to mobilise and scandalise management. The respectment tools utilised to earn a care plan concord to priority are those implemented and used by the trust. All activities discussed will be reflected upon as part of in the flesh(predicate) and professional development.CASE STUDYMrs Oni is a married arrest with two children under the age of ten. She is a health support worker and is employed full time. Mrs Oni complained that the pain started at the umbilicus region and then later the pain intensified at her make up lower abdominal quadrant. When she was admitted upon examination by the general surgical team it was reported that her abdomen was tender and gardening. Other sympt oms presented included constipation, nausea, fever and loss of appetite which alone common to the determine.Patient had past medical history of being hardened for urinary tract infection to rule out this as a possible re pass a federal agencyring reason a urine analysis was performed and sent to microbiology interrogation and further analysis. Bloods were likewise taken to check for raised neutrophil (white assembly line cell) count. No previous history of abdominal pain, aggravating factors, patient mat relief when lying down with knees pulled up, presented no urinary symptoms, no intoxicant consumption, and patient is not on any medication. On observing Mrs Oni she appeared nervous and was tired due to pain.When the patient was assessed utilise interview skills and attempting to form a remedy relationship with the patient it was revealed that Mrs Oni wanted to maintain a handed-down African diet rich in fiber with lots fruit and vegetables, but found it hard to fin d time to prepare the repasts and replaced it with sickly snacks part at work and didnt eat at regular meal times. She also revealed that she did not get much exercise and weight gained plummeted after her second child.Oxford dictionary for nurses state that the appendix is the short thin filmdom ended tube, 7 10 long and is attached to the end of the caecum. The caecum is the first part of the large intestine according to Clancy McVicar (2002) appendicitis occurs when this tube becomes alter with faecal matter and or with other debris. It can also occur if the caecum is obstructed resulting in damage and blockage to the appendix. In two cases inflammation occurs which can cause rupture of the appendix and appendectomy surgery is required to stop other bowel and abdominal inflammatory conditions developing.I have chosen this patient because NHS Choices (2012) states that appendicitis is considered to be a common condition and that around 7% of UK population will develop the condition at nearly stage in the lives. It also states a lack of fibre in in diet can be a cause for the condition. I have also formed a good therapeutic relation with the patient.USING ROPER LOGAN TIERNEY MODELCronin Rawlings-Anderson (2004) cited Walker Avant (1995) who depict charge theories as goal oriented actions.Llewellyn Hayes (2008) describes the model as an serve in assisting and measuring the patients ability to win independence at apiece stage of care. All 12 activities include, maintaining a safe environment, talk, respiration, eating and drinking, eliminating, personal cleansing and dressing, controlling organic structure temperature, mobilising, working and playing, expressing sexuality, sleeping and dying. All activities according to Holland et al (2008) are used as a poser for the assessment, planning, implementing and evaluating butt in the provision of care.Maintaining a safe environment is one exercise of how the activities can relate to patient c are. Diamond (2011) uses the care setting as an example how a person human rights can become good compromised. The Human Rights Act (1998) article 3 states that No one shall be subjected to torture or to inhuman or degrading treatment or punishment.This clearly illustrates that the environment in which a patient is care for should be maintained to ensure patient physical, mental and psychological wellbeing while also reduction the jeopardize of infections. The Roper et al model of care is in that locationfore a useful tool for ensuring that all patient unavoidably are considered. Holland et al, (2008) also includes care for the internal environment that which is on a cellular level. This aspect forms a in truth authoritative part of the convalescence process for the case study patient Mrs Oni.ACTIVITIES OF DAILY LIVING textile OF CAREChinn Kramer (2008) argues that a nurses action can help to purify patient experience by using their awareness and theoretical knowledge in si tuations, thus dislodging patient fears about situations that are cutting to them.The handover received for Mrs Oni described the patient sleep patterns throughout the night, stated the analgesics paracetamol and tramadol ordained for pain, discussed patient mobility, discussed patient intervention that was the physiotherapy sessions which were required for chest exercises, outrage care discussed where surgical clips removed from the wound sloughing observed and surgical team notified as a result antibiotics now prescribed eight hourly and stated wound dressing needed to be changed and catheter to be removed.Although the assessment of the patient was received from a secondary source in handover the patient care exempt needs to be assessed in order to establish care priority for the patient. Holland et al, (2008) assessment is therefore the first stage in the process where the nurse uses communication skills to gather to begin planning care for the patient. eupnoeicOn assessing Mrs Oni it was found that she was still feeling tired after acquiring a full nights rest. While listening to the patient it was observed that her reference was quiet and chest movements were irregular. The pulse oximetry machine was used to further assess the levels of oxygen in the patient. Correctly using the equipment making sure the patient was not snaping nail polish which can alter interpretings.The diagnosing with the reading confirmed that Mrs Oni was lacking oxygen. The normal range for the baseline measurements are charted out using the Glasgow Coma Scale used by the trust. It indicated that reading above 94% is considered within the normal range, Mrs Oni reading were 93%. It was determined that oxygen therapy was needed.A second intervention after the oxygen therapy was reassessed and had better the patient breathing was made to prevent secondary infections the physiotherapists work with Mrs Oni, to thatched roof her deep breathing exercises to avoid developing chest infections. The use of communication in assisting Mrs Oni by first providing a vomitus bowl and tissues as needed with the nurse explaining to patient why it was important to expectorate any excess sputum while giving the nurse the opportunity to see colour of sputum for signs of infection, according to Basford Slevin (2001) this reduces the chances of developing other complications.MobilityMobility according to Perry ceramicist (2004) is affected by events and nursing intervention can improve consistency function and ability to date fromy. NICE clinical guidelines (2010) to encourage hydration and mobility to reduce risk of venous thromboembolism (VTE). This condition according to Clancy McVicar (2002) is where clotting occurs in the veins and affects patients who have had abdominal surgery and experienced child birth.The surgical team did prescribe some(a) prophylaxis treatment anti-embolism stockings which are referred to as TED stockings. However, the patient refused to we ar them and has a right to do so according NHS Choices (2011) under the Mental Health susceptibility Act 2005 which advises that a person has the right to voluntarily refuse treatment.On assessing the patient no real barriers to mobility was observed and with improvements on the patient breathing and fatigue levels, knowledge of psychological issues was required to further diagnose the patient.Using communication skills to form a therapeutic relationship as an intervention, Mrs Oni revealed that she was very worried about her children, she became tearful but discussing her children helped to remind her that she need to recover quickly to get back to her family and home. She was able to later agree to wear the anti-embolism stocking and began to attempt to mobilise without assistance. Another nursing intervention used to incite Mrs Oni in mobilising was to administer prescribed analgesics for pain management thus reducing the effects of the surgical wounds present.Personal Cleansin g and dressingMrs Oni had a wound had become infected and needed to take meropenem by intravenous extract which according to BNF (2012) an penicillin antibiotic prescribed forintra-abdominal infections, skin and soft-tissue infections. Mrs Oni stated she was not supersensitized to penicillin upon admission but the side effects from the drug were likely to be nausea, vomiting, diarrhoea, abdominal pain and headaches. According to BNF (2012) patients most at risk of developing anaphylactic reactions are asthma, eczema and hay fever sufferers.On inspection of the wound while changing the dressing it appear to be little exudate. On previous dressing change I was reported that there was some sloughing which is according to Perry tinker (2004) pg. 1278 are tissue cells that have died and have been removed from the body. Cleaning of the wound using the aseptic technique and new dressing were applied. Mrs Oni was then assisted with her personal hygiene needs and convey that she was fe eling much better. These actions taken will help to improve body image and reduce risk of prolonging the infection.PainAlthough not mentioned in the handover it is still an effect experience after surgery. The tool used to measure pain is done using a numerical rating system with a scale rating pain from 0 to 10. Zero being there is no pain and ten being the highest value Indicating intervention needed. Perry Potter (2004) p.1274 definition of pain, subjective, unpleasant sensation caused by noxious stimulation of arresting nerve endings. This notion that pain is subjective is very true as each individual experiences pain in a different way according to Ewards R. article in Benzon et al (2005) pain can also be measured through observing behaviour. Mrs Oni did report pain and the prescribed analgesics were given as prescribed. Upon evaluation it was verbalised by Mrs Oni that she was in less pain four hours an hour later after administration.CONCLUSIONThe important aspect of the re flective process is to develop critical thinking skills which according to Jasper (2006) helps to develop the ability give clear rationales when making decisions. Reflecting using Gibbs et al (1988) cited by Bulman Schutz (2008) cycle where a series of reflective questions to be thoughtfully answered in retrospect which begins with the experience, a description of feelings, taking in depict the positives and negatives, looking at the situation from different angels, what else I could have added to improve the outcome and finally the actions taken. Using the experience of caring for someone post-operative using the Roper et al, framework of care was a good teaching guide and created self-awareness of the process while helping to give a structured framework to gather knowledge in a way that was useful. I felt more comfortable and confident in discussing issues with my mentor on issues of care. The environment was very challenging but the framework help me to focus and achieve my obj ectives.Evaluation of care using Llewellyn Hayes (2008) uses Huycke and Alls (2000) framework that encompasses all winding in the provision and receipt of care. The ward provides a comment display board for patients, this way the immediate providers of care the staff receive instant and authoritative feedback. This shows the patient experience is valued.