Throughout the course, we have provided care to Timothy Smith in various environments and discussed various considerations regarding transitions

Plan of Care

When assuming care of this patient, you were told that the plan for Mr. Smith is to be discharged home tomorrow. This was not the plan when you took care of Mr. Smith yesterday.

Part 1: Evaluate Outcomes of Care

1. Evaluate Mr. Smith's readiness for discharge based on the information provided in the case study. Based on your findings, evaluate health goals for this patient. Discuss how you would modify the plan of care. Your response should be a minimum of 200 words.

The willingness of Mr. Smith to be discharged ought to be looked at comprehensively based on his physical, emotional, and psychological states. On the bright side, Mr. Smith is not oxygenating well, as the SpO2 is 94 percent, but the GCS score is 14, indicating that his cognitive ability appears intact despite confusion. He is still on a 2L nasal cannula, though, and tube feeding is not finished yet. All these indicate that his nutrition and respiratory requirements are yet to be covered. His broken ribs and the pain they cause, especially during deeper breathing, can become an obstacle to his capacity to perform the physical activities after discharge, and his wounds, e.g., abrasion ones, awaiting care, e.g., when the dressing is changed, point to a certain risk factor.

Psychologically, that Mr. Smith had PTSD and depression, exacerbated by the fact that he is in the hospital and in the ICU undergoing psychosis, points to the fact that his emotional wellness needs additional support. The consequences of the trauma he experienced during his accident are posing a problem in how he is adapting to the new changes with his physical condition. This considered, it is too early to release him tomorrow until psychological and physical rehabilitation measures are carried out again. It would be possible to improve his willingness to be discharged by focusing on these issues in a more structured way.

Health Goals:

Get sufficient nutrition and be able to swallow safely by discharge.

Reduce pain (in particular, pain in the ribs and legs).

Minimize confusion and increase cognitive clarity so that he can take care of his daily business safely.

Psychiatric support in PTSD and depression should be provided in order to avoid the development of symptoms.

 Plan Modification:

The one-day discharge plan in use has to be changed. There should be a more gradual process and still maintain the help of physical therapy, respiratory therapy and psychiatric services (Wang et al., 2022). The medical team has to give Mr. Smith a detailed discharge plan that will consist of follow-up visits where leniency will be provided both psychologically and physically. A social worker is needed to evaluate his house conditions and guarantee that he has the support he needs in continuous recovery.

2. Based on your assessment, how would you recommend modifying the plan of care to meet Mr. Smith's needs? Your response should be a minimum of 150 words.

Considering such a state of Mr. Smith, a number of changes to the discharge plan should be implemented. On the one hand, his pain control plan should be changed. The fact that his analgesic treatment did not prove to be effective enough could be implied by the current pain estimate being 6/10, particularly in the leg, as well as when he performs deep breathing. They should consider a more in-depth plan of pain management, which might include both pharmacologic and non-pharmacologic management of pain, before discharge.

Second, additional assistance of psychiatric services is required. Considering the fact that he had PTSD and depression, it is important to ensure that they are handled prior to discharge in order to avoid the aggravation of his mental conditions. This must contain counseling and even referral to get outpatient mental care. Besides, due to his unstable cognitive state, he can observe and undergo cognitive training longer than necessary in order to avoid adversely influencing his home transition with psychosis in the ICU.

Finally, his nutritional status ought to be monitored properly. Tube feeding is under utilization and his capacity to resume swallowing was not well determined. A swallow study must be conducted prior to discharge to make sure that he will be able to safely resume an oral diet.

Part 2: Protocol

What protocol would you use to implement your recommendations for Mr. Smith's updated plan of care? Your response should be a minimum of 200 words.

A more reliable strategy to facilitate the proposed change to the care plan of Mr. Smith is to form a multidisciplinary team in order to focus on his physical, psychological and social needs. The team ought to consist of:

Physical Therapy: The therapy will have to continue and focus on the recovery of strength and mobility of Mr. Smith with special emphasis on the rib injuries he suffered and enhancing his overall physical returns. The therapy will also assist to ascertain that he will safely enter the phase of mobilizing and performing daily activities prior to discharge.

Psychiatric Nurse Practitioner: This specialist will be essential in the future management of the PTSD and depression of Mr. Smith who will provide trauma-informed care and be keen on the challenges of coping by taking into consideration the emotional aspects of his accident. Mental health evaluation will be required regularly to check the progress made and modify interventions accordingly.

Pain Management Specialist: His pain control program should be changed with the help of pain management specialist. This can encompass the pharmacological and non-pharmacological ways of addressing the pain caused by the fracture in the ribs, injuries in the leg, and any possible complications caused by the treatment processes.

Speech and Swallowing Therapy: The therapist of this specialty will evaluate the status of Mr. Smith whose tube feeding is still ongoing to enable him transfer to oral feeding with a capability to swallow on his own before release.

Social Worker: A social worker is also advised to evaluate the home situation of Mr. Smith so as to make sure that he is equipped with support at home to enable an easy transition. They will also find the resources that will help them solve the socioeconomic issues, such as the financial support and maintenance of the care.

Case management will coordinate this interdisciplinary team so that there is integrated communication and care. Because professionals of other specialties are involved, the recovery of Mr. Smith can be comprehensive since it will cater to his immediate as well as long-term ambitions.

Recovery and Response to Treatment

Consider Mr. Smith's history of PTSD and depression.

Discuss the impact his PTSD and depression history might have on his recovery and response to treatment. Your response should be a minimum of 150 words.

The experience of PTSD and depression will have an enormous effect on the recovery of Mr. Smith. PTSD is a disorder that may worsen the physical pain and make it harder to recover because it amplifies anxiety levels and stress and thus may promote the stall in his healing process (Birlingmair, 2023). It may be difficult to require Mr. Smith to comply with rehabilitation strategies because patients with PTSD have related hyperarousal. Additionally, depression may result in reduced motivation, fatigue, lack of hope and thereby it may make him experience poor adherence on physical therapy and wound care.

To ensure that such problems are resolved, his treatment plan will have to incorporate and merge psychiatric assistance that might involve therapy and/or medication. Having understood that the symptoms of mental health issues can be presented as physical ones in conditions such as PTSD and depression, the emotional and psychological conditions of the patient have to be carefully observed during his recovery. By equipping Mr. Smith with a complex support strategy including the mental health consultation and stress relief approaches, the emotional states of the latter would benefit, and the recovery process would occur more effectively.

Complications

Consider Mr. Smith's history of PTSD and depression in addressing the following questions.

Discuss the overall complications that may affect Mr. Smith's motivation, compliance, and psychological well-being. Your response should be a minimum of 150 words.

The PTSD and depression experienced by Mr. Smith would most certainly play a factor in his willingness to engage in the process of his healing. Depressed people are not likely to have enough energy or desire to undergo physical rehabilitation or follow medical orders. His PTSD may impose avoidance behaviors especially in case his recovery process reminds him of the trauma accident. Moreover, the two conditions may cause him to have a hard time dealing with the ordeals of recovery and therefore the likelihood of becoming psychologically distressed is increased.

In order to prevent these complications, early engagement of a psychiatric team into his treatment would be very important. They are able to assist in attaining his emotional needs and instruct different coping techniques and be supportive to his survival. He should also be made to undergo routine emotional evaluations just to make sure he does not lack psychological support in the recovery process.

Put together an interdisciplinary team to support all areas of his recovery, including mental health support. Provide rationale for your response by referencing his assessment findings. Your response should be a minimum of 150 words.

A recovery of Mr. Smith should be provided through the assembling of an interdisciplinary team to recover him in a holistic approach. This team ought to comprise:

Psychiatric Nurse Practitioner: To continuously supervise mental health and watch out for the indicators of PTSD worsening or depression.

Physical Therapist: In order to rehabilitate him in terms of mobility and managing his physical rehabilitation.

Social Worker: To mobilize help at home and to evaluate the presence of financial/insurance help to be safe with the plan of discharge.

Pain Management Specialist: To change his pain management procedure and make sure he will be well managed after being discharged.

Respiratory Therapist: To observe his levels of oxygenation and work on breathing exercises.

Nutritional Support: To evaluate his nutrition demands and to make sure that he is able to move to oral feeding.

Family and Caregivers: The family members, especially the mother, should be put in the decision-making process about his care, as they are imperative to his emotional comfort as well as providing care after release.

This team will play a critical role in helping Mr. Smith with his complicated needs on the physical level as well as the psychological one.

Smoking and Drug Use

Consider Mr. Smith's history of smoking and recreational drug use.

History of Smoking

How might his history of smoking impact healing of the bones? Your response should be a minimum of 150 words.

The historical smoking of Mr. Smith is expected to play a negative critical role in ensuring the recovery process of the rib fractures and other injuries sustained. Smoking decreases circulation by narrowing blood vessels hence is the reason why there is a lack of supply of oxygen and essential nutrients needed to repair the bones. This impairment may retard healing process, pose a risk of non-union or malunion of fractures and decrease the whole structural stability of the bone. Further, smoking affects the functionality of the immune system and increases chances of infections which is highly alarming among his abrasions and surgical wounds following ORIF procedure (Harrogate et al., 2023).

The toxic chemicals contained in tobacco (such as nicotine) also inhibit collagen that is crucial to the healing of tissues and bones. The effects of these risks may be avoided by integrating smoking cessation into the treatment regimen of Mr. Smith as soon as possible. A complex program including counseling, behavioral therapy, pharmacologic measures including nicotine replacement therapy or pharmaceutical drugs will be essential in increasing his recovery rates and minimizing issues after discharge.

Cessation of Smoking

1. Discuss how you would integrate smoking cessation and rehabilitation experts into Mr. Smith's recovery team. Your response should be a minimum of 150 words.

The incorporation of smoking cessation specialists into the recovery team of Mr. Smith would serve him a great deal. Such specialists are able to provide individual counseling and addressing his emotional needs in order to deal with the psychological drop of smoking. Besides, medications to curtail the effects of withdrawal might also be provided as part of pharmacological interventions, including nicotine replacement therapy (NRT). Medications such as varenicline which minimizes the pleasant feeling of smoking and alleviates the desire to smoke may also be factored in his treatment programme. Patches of nicotine, nicotine gums or lozenges would also assist him in coping with the issue of nicotine addiction and reduce the pressure of quitting it. In addition, smoking cessation specialists have the capability to administer behavioral therapy to equip Mr. Smith with coping skills and ways to deal with triggers and stressors that can motivate his relapse into smoking. The inclusion of such professionals in his team will also guarantee Mr. Smith extensive help, which increases his likelihood of successful smoking cessation and positively affects his overall recovery.

2. How might Mr. Smith's past usage of recreational drugs impact his pain management? Your response should be a minimum of 150 words.

The problem with managing the pain of Mr. Smith is that he has a history of recreational use of drugs. Prolonged use of medications may change the pain pathways in the brains resulting to either an increase or the reduction of the perception of pain hence making it difficult to determine the exact level of pain he is going through. Such changed perception can complicate the decision as regards the dosage of the pain medications to administer and leave one with either insufficient analgesia or the possible risk of overdose of the medication. In addition, negative drug reactions may occur because of the interaction between recreational drugs and medications used to manage pain, thus aggravating any side effects or make them ineffective. It is also important to have a detailed review of the history of substance use of Mr. Smith to make alterations to his pain treatment plan. This evaluation should be conducted with screening of any possible addiction, not to mention an evaluation of his current substance use. As per these findings, there must be other pain management methods, like the non-opioid medication or the complementary therapy to make sure that safe and effective pain management occurs.

Balancing

Discuss how the nurse would balance promoting smoking cessation for Mr. Smith while respecting his self-determination in his health care decisions. Your response should be a minimum of 150 words.

As much as it is important to encourage smoking cessation on Mr. Smith, the nurse is also supposed to support the principle of self-determination in his health care choices. Being a patient, Mr. Smith will be autonomous in making informed decisions concerning his treatment process, and this includes whether he decides to stop smoking or not. The nurse should be sensitive when broaching this subject matter, and he should make Mr. Smith feel that he is making a decision as opposed to being coerced to do anything. Though smoking should be part of his healing process especially in enhancing bone healing and avoiding complications, it should be noted that whether to quit or not remains his choice. The nurse is able to give clear evidence based teaching on the dangers of smoking especially as far as his healing process is concerned including delayed bone healing, poor oxygenation, and heightened risk of infection. Also, the nurse can subtly suggest Mr. Smith to think about office options by proposing them without any coercion but providing additional resources at their disposal which includes smoking cessation programs and smoking counseling. Striking the right balance between fostering smoking cessation and a respect of his autonomy, the nurse can form a therapeutic relationship based on collaboration and trust and help Mr. Smith to improve his general well-being.

Psychosocial and Spiritual Considerations

Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient's psychosocial and spiritual needs.

Given the patient's current situation, discuss ways in which the nurse can take into account and address the patient's psychosocial and spiritual needs. Your response should be a minimum of 150 words.

The motivators of doing this to Mr. Smith are to make up the psychosocial and spiritual needs as part of his wholesome recovery. He has gone through post-traumatic stress disorder as well as depression, so his emotional and spiritual health is also an important factor to be taken into account. These points are essential towards the attainment of his recovery being not only physical but also holistic and enabling towards every domain of his life. The nurse can assist him with his spiritual needs by referring him to a chaplain/spiritual counselor to help him deal with the emotions he might have had regarding this accident and the continuous recovery. This will give him the chance to gain meaning and peace out of the trauma. Also, psychosocial support is needed, and Mr. Smith should be offered counseling to understand how to deal with emotional issues of PTSD and depression. An efficient counseling endeavor can equip him with the coping mechanism to deal with his emotional distress, which will aid him in ensuring these factors do not enable him in averted progression of his physical healing. Other dimensions that need to be included in the care plan of Mr. Smith include spiritual and psychological support to ensure that recovery and rehabilitation is based more holistically.

Care Planning and Insurance

Nurses have to have an awareness of the socioeconomic impact of care delivery, especially when planning care for patients with complex needs.

Who would you need to involve if you discover that the patient is uninsured? Your response should be a minimum of 150 words.

In case Mr. Smith lacks insurance, it is in the best interest of the nurse to liaise with few professionals in order to make sure that a holistic plan of care is established. The front line of contact should be the social worker because she can help with addressing the financial aspect and may know how to refer the patient to community sources, including charity care programs or government available help. The social worker may also investigate the possibilities of Medicaid or cheaper insurance programs, in case available, and assist Mr. Smith in the intricacies of getting monetary assistance in his treatment. Moreover, the case manager is to be engaged to determine the needs of the patient post-discharge which should include home healthcare services, physical therapy, and possible follow-up visits that are to be made available irrespective of insurance coverage. Last, the hospital billing department or a financial counselor is to be informed about the necessity of discussing payment plans or discounts depending on the lack of insurance due to the uninsured Mr. Smith so that the obligation does not prove to be overwhelming.

How would this impact the socioeconomic aspect of Mr. Smith's care planning moving forward? Your response should be a minimum of 150 words.

The socioeconomic aspect of his care planning in coming time will be among the major implication of being an uninsured Mr. Smith. In the absence of the insurance, he is exposed to significant out-of-pocket costs and the cost of drugs, follow-up visits, physical and home treatments, and care costs. Such economic obstacles may defer or confine his ability to obtain primary care and drugs, and those may result in adverse effects in his recovery. The care team needs to collaborate with Mr. Smith to determine financial aid programs like nonprofit organizations, government health program or charitable care offered by the hospital to assist in reducing the charges. Moreover, his uninsured status can also affect the rate and the quality of care he will receive after discharge as he might be unable to get follow-up appointments or physical rehabilitation. However, both social workers and case managers will be vital when it comes to assisting Mr. Smith in getting the care that he requires, though the financial constraints will probably continue to pose challenges to be handled during his recovery process.