Summary Of The Roper Logan And Tierney Model

Introduction
The aim of this paper is to present a case study in relation to a patient the author has cared for whilst on clinical placement in the orthopedic unit in midlands regional hospital, Tullamore and to critically explore the care provided to the chosen patient. The author will focus this case study on the care provided after hip fracture surgery. A detailed bio-psychosocial profile and a detailed assessment of Ann will be presented used the Roper Logan and Tierney model of nursing which focuses on the twelve activities of daily living. Four key priorities of care will be identified under the NANDA. Supporting Rationales for the priorities of care chosen for the patient will be provided. To protect the privacy and confidentiality of
the chosen patient, their name will be changed to Ann. This women’s admission was due to a mechanical fall which occurred at home which resulted in a hip fracture. A hip fracture is a term used to describe a fracture or break in the upper region of the thigh bone (femur) where it meets the meets the pelvis, it is commonly referred to a ‘fractured neck of femur’ or a ‘proximal femur fracture’ (Ahern et al., 2016).
Following admission, Ann underwent a hemiarthroplasty to the right hip less than 24hours after admission.
A hemiarthroplasty is the surgical removal of the femoral head and neck and replacement with a metal component (Gulanick and Myers., 1998). This adheres to the Blue Book standard number 2 which states that patients should have surgery in the first 48 hours of admission providing they are medically fit (Ahern et al., 2016). Achieving early surgery is said to reduce mortality rates with the first-year post surgery (Colais et al, 2015). It is also said to reduce the risk of complication such as pressure sores, deep vein thrombosis, urinary tract infections and length of stay post-operatively (Rodriguez-Fernandez et al.,
2011).

Patient Profile & Assessment:
Name: Ann Specter
D/O/B: 01/01/1927
Chart number: 251
Consultant on admission: Mr Bayer.

ID bracelet applied: yes. Age: 91. Gender: Female
Address: 2 Main street, Co.Tipperary.

Date of Admission: 02/01/18
Time of Admission: 18:30
Reason for Admission: Pain and reduced movement to right leg
Diagnosis: Fracture to Right neck of femur. Medical/Surgical History:
Type 2 Diabetes.
Hypertension.
Neuralgia post shingles 5years ago.
Rheumatoid arthritis.
Total Knee Replacement 1985.

Preferred name: Ann
Occupation: Retired.
Religion: Roman Catholic.
Nationality: Irish.
Referring General practitioner:
Dr. Sam Kelly. Regular Medication:
Prednisolone 5mg once daily
Perindopril 5mg once daily
Linagliptin 5mg once daily
Plaglitazone Accord 15mg once daily
Omeprazole 20mg once daily
Pregnablin TDS.

Name of next to kin:
Maire Specter
Relationship:
Daughter.
Address:
2 Main Street,
Co.Tipperary. Telephone numbers:
Home:
092-5297394
Mobile:
085-6627837

Allergies: Penicillin. Reactions: Itchiness and swelling.

Temp: 36.4 Pulse: 86 Resp:24 B.P: 132/88
Weight: 74.2kg Oxygen Saturations: 93% Accommodation: Bungalow.
Lives alone: with daughter Marie.
Dependents: 3 daughters.
Services in place on Admission:
Home help 2 days a week for an hour.

Maintaining a Safe Environment: Ann was alert and orientated on admission. An identification band was put in situ, the patient-nurse call bell was explained and left in reach of Ann. On admission a falls risk assessment was carried out with showed Ann to be a risk of falls. A risk of falls alert band was placed on Ann’s wrist with consent.
Communicating: Ann communicates well with others in English.
Ann has no speech or visual impairments. Ann’s hearing in the right ear is impaired and she wears a hearing aid.
Breathing: Ann has no new or previous breathing problems. Ann’s immobility now places her at a greater risk of chest infections.
Eating and Drinking: Ann can eat and drink independently. Ann has Type 2 diabetes and takes a diabetic diet.
Eliminating: Ann wears incontinence wear day and night due to previous experiences of rushing to bathrooms and falling as a result. Due to Ann’s injury at present her mobility will be restricted and assistance is required for Ann to meet her elimination needs. Ann voices that her bowel habits are not an issue and that they move on a regular basis.
Personal Cleansing and Dressing: Ann’s Daughter assists her with personal hygiene needs and dressing at home. During the skin assessment carried out on admission, Ann’s skin appeared dry, tissue paper alike, oedematous and had two broken spots to lower leg and knee. Water low score was 30 which placed her at very high risk of developing pressure sores.
Controlling Body Temperature: Ann was Apyrexial on
admission.
Mobilizing: Ann mobilizes at home with a rollator. On admission Ann had restricted mobility and movement for Ann was very painful. Neurovascular assessment on admission was satisfactory. Ann will need physio and Occupational therapist input post-operatively.
Anxieties: On admission Ann was anxious due to surgery, reassurance and information regarding the surgery was giving to Ann.
Expressing Sexuality: Ann voiced that she wishes that her dignity will be respected always, and that privacy will be maintained.