Nursing Care Plan Using Gordon’s Functional Health Pattern
89-year-old Anthony underwent a hip replacement under epidural anaesthetic on Monday at 8.00am. he is now back in the ward and will spend 5 days in the hospital with the plan to discharge him on Friday ta 12.00am to a convalescent home. A care plan will be devised to provide the enough care for Anthony and to ensure he recovers to the best of his ability. the Gordon’s functional health pattern nursing care plan will be used to plan, assess and implement. Gordon’s functional health patterns is developed by Marjory Gordon. It is a care plan used by nurses in the nursing process to provide a comprehensive nursing assessment of the patient. During the surgery and epidural anaesthetic was used. The involves a catheter being placed into your lower back to administer anaesthetic. The epidural is placed between the spinal column and spinal cord and the catheter is put in place for numbing. Post-operative, Anthony’s vital signs will be monitored every 15 minutes to observe for shock. A neurovascular assessment will assess the skin incision, colour, the temperature, integrity or if there is any inflammation.
Anthony will be spending 5 days in hospital, during these 5 days the nurse will assess him every day looking for any signs or symptoms for any complications. He will have pain after his surgery, so it is up to the nurse to prevent the pain with the prescribed medications. A hip replacement includes 5 phases for rehab protocol. Since Anthony’s only in the hospital for phases 1 his main goal is to perform bed mobility and transfers with minimal assistance.
Firstly, using Gordon’s functional health pattern, we will assess Anthony’s health perception and management. This involves assessing any habits he has that is harmful to his health and may affect his recovery. For example, the amount of alcohol he may drink every week or if he smokes. His general health will be assessed and if he can perform good personal hygiene practices. It is important Anthony practices good health managements when recovering to prevent infection. the site of the wound should be assessed for redness, oozing or bleeding. Aseptic technique should be used to clean the wound and prevent contamination. This is important this is carried out every day when Anthony’s in hospital and he also should have follow up appointments to ensure the site isn’t infected.
Nutrition and metabolism focus on the pattern of food and fluid consumption in terms of metabolic need. Enough nutrients are required to maintain a healthy body and an adequate recovery. It’s important Anthony’s body weight is weighed every day to ensure he isn’t losing weight as this could affect mobility and recovery. Problems with fluid balance, tissue integrity and host defences may be identified. If Anthony doesn’t have adequate nutrients the risk of infection is prevalent. A nutritious meal should be devised for Anthony to have for the 5 days and the nurse should educate him before discharge about the right foods he should be eating to maintain a health diet.
The risk of infection is one of the top complications when a patient undergoes surgery. This can be a result of lack of nutrients that can lead to a weakened immune system or inadequate primary or secondary defences. The desired outcome for a patient with infection includes timely wound healing, be free of purulent drainage or erythema, and be afebrile. Nursing interventions include promoting good hand hygiene for patients and staff members, using strict aseptic or clean techniques to clean or change dressing or when handling drains. The patient should not scratch or touch the site either. This will prevent contamination and infection of the wound. Encouraging fluid intake and a high protein diet will maintain fluid and nutritional balance to support tissue perfusion and tissue healing.
Elimination is an important aspect in the Gordon’s functional health pattern. This involves the function of the excretory patterns- the bladder, bowels and skin. Fluid maintenance is important post op in the nursing care plan. Using a fluid balance chart can indicate if the patient has any urinary problems. It is also important to note if the patient is suffering with diarrhoea or constipation as this can be easily managed.
Activity and exercise pattern describe Anthony’s activity levels, exercises, leisure and relaxation. After the operation Anthony will be restricted in many ways with his movements until he recovers. He must avoid hip flexion past 90 degrees, internal rotation of the lower extremity and sitting on low, soft surfaces. Anthony will be weight bearing as tolerated with a rolling walking or other piece of medical equipment as seen fit by the surgeon. He may progress from a walker to a straight cane when they can demonstrate equal weight distribution, adequate balance, and limited Trendelenburg gait or limp. Dislocation of the new hip can happen very easily, so it is vital the right mobility is used, and adequate rest is needed. Anthony’s leg should be positioned in ABDUCTION. This is to prevent dislocation of the prosthesis. It is very crucial that the femoral head component of the acetabular cap is maintained in the correct position. Abduction splints, wedge pillows and two or three pillows between the legs of the patient will keep the hip in abduction.
Impaired physical mobility is a common complication after surgery. This can be due to pain and discomfort, lack of muscles strength or being reluctant to move. The desired outcome for the nurse is that the patient displays increased strength and function of the hip and mobility improves. Nursing intervention include maintaining the affected joint in a prescribed position with the body in alignment, this stabilises the prosthesis after the operation and allows for recovery. The use of mobility aids and assistance should be used when moving to prevent falls which could lead to further damage.
Sleeping patterns will be also be assessed to see if Anthony’s getting enough rest and relaxes. Dysfunctional sleeping patterns can lead to fatigue and sleep deprivation. This can affect his energy levels which can lead to a lack of mobility and adequate physiotherapy for the prosthesis. If Anthony isn’t getting enough sleep the nurse can look at giving him medications or help him get more relaxed before going to bed.
Cognitive- perceptual pattern involves the senses. This involves if Anthony has any hearing difficulties and if he needs hearing aids or not, if he uses glasses and if his vision has gotten worse. It also looks at if he has lost any memory lately and if it easy or difficult for him to make decisions. Anthony is and elderly man, so all these factors are prominent to him. It’s important to implement the care for Anthony’s hearing, vision and if he has any memory loss to make him more mobile.
The self-concept and self-perception pattern involve how one feels about oneself and how your feeling in terms of your mood and emotions. It’s important Anthony doesn’t let this operation affect his mood and how he feels. He should be made feel comfortable as possible and ensure he’s happy with the level of care he’s receiving. If Anthony is not feeling himself after the operation the hospital should offer some guidance and someone that he can talk to about this.
Role-relationship pattern is who is involved in Anthony’s life and plays a role in it. This is whether he has a family structure, if he lives alone and who is his support group for when he needs care when returning home. Anthony should be able to rely on his family when he needs care and help. They should be a moral support group in his life. The nurse will look at how the family are handling the situation of Anthony’s condition and whether they can look after him. It is up to the hospital to make sure he has adequate care when he returns home and whether he’ll need assistance at home.
Lastly the nurse will look at Anthony’s coping stress pattern. They will assess how he is handling his current situation and if this big change is affecting him in any way. At the end of his stay in the hospital the nurse will educate Anthony on the affects and what will happen over the next few weeks with his recovery, he will be given lots of physio to recovery and lots of guidance and care from medical staff. This will give Anthony peace of mind that he will be getting looked after.
It is important all the healthcare providers involved looks at KPIs when dealing with the care of patients. They need to use the 3 PIs: structure, process and outcome. This will ensure good practice is provided as they will demonstrate improvements being made over time. Anthony should be provided with the best care he can be given and its important for the nurse to assess, evaluate and implement a care plan for the 5 days Anthony is in the hospital for. The main goal is for Anthony to be discharged at the time he is given so adequate care is needed in those 5 days to ensure this is achieved. Using the Gordon’s functional health patterns, the nurse should use this care plan that’s suitable for Anthony to ensure quality of care and a good recovery.
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