The purpose of this assignment is to evaluate and synthesize patient data to propose interventions for an individualized plan of care prioritizing health problems and health concerns

Evaluate Mr. Doe’s health history and other pertinent medical information presented above to answer the questions that follow.

1. Internal hemorrhage -The urine tests reveal the presence of RBCs, indicating possible internal hemorrhage. Bleeding internally can be due to injured bladder, resulting to rapturing of the bladder. It is also possible that the bleeding could be due to the trauma on the kidney or even injured urethra (Erasu et al., 2022). However, a blood-clot health issue could be considered a factor as well.
2. Substance dependence problem -Doe’s accident happened as he rode his motorcycle under the influence, and considering that he tested positive for cannabinoids, assessing his neurological functioning, and treating him is likely to be a challenge. The reason for this is that cannabinoids hamper cognition by reducing focus, information processing, and memory. It also delays reflex actions, making it difficult for the patient to coordinate certain essential functions. Combined with additional symptoms like agitation, these disruptions in mental functioning can complicate the assessment in the sense that Doe may fail to provide substantive details about his health that can improve assessment outcomes.
3. Serious Traumatic Brain Injury (TBI) -This signified by Glasgow Coma Scale (GCS) score of 6. It also indicated by the fracture of Doe’s skull which is tied to the different manifestations he exhibits like agitation, uneasiness, stretched pupils, and impaired Level of Consciousness (LOC).
4. The presence of orthopedic Injuries – Fracture of the left ribs, and closed left femur are some of the injuries revealed by the case study information. With injured ribs, Doe may struggle with sustaining normal breathing. Conversely, the fractured femur may complicate the hemorrhage problem by causing fat embolism.
5. Circulatory collapse – This is a potential clinical issue for Doe considering the vitals like respiratory rate which is 28. Because a healthy adult’s RR lies within the range, 12 and 18, the RR of 28 is irregularly high. Other abnormal labs include Heart Rate (HR) of 136, which is an elevated HR, and significantly low blood pressure levels of 84/60 mmHg.

1. Hemorrhage that is internal -It could be an indication of injured bladder, which may require additional screening using the CT scan. Considering this manifestation, the provider may monitor Doe’s urine volume including renal function.
2. Cannabinoid impairs the functioning of the brain, which makes it difficult to monitor Doe’s neurological health. Considering this issue, the provider working with Doe needs to properly document the use of cannabis (Pognan et al., 2023). Involving a toxicologist is crucial to provide information that can help prevent adverse events linked to withdrawal.
3. Fast embolism syndrome is a potential medical complication that may occur due to the injuries that affect the ribs. This syndrome is associated with breathing difficulties among other manifestations. Managing the TBI may require administering opioids to lessen the pain, and performing surgery.
4. Circulatory collapse– Extremely low B.P. coupled with elevated HR is an indication of trauma. Initially when the patient presents to the ER, the intervention goal should be restoring perfusion including the supply of oxygen to the lungs and the brain. Part of the intervention may involve the transfusion of blood.
5. With a TBI that is severe, the patient risk developing complications characterized by the significant decline in tissue oxygen levels. The patient can benefit from osmotic therapy among other interventions.

1. ER Doctor: Works in collaboration with ER nurses to resuscitate and stabilize the patient, and initiate interventions that help save the patient’s life. In addition, they are responsible of coordinating the CT scan, ensuring that the screening is adequate.
2. Neurologist: Assesses the status of Doe’s head injuries including the TBI, establishing whether interventions like surgery are required to prevent serious complications.
3. Orthopedist: Examines the extent of the orthopedic injuries to establish if the patient needs fixing of their ribs.
4. Cardiorespiratory physician: They evaluate the patient, examining the level of aeration of the lungs. They also administer interventions meant to increase the supply of oxygen to the lungs (Taylor et al., 2023).
5. Toxicologist: Prepares the toxicology report, highlighting the amount of cannabis products in Doe’s blood. Their other role entails adjusting the drug dosage to minimize the risk of serious drug events.
6. The ER nurses: They work with physicians, receiving and implementing the instructions they receive. They also monitor the patient’s vital signs, sharing with physicians, pertinent information regarding the patient’s progress.
7. Psychologist: It is important to involve a psychologist to address the emotional and psychological issues tied to the stressors. The pain linked to injuries is a major stressor, and if left unmanaged, stress can lead to depression or alter Doe’s sleep cycle.

 Mr. Doe requires numerous interventions upon arrival to the hospital.

1. Restoration of normal breathing: This is achieved by initiating mechanical ventilation and maintaining endotracheal intubation, ensuring that the amount of oxygen dissolved in the blood is greater than 60 mmHg. Maintaining the blood’s Carbondioxide levels within the range 35 to 45 mmHg is recommended. Maintaining these levels of oxygen and Carbondioxide levels prevents decline in oxygen supply to the brain tissues, and elevation of the blood’s Carbondioxide which can be harmful.
2. Restoration of normal hemodynamics: This involves controlling the blood pressure and stabilizing the HR through interventions like blood transfusion to help deliver more oxygen. The other intervention considered is normal saline which is an intravenous (IV) crystalloid. Administering these interventions is critical to the restoration of perfusion, and it is imperative that the nurse in charge monitor the administered blood and (IV) crystalloid. This is necessary to minimize the risk of, or prevent hypervolemia which is tied to the internal fluid overload. With persistent low B.P. levels, epinephrine, which is a vasopressor, is administered, maintaining the required levels of mean arterial pressure.
3. Management of the fracture: Prior to performing a surgical procedure on the fractured femur, stabilizing using a splint is crucial. With the patient facing the possibility of developing a respiratory disorder like pneumonia, providing respiratory support is necessary during the management of the fractures on the ribs (Franklin et al., 2022).
4. Monitoring neurological performance: With the injuries sustained on the head, Doe faces the risk of internal bleeding and other brain-based complications. To minimize this risk, the ER nurse maintains normal temperatures including adequate elevation of the bed.
5. Management of pain: Pain is one of the clinical manifestations that Doe exhibits when he first presents to the ER. This is managed using oxycodone that is intravenously administered. This intervention requires consideration of the precautionary measures like administering the right volume of medication, which essentially minimizes the serious sedative effects of the medication.

Review the diagnostic tests that were ordered.

1. The GCS score: 6, which is the value of the GCS score indicated on the scale signifies serious decline in neurological functioning. However, it is worth noting that this score represents the score for motor, verbal and eye responses, and in order, they are represented by 4, 1 and 1. With a verbal response score of 1, assessing this patient can be a challenge considering that this score is also a sign of serious levels of unconsciousness. Thus, there is need to immediately respond by implementing clinical procedures that increase aeration or the delivery of oxygen.
2. Panscan CT: Part of the diagnosis involved performing the Panscan which essentially reveals comprehensive information related to the nature of the patient’s injuries. According to the scan results, Doe had a TBI with a fracture of the frontal-temporal skull (Harntaweesup et al., 2022). The scan also indicates the presence of fractures on the left ribs and the frontal-temporal scull. Scanning of the internal organs and tissues to determine the nature of the injuries or fractures is imperative in the sense that it indicates the seriousness of the injury on the central nervous system. It also shows the possibility of intracranial bleeding. The results of the scan can help guide the provider in choosing appropriate treatment.       

Review your assessment of Mr. Doe’s physical injuries to answer the questions below.

1. TBI and Skull Fracture: skull surgery would be required in the event that hematoma forms or the cranial pressure builds up. With this surgical procedure, a neurologist operates on the skull to remove hematoma, which reduces the possibility of damage of the brain by relieving pressure. Following the surgical intervention, a nurse or the neurologist monitors the patient, and addresses complications that occur after surgery.
2. Fractured ribs: The conservative management of the hairline fractures is recommended in a case in which these fractures do not cause adverse clinical events such as collapsed lung. In case of adverse events, a surgeon may perform a surgical operation. This kind of operation may involve the use of the titanium plates as part of surgical intervention focused on fixing Doe’s ribs. This intervention helps resolve breathing difficulties, and lessens pain. In case of collapsed lung, air draining intervention like inserting a tube insert Doe’s chest is recommended.
3. The ORIF is an ideal surgical intervention for the fracture of the closed femur. With this intervention, the orthopedic realigns the affected bones, and uses metal plates to hold the bones in place. With this intervention, Doe has limited chances of developing malunion among other serious complications.

1. The use of an external brace to immobilize the closed femur can help stabilize the fractured area, hastening healing of bone when it is properly aligned. Even with this intervention, it is still necessary to take X-ray imaging details of the area to identify and rectify deformity or nonalignment of the bone.
2. Physiotherapy: Implementation of physiotherapy interventions can also benefit Doe. To avoid contracting pneumonia, Doe will need to exercise deep breathing, which addresses the concerns associated with rib fracture. Conversely, the prevention of the stiff femur may involve the use of exercises characterized by gentle range-of-motions.
3. Nutritional support: This is necessary in healing of the wound and the growth of the bone. Given the significance of the minerals like Vitamin D and Calcium in maintenance of the bone health, a nutritionist or a dietician should emphasize foods rich in these elements. The goal is to enhance the healing of the bones and the wounds.
4. Addressing the discomfort linked to pain: Thoracic epidural is an intervention that should be considered when managing pain. This is particularly helpful when it comes to the management of the pain that stems from the rib fracture.      

The panscan results indicate a positive TBI.

1. Observing neurological progress: Monitor ICP, which helps determine signs of elevation of pressure that could potentially lead to swelling of the brain. With sustained elevation of the pressure, the physician may order the administration of the corticosteroids. Other interventions include administering IV saline fluid, and repositioning the patient’s head. Physically draining the cerebrospinal fluid can also help relieve the pressure.
2. Continuously assess and manage pain: The discomfort linked to pain is a significant source of distress for patients with injuries. This necessitates pain management using medications including anesthetic drugs.
3. Management and control of infection: With Doe’s injuries, he is at risk of contracting infections including those caused by streptococcus bacteria. Maintaining high hygienic standards is necessary to minimize the chances of occurrence of infections like deep incision SSI. Some of the measures of ensuring that one adheres to these standards include the correct use of the gloves and surgical equipment, and proper wound care (Ding et al., 2022). A provider may have to rely on infection prevention guideline to inform decision-making.
4. Prevention of DVT: The DVT is a possible disorder that the patient risk developing with sustained immobilization. Prevention of this disorder requires the use of intermittent pneumatic compression tools in combination with medications. Warfarin is an ideal drug to administer in this scenario because it treats the VTE prophylaxis.
5. Emotional and psychological support: During treatment, the nurse monitors them, examining any sign of emotional and psychological issues. This is necessary considering that he might be experiencing difficulty coping with pain and the shock linked to his injuries. To alleviate negative emotions and improve holistic healing, the patient receives counseling.
6. Cultural and spiritual care: Examining aspects of the patient’s cultural or spiritual practices, and integrating these practices into the health care plan is crucial. This ensures that the care is consistent with patient’s needs.  

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

1. Involvement of the family: Involving Doe’s family to actively contribute towards providing the necessary support like assistance with mobility can help reduce the distress tied to the lack of social support. The family can provide relevant feedback with details such as side effects of the medications or the patient’s recovery.
2. Spiritual and religious support: Assess the patient’s spiritual needs, and use this information to prepare a plan that defines approach to responding to these needs. For instance, including prayer sessions into the healthcare plan is an example of an approach to spiritual care.
3. Counseling: This is meant to readjust the patient’s emotions including normal psychological functioning. It also serves the role of empowering Doe with information on how to overcome stressors.
4. Rehabilitation: The rehabilitation of Doe requires collaboration with physiotherapists and dieticians to provide mobility support, and other forms of support that can help with full recovery, and integration of Doe into the community.

Ding, X., Tang, Q., Xu, Z., Xu, Y., Zhang, H., Zheng, D., Wang, S., Tan, Q., Maitz, J., Maitz, P. K., Yin, S., Wang, Y., & Chen, J. (2022). Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice. Burns & trauma, 10, tkac014. https://doi.org/10.1093/burnst/tkac014.

Erasu, V., Novak, A., Gibbs, V. N., Champaneria, R., Dorée, C., Hafeez, A., Moy, R., Sandercock, J., Brunskill, S. J., & Estcourt, L. J. (2022). Pharmacological interventions for the treatment of bleeding in people treated for blunt force or penetrating injury in an emergency department: a systematic review and network meta‐analysis. The Cochrane Database of Systematic Reviews, 2022(6), CD014600. https://doi.org/10.1002/14651858.CD014600.

Franklin, B. A., Eijsvogels, T. M. H., Pandey, A., Quindry, J., & Toth, P. P. (2022). Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the ASPC Part I: Bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations. American journal of preventive cardiology, 12, 100424. https://doi.org/10.1016/j.ajpc.2022.100424.

Harntaweesup, S., Krutsri, C., Sumritpradit, P., Singhatas, P., Thampongsa, T., Jenjitranant, P., Wongwaisayawan, S., Saksobhavivat, N., & Kaewlai, R. (2022). Usefulness and outcome of whole-body computed tomography (pan-scan) in trauma patients: A prospective study. Annals of medicine and surgery (2012), 76, 103506. https://doi.org/10.1016/j.amsu.2022.103506.

Pognan, F., Beilmann, M., Boonen, H. C. M., Czich, A., Dear, G., Hewitt, P., Mow, T., Oinonen, T., Roth, A., Steger-Hartmann, T., Valentin, J. P., Van Goethem, F., Weaver, R. J., & Newham, P. (2023). The evolving role of investigative toxicology in the pharmaceutical industry. Nature reviews. Drug discovery, 22(4), 317–335. https://doi.org/10.1038/s41573-022-00633-x.

Taylor, R. S., Dalal, H. M., & McDonagh, S. T. J. (2022). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature reviews. Cardiology, 19(3), 180–194. https://doi.org/10.1038/s41569-021-00611-7.

Evaluate Mr. Doe’s health history and other pertinent medical information presented above to answer the questions that follow.

 Mr. Doe requires numerous interventions upon arrival to the hospital.

Review the diagnostic tests that were ordered.

Review your assessment of Mr. Doe’s physical injuries to answer the questions below.

The panscan results indicate a positive TBI.

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