Essay plan: Introduction of Patient: - 78 male, admitted with a fractured patella from slipping on wet kitchen floor, has

uncontrolled type II diabetes diagnosed 1998, sedentary lifestyle, hypertension, loss of sensation in feet, history of chest infections, excessive carbohydrate diet, high blood pressure - Brief explanation of diabetes with relation to the patients conditions - 1 week duration Nursing and Health Model: - Risk assessment for moving and handling due to fracture - Medley score - Care plan based on Roper, Logan and Tierney: 12 activities of living - Maintaining a safe environment: patient has peripheral neuropathy so cannot feel any injuries that may occur on his feet - Breathing: history of chest infections - Eating and drinking: special diabetic diet -intake has to be managed, at risk of malnutrition, blood sugars recorded twice daily - Working and playing: retired, generally sedentary lifestyle though participates in voluntary work, limited exercise - Sleeping: documented as may be unable to sleep in an unfamiliar environment - Elimination: often has nocturia after a high glucose meal - Communication: hearing difficulties - Mobilisation: help will be required due to fracture - Pain Control: fracture causing pain - Emotional Well being: explain all procedures and gain consent - Personal Hygiene: may require help at times due to fracture but usually independent Orems self care model better suited? Care and Treatment Demonstrating the Patients Beliefs and Needs - The patient's fractured patella was displaced which meant he had to undergo surgery and a combination of pins and screws were used to realign the ends of the bone. After his operation his knee had to be kept straight and he had a plaster cast put on to help with this. - Ward environment: lack of privacy - Handovers and patient involvement - Early mobilising - Keeping to the diabetic diet - Weight issues affecting diabetes - Neurological assessment: peripheral neuropathy and foot care Patient's psych-social well being: - Lack of privacy on wards resulting in agitation and stress - Patient very unwilling to be sociable as very private and has hearing difficulties. - Some visitor and occasionally nurses/healthcare assistants would sit and talk with him Health Promotion and Patient Education Activities - Weight loss management - Patient exercise, relevant for weight loss and with glucose control. - Foot care explained - Suggestion of hypertension medication Conclusion: - After cast removal and physio - After surgery complications - Level of satisfaction with care - Potential improvements