Question

Using Dorothea Orem's Self-care deficit theory, list the following caregiver and patient goals for this scenario.

The Scenario:

• Patient is a 25-yr old construction worker, lives with his fiancé who is 8 months pregnant with their first child. He has a younger brother who lives with their parents.
• Motorcycle head-on collision, was wearing his helmet
• Treated at local ER Trauma Hospital
• Taken to surgery for emergent surgical procedure to repair lacerated liver, kidneys and pancreas, with massive internal bleeding.
• Fractured right leg, pins placed on R leg, on orthopedic leg traction
• Extensive surgery done to save right foot
• Taken to Surgical ICU (SICU) post operatively, sedated, on mechanical ventilator (respirator), with multiple IV drips to maintain blood pressure, on dialysis for acute kidney failure, on a special orthopedic bed with traction.

Patient Timeline:

• April 2: Motor Vehicle Accident (MVA) ; taken to ER Trauma Hospital
• April 3: Emergency surgery, taken to Surgical ICU (SICU), intubated, mechanical ventilation (respirator), sedated most of the time, IV medication for Bp, unstable VS, multiple blood transfusions, kidney failure, dialysis 3x a week. On ortho bed with R leg traction. Parents and fiance’s family visit.
• April 25: SICU, Off sedation, weaned off respirator. Regained consciousness, does not remember a lot. Asks “what happened”? Still on hemodialysis 3x a week. Complains of pain from abdominal incision. Refuses to get out of bed. Does not do his breathing exercises. Does not want to eat. Parents and brother visits. Fiancé’s family visits.
• May 4: Stepdown unit surgical floor, withdrawn, does not talk much. Fiancee delivers to an 8.2-lb. baby boy. Fiance’ mad because “he missed everything…” Still on hemodialysis 3x a week, R leg and R foot on cast, Physical Therapy sees patient 2x a day, experiences mod.-severe pain of abdominal incision when walking. Cooperative and works with Physical Therapists. Wants to go home.
• May 15: Rehabilitation facility, continues to progress. Verbalized different perspective in life. Noted to keep to himself on some days. Ambulates with crutches, still with right leg and foot cast. Taken to outpatient dialysis 2x a week. Fiance’ much better, visits more frequently with baby.
• June 1: Discharged to home with RN visits. Walks with crutches, with right leg/ foot cast. Abdominal incision with mild – moderate pain. Takes pain medicine when reminded by fiancé. Has sacral (tailbone area) bedsore measuring 3cm. x 4 cm., being treated and followed by RN. Needs assistance with ADL’s. On disability.

Answer 1

The given case is high risk case because the laceration of liver, kidney, pancreas can cause massive bleeding, shock and death. After surgical correction also the patient should be taken care very well. Vitals should be monitored regularly. Feeding should be given through jejunostomy. As the patient need prolonged bed rest, feeding jejunostomy or gastrostomy will suffice. Care should be taken to prevent venous pulmonary embolism. Anticoagulant should be given for this purpose. Fluid management should be done adequately. Care should be given to prevent pressure sore.