Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith's primary care nurse. It has been reported that the patient started confusing his days and nights and becoming restless.

Question

Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith's primary care nurse. It has been reported that the patient started confusing his days and nights and becoming restless. Once his family was identified in the Intensive Care Unit (ICU), his mother was an active visitor and helped with care decisions. She notified his care team that Timothy was an active military service member with a history of post-traumatic stress disorder (PTSD) and depression, which have led to smoking and recreational drug use. Two days prior to arrival to the med-surg unit, Mr. Smith was extubated from the ventilator and has been weaned down to a 2L nasal cannula. Three days prior his EVD was removed. The focus has been shifted to strengthening him to walk and healing abrasions from the accident. Tube feeding was continued from the ICU while awaiting clearance to begin swallowing on his own. Dressing changes are ordered from the open reduction internal fixation (ORIF) and for any third-degree abrasions from the accident. Oxygen - 2L Nasal Cannula, FaO2: 21-24%; Hypoventilation (splinting, coughing, deep breathing) Physical therapy Respiratory therapy Hairline fracture of 3 left ribs Wound care for ORIF and abrasions Psychosocial needs (PTSD, depression, ICU psychosis) Pain control Laboratory Tests, Results, and Vitals: Skin assessments Protein level Follow-up x-rays of ribs show healing and no punctures, tube feeding catheter tip located in the upper stomach GCS: 14 (deficit for confusion at times) Respiratory rate - 16 SpO2 94% Blood pressure - 118/68 A psychiatric nurse practitioner has begun visiting and noticed he is showing signs of depression and is struggling to cope with the accident. CT scan of the head Pain assessment score of 6 out of 10, with the patient reporting his leg is the worst source of pain, also experiencing pain with deep breaths, and mild headache

Dan Palmer · Accepted Answer

Based on the information provided, Mr. Smith is not yet ready for discharge due to several unresolved medical, psychological, and physical needs. While his oxygenation status (SpO2 94% on 2L nasal cannula) and respiratory rate are stable, he continues to require interventions for pain management, wound care, and physical rehabilitation. His confusion and ongoing psychosocial challenges, including PTSD, depression, and ICU psychosis, further indicate the need for continued multidisciplinary support before discharge. Health goals for Mr. Smith should focus on stabilizing his mental health, promoting physical recovery, and preparing him for safe and sustainable care at home (Purwasih et al., 2023). Specific goals include achieving adequate pain control (pain score below 4), improving his strength and mobility through physical therapy, ensuring proper wound healing, and establishing a comprehensive psychosocial support system. These goals can be supported through regular psychiatric evaluations, physical therapy sessions, and ensuring a gradual transition to oral nutrition as his swallowing improves. To modify his plan of care, additional interventions should include incorporating more frequent psychiatric consultations to address his mental health needs and tailoring pain management strategies to reduce his discomfort, especially in his leg and ribs. Family involvement should also be emphasized, with education provided on managing his care at home to support a smooth transition post-discharge. Modifications to the Plan of Care To better meet Mr. Smith’s needs, his plan of care should include a focus on coordinated care between multiple disciplines. Enhancing communication between physical therapy, respiratory therapy, and psychiatric services is critical to ensure all aspects of his recovery are addressed. Regular wound care assessments and adjustments to dressing protocols are necessary to prevent infection and promote healing. Pain management should be reassessed, potentially involving multimodal strategies like regional anesthesia or non-opioid analgesics to target his leg and rib pain. Additional psychosocial support is essential, given his history of PTSD and depression (Predko et al., 2023). Continued engagement with the psychiatric nurse practitioner should include exploring therapy techniques such as cognitive-behavioral therapy (CBT) or trauma-focused approaches. A social worker or case manager should assist in coordinating post-discharge services, including follow-ups and access to community mental health resources. Educational sessions for Mr. Smith and his family on medication management, wound care, and signs of complications will empower them to manage his care effectively at home. Part 2: Protocol To implement these recommendations, a comprehensive protocol should be developed to ensure all aspects of Mr. Smith’s care are addressed systematically. This protocol should begin with a multidisciplinary team meeting involving the medical, nursing, physical therapy, respiratory therapy, and psychiatric teams to establish a cohesive plan of care (Hamad et al., 2024). Weekly care team reviews should be conducted to track progress on key goals, such as pain control, mobility improvement, and psychosocial stabilization. A standardized pain management protocol should be implemented, including daily pain assessments and tailored interventions (Leyde et al., 2024). For example, his leg and rib pain can be managed with a combination of scheduled non-opioid medications and as-needed short-acting opioids, supplemented by physical therapy exercises to reduce stiffness and improve circulation. The psychosocial care protocol should involve regular sessions with the psychiatric nurse practitioner, supplemented with referrals to PTSD-specific counseling and peer support groups. Family education sessions can be structured into his care plan to ensure his mother understands how to assist him with wound care, medication adherence, and recognizing signs of psychological distress or physical complications (Hamad et al., 2024). Finally, a discharge planning protocol should ensure Mr. Smith transitions smoothly to outpatient care. This includes scheduling follow-up appointments with his primary care provider, specialists, and physical and psychiatric therapists, along with establishing clear communication channels between his care team and family to address any emerging concerns after discharge. Recovery and Response to Treatment Impact of PTSD and depression history in recovery and response to treatment Mr. Smith's history of PTSD and depression significantly impacts his recovery and response to treatment. These mental health conditions can influence his ability to engage fully in the healing process, both physically and emotionally (Convertino & Mendoza, et al., 2023). PTSD may heighten his stress response, leading to increased anxiety and difficulty coping with the trauma of his recent accident and hospitalization. This heightened stress can impede physical recovery by prolonging inflammation, weakening the immune system, and exacerbating pain perception. For instance, his pain, particularly in his leg and ribs, may feel more intense due to the interplay between psychological and physical stressors. Depression can further complicate his recovery by reducing his motivation to participate in necessary interventions, such as physical therapy and wound care. Fatigue and feelings of hopelessness may result in nonadherence to treatment regimens, such as taking medications or attending scheduled therapy sessions (Convertino & Mendoza, et al., 2023). Additionally, his depressive symptoms may impair his appetite and sleep, delaying tissue repair and overall recovery. Addressing Mr. Smith’s PTSD and depression is essential to optimize his response to treatment. A multidisciplinary approach, including psychiatric interventions, trauma-focused therapy, and peer support, should be integrated into his care plan. By prioritizing mental health alongside physical recovery, healthcare providers can improve his overall outcomes and foster a more positive trajectory in his healing process. Complications Complications that may affect Mr. Smith's motivation, compliance, and psychological well-being. Mr. Smith’s history of PTSD and depression poses significant complications that may hinder his motivation, compliance, and psychological well-being during recovery. PTSD may result in hypervigilance, anxiety, and intrusive thoughts that make it difficult for him to focus on physical recovery or adhere to prescribed treatments. Depression can exacerbate these challenges by reducing his energy levels, impairing his ability to engage in physical therapy or wound care, and contributing to feelings of hopelessness or apathy (Convertino & Mendoza, et al., 2023). These mental health conditions may also amplify his perception of pain, further demotivating him from participating in activities necessary for recovery. Additionally, ICU psychosis and confusion stemming from his recent critical care experience may affect his cognitive functioning, complicating communication and adherence to complex treatment regimens. Without proper support, these psychological complications can prolong his recovery, reduce the effectiveness of medical interventions, and compromise his long-term well-being. Addressing these barriers requires a holistic approach tailored to his unique physical and mental health needs. Interdisciplinary Team and Rationale. An interdisciplinary team is essential to support Mr. Smith’s comprehensive recovery. The team should include a psychiatric nurse practitioner to address his PTSD and depression through trauma-focused therapy, cognitive-behavioral therapy, and medication management (Convertino & Mendoza, et al., 2023). A social worker or case manager can provide access to community resources, including support groups for veterans, and ensure continuity of care post-discharge. A physical therapist will guide his mobility and rehabilitation exercises to improve strength and reduce pain, while a pain management specialist can optimize his pain control with multimodal approaches. A dietitian should also be involved to assess his nutritional needs and promote healing, especially as he transitions from tube feeding to oral intake. Finally, a primary care physician or hospitalist should oversee coordination between specialties, ensuring that his physical and mental health needs are addressed holistically (Cheng et al., 2023). This team-based approach ensures that Mr. Smith receives the psychological, physical, and social support necessary to enhance motivation, improve compliance, and foster a successful recovery. Smoking and Drug Use History of Smoking Mr. Smith’s history of smoking can significantly impact the healing of his bones. Smoking is known to delay the bone-healing process by impairing the oxygenation and blood supply required for tissue repair. Nicotine in cigarettes constricts blood vessels, reducing blood flow to the site of injury, which slows the delivery of essential nutrients and oxygen to fractured bones. Smoking also reduces the production and activity of osteoblasts, the cells responsible for bone formation, further hindering the healing process. Additionally, smoking impairs collagen synthesis and disrupts the balance between bone resorption and formation, resulting in weaker bone structures. For Mr. Smith, this delay in bone healing can prolong his recovery from the hairline rib fractures and leg injury, increasing the risk of complications such as nonunion or malunion. Addressing his smoking habit is vital to enhance his recovery outcomes and ensure optimal bone regeneration. Cessation of Smoking To support Mr. Smith’s recovery, smoking cessation and rehabilitation experts should be integrated into his care team. A smoking cessation counselor or nurse specialist can provide tailored education on the effects of smoking on healing and overall health (Darabseh et al., 2023). They can help Mr. Smith develop a personalized quit plan that includes behavioral strategies and pharmacological aids such as nicotine replacement therapy or medications like bupropion. These interventions can reduce withdrawal symptoms and cravings, making cessation more achievable. Rehabilitation specialists can assist with managing physical and psychological triggers that may contribute to smoking. This integration ensures that Mr. Smith receives holistic support in addressing his smoking habit, which directly impacts his healing process. Regular follow-ups with these experts can track his progress, adjust the intervention strategies, and provide encouragement (Darabseh et al., 2023). Including his family in the cessation process can also create a supportive environment that reinforces positive behavior changes during his recovery. Impact of Recreational Drug Use on Pain Management Mr. Smith’s history of recreational drug use may complicate his pain management. Chronic use of certain substances, particularly opioids, can result in tolerance, where higher doses of pain medication are required to achieve the same analgesic effect (Pezel et al., 2023). This history can make it challenging to manage his acute pain effectively without risking over-sedation or adverse side effects. Additionally, recreational drug use can alter pain perception, making him either hypersensitive or less responsive to standard pain management protocols. The healthcare team must carefully assess his history of drug use to tailor his pain management plan. Multimodal strategies, including non-opioid medications, regional anesthesia, and complementary therapies like physical therapy or cognitive-behavioral therapy, may be employed (Pezel et al., 2023). Close monitoring and collaboration with a pain specialist and an addiction counselor are essential to ensure that his pain is managed effectively while minimizing the risk of relapse or dependency on prescribed medications. Balancing Smoking Cessation and Self-Determination Nurses play a critical role in promoting smoking cessation while respecting a patient’s autonomy and self-determination (Darabseh et al., 2023). For Mr. Smith, the nurse should adopt a nonjudgmental and empathetic approach to initiate discussions about the impact of smoking on his recovery. Providing evidence-based information on how smoking delays bone healing and increases the risk of complications can empower him to make informed decisions. At the same time, the nurse must respect Mr. Smith’s right to make his own healthcare choices. Shared decision-making can be employed to collaborate on setting realistic goals for smoking cessation without imposing rigid expectations. Motivational interviewing techniques can help explore his willingness to quit and address any ambivalence or resistance. By creating a supportive and patient-centered environment, the nurse can encourage behavior change while maintaining trust and ensuring that Mr. Smith feels respected and involved in his care decisions. Psychosocial and Spiritual Considerations Addressing the patient's psychosocial and spiritual needs. Providing holistic care for Mr. Smith involves addressing his psychosocial and spiritual needs alongside his physical recovery. The nurse can support his psychosocial well-being by fostering a supportive and nonjudgmental relationship. Acknowledging his history of PTSD and depression, the nurse should collaborate with the psychiatric nurse practitioner to implement interventions like trauma-informed care and therapeutic communication (Aji et al., 2023). Encouraging Mr. Smith to express his feelings about the accident and his current condition can help alleviate emotional distress. Engaging his family, particularly his mother, as active participants in his care plan can also provide emotional support and strengthen his coping mechanisms. To address his spiritual needs, the nurse can explore his beliefs and values by asking open-ended questions about what brings him comfort or hope during difficult times. If appropriate, the nurse can facilitate access to a chaplain or spiritual counselor who aligns with Mr. Smith’s beliefs. Recognizing the potential role of spirituality in healing, the nurse can encourage practices like prayer, meditation, or reflection if these resonate with him (Aji et al., 2023). By addressing his psychosocial and spiritual needs, the nurse helps foster resilience, enhance his sense of purpose, and promote overall well-being during his recovery journey. Care Planning and Insurance Involving Key Stakeholders if the Patient Is Uninsured If Mr. Smith is uninsured, it is essential to involve a multidisciplinary team to address his financial and care planning needs. A social worker or case manager should be engaged to assess his financial situation, explore available resources, and help identify government or community programs that could cover his medical expenses (Cheng et al., 2023). For example, they can assist in applying for Medicaid, veterans' benefits, or charity care programs, given his status as a former active military service member. Financial counselors within the hospital can also collaborate to create payment plans or provide guidance on affordable healthcare options. Additionally, outreach to veteran-specific organizations and nonprofits specializing in assisting uninsured patients can be crucial. The care team may also need to involve his family to discuss support options and ensure continuity of care post-discharge (Cheng et al., 2023). Coordinated communication between these stakeholders will ensure that Mr. Smith's financial barriers are addressed without compromising his recovery. Impact on Socioeconomic Aspects of Care Planning The lack of insurance can significantly influence the socioeconomic aspects of Mr. Smith's care planning, necessitating adjustments to balance cost-efficiency with optimal care. Uninsured patients often face limited access to medications, follow-up appointments, and rehabilitation services, which could delay or compromise recovery (Kurniawan et al., 2023). The care plan must focus on prioritizing essential treatments and identifying cost-effective alternatives. For instance, generic medications or outpatient wound care services could reduce costs while maintaining quality care. Additionally, the team would need to consider his ability to afford durable medical equipment or transportation for follow-up appointments. Rehabilitation services, such as physical therapy, might need to transition to home-based exercises or community-funded programs. Socioeconomic factors also require the nurse to focus on educating Mr. Smith and his family about cost-conscious self-care techniques and available resources (Kurniawan et al., 2023). These efforts ensure that Mr. Smith’s complex care needs are met despite financial limitations, promoting his recovery and reducing the risk of readmissions.

Plan of Care.
Part 1: Evaluate Outcomes of Care	Based on the information provided, Mr. Smith is not yet ready for discharge due to several unresolved medical, psychological, and physical needs. While his oxygenation status (SpO2 94% on 2L nasal cannula) and respiratory rate are stable, he continues to require interventions for pain management, wound care, and physical rehabilitation. His confusion and ongoing psychosocial challenges, including PTSD, depression, and ICU psychosis, further indicate the need for continued multidisciplinary support before discharge. Health goals for Mr. Smith should focus on stabilizing his mental health, promoting physical recovery, and preparing him for safe and sustainable care at home (Purwasih et al., 2023). Specific goals include achieving adequate pain control (pain score below 4), improving his strength and mobility through physical therapy, ensuring proper wound healing, and establishing a comprehensive psychosocial support system. These goals can be supported through regular psychiatric evaluations, physical therapy sessions, and ensuring a gradual transition to oral nutrition as his swallowing improves. To modify his plan of care, additional interventions should include incorporating more frequent psychiatric consultations to address his mental health needs and tailoring pain management strategies to reduce his discomfort, especially in his leg and ribs. Family involvement should also be emphasized, with education provided on managing his care at home to support a smooth transition post-discharge.
Modifications to the Plan of Care	To better meet Mr. Smith’s needs, his plan of care should include a focus on coordinated care between multiple disciplines. Enhancing communication between physical therapy, respiratory therapy, and psychiatric services is critical to ensure all aspects of his recovery are addressed. Regular wound care assessments and adjustments to dressing protocols are necessary to prevent infection and promote healing. Pain management should be reassessed, potentially involving multimodal strategies like regional anesthesia or non-opioid analgesics to target his leg and rib pain. Additional psychosocial support is essential, given his history of PTSD and depression (Predko et al., 2023). Continued engagement with the psychiatric nurse practitioner should include exploring therapy techniques such as cognitive-behavioral therapy (CBT) or trauma-focused approaches. A social worker or case manager should assist in coordinating post-discharge services, including follow-ups and access to community mental health resources. Educational sessions for Mr. Smith and his family on medication management, wound care, and signs of complications will empower them to manage his care effectively at home.
Part 2: Protocol	To implement these recommendations, a comprehensive protocol should be developed to ensure all aspects of Mr. Smith’s care are addressed systematically. This protocol should begin with a multidisciplinary team meeting involving the medical, nursing, physical therapy, respiratory therapy, and psychiatric teams to establish a cohesive plan of care (Hamad et al., 2024). Weekly care team reviews should be conducted to track progress on key goals, such as pain control, mobility improvement, and psychosocial stabilization. A standardized pain management protocol should be implemented, including daily pain assessments and tailored interventions (Leyde et al., 2024). For example, his leg and rib pain can be managed with a combination of scheduled non-opioid medications and as-needed short-acting opioids, supplemented by physical therapy exercises to reduce stiffness and improve circulation. The psychosocial care protocol should involve regular sessions with the psychiatric nurse practitioner, supplemented with referrals to PTSD-specific counseling and peer support groups. Family education sessions can be structured into his care plan to ensure his mother understands how to assist him with wound care, medication adherence, and recognizing signs of psychological distress or physical complications (Hamad et al., 2024). Finally, a discharge planning protocol should ensure Mr. Smith transitions smoothly to outpatient care. This includes scheduling follow-up appointments with his primary care provider, specialists, and physical and psychiatric therapists, along with establishing clear communication channels between his care team and family to address any emerging concerns after discharge.
Recovery and Response to Treatment
Impact of PTSD and depression history in recovery and response to treatment	Mr. Smith’s history of PTSD and depression significantly impacts his recovery and response to treatment. These mental health conditions can influence his ability to engage fully in the healing process, both physically and emotionally (Convertino & Mendoza, et al., 2023). PTSD may heighten his stress response, leading to increased anxiety and difficulty coping with the trauma of his recent accident and hospitalization. This heightened stress can impede physical recovery by prolonging inflammation, weakening the immune system, and exacerbating pain perception. For instance, his pain, particularly in his leg and ribs, may feel more intense due to the interplay between psychological and physical stressors. Depression can further complicate his recovery by reducing his motivation to participate in necessary interventions, such as physical therapy and wound care. Fatigue and feelings of hopelessness may result in nonadherence to treatment regimens, such as taking medications or attending scheduled therapy sessions (Convertino & Mendoza, et al., 2023). Additionally, his depressive symptoms may impair his appetite and sleep, delaying tissue repair and overall recovery. Addressing Mr. Smith’s PTSD and depression is essential to optimize his response to treatment. A multidisciplinary approach, including psychiatric interventions, trauma-focused therapy, and peer support, should be integrated into his care plan. By prioritizing mental health alongside physical recovery, healthcare providers can improve his overall outcomes and foster a more positive trajectory in his healing process.
Complications
Complications that may affect Mr. Smith’s motivation, compliance, and psychological well-being.	Mr. Smith’s history of PTSD and depression poses significant complications that may hinder his motivation, compliance, and psychological well-being during recovery. PTSD may result in hypervigilance, anxiety, and intrusive thoughts that make it difficult for him to focus on physical recovery or adhere to prescribed treatments. Depression can exacerbate these challenges by reducing his energy levels, impairing his ability to engage in physical therapy or wound care, and contributing to feelings of hopelessness or apathy (Convertino & Mendoza, et al., 2023). These mental health conditions may also amplify his perception of pain, further demotivating him from participating in activities necessary for recovery. Additionally, ICU psychosis and confusion stemming from his recent critical care experience may affect his cognitive functioning, complicating communication and adherence to complex treatment regimens. Without proper support, these psychological complications can prolong his recovery, reduce the effectiveness of medical interventions, and compromise his long-term well-being. Addressing these barriers requires a holistic approach tailored to his unique physical and mental health needs.
Interdisciplinary Team and Rationale.	An interdisciplinary team is essential to support Mr. Smith’s comprehensive recovery. The team should include a psychiatric nurse practitioner to address his PTSD and depression through trauma-focused therapy, cognitive-behavioral therapy, and medication management (Convertino & Mendoza, et al., 2023). A social worker or case manager can provide access to community resources, including support groups for veterans, and ensure continuity of care post-discharge. A physical therapist will guide his mobility and rehabilitation exercises to improve strength and reduce pain, while a pain management specialist can optimize his pain control with multimodal approaches. A dietitian should also be involved to assess his nutritional needs and promote healing, especially as he transitions from tube feeding to oral intake. Finally, a primary care physician or hospitalist should oversee coordination between specialties, ensuring that his physical and mental health needs are addressed holistically (Cheng et al., 2023). This team-based approach ensures that Mr. Smith receives the psychological, physical, and social support necessary to enhance motivation, improve compliance, and foster a successful recovery.
Smoking and Drug Use
History of Smoking	Mr. Smith’s history of smoking can significantly impact the healing of his bones. Smoking is known to delay the bone-healing process by impairing the oxygenation and blood supply required for tissue repair. Nicotine in cigarettes constricts blood vessels, reducing blood flow to the site of injury, which slows the delivery of essential nutrients and oxygen to fractured bones. Smoking also reduces the production and activity of osteoblasts, the cells responsible for bone formation, further hindering the healing process. Additionally, smoking impairs collagen synthesis and disrupts the balance between bone resorption and formation, resulting in weaker bone structures. For Mr. Smith, this delay in bone healing can prolong his recovery from the hairline rib fractures and leg injury, increasing the risk of complications such as nonunion or malunion. Addressing his smoking habit is vital to enhance his recovery outcomes and ensure optimal bone regeneration.
Cessation of Smoking	To support Mr. Smith’s recovery, smoking cessation and rehabilitation experts should be integrated into his care team. A smoking cessation counselor or nurse specialist can provide tailored education on the effects of smoking on healing and overall health (Darabseh et al., 2023). They can help Mr. Smith develop a personalized quit plan that includes behavioral strategies and pharmacological aids such as nicotine replacement therapy or medications like bupropion. These interventions can reduce withdrawal symptoms and cravings, making cessation more achievable. Rehabilitation specialists can assist with managing physical and psychological triggers that may contribute to smoking. This integration ensures that Mr. Smith receives holistic support in addressing his smoking habit, which directly impacts his healing process. Regular follow-ups with these experts can track his progress, adjust the intervention strategies, and provide encouragement (Darabseh et al., 2023). Including his family in the cessation process can also create a supportive environment that reinforces positive behavior changes during his recovery.
Impact of Recreational Drug Use on Pain Management	Mr. Smith’s history of recreational drug use may complicate his pain management. Chronic use of certain substances, particularly opioids, can result in tolerance, where higher doses of pain medication are required to achieve the same analgesic effect (Pezel et al., 2023). This history can make it challenging to manage his acute pain effectively without risking over-sedation or adverse side effects. Additionally, recreational drug use can alter pain perception, making him either hypersensitive or less responsive to standard pain management protocols. The healthcare team must carefully assess his history of drug use to tailor his pain management plan. Multimodal strategies, including non-opioid medications, regional anesthesia, and complementary therapies like physical therapy or cognitive-behavioral therapy, may be employed (Pezel et al., 2023). Close monitoring and collaboration with a pain specialist and an addiction counselor are essential to ensure that his pain is managed effectively while minimizing the risk of relapse or dependency on prescribed medications.
Balancing Smoking Cessation and Self-Determination	Nurses play a critical role in promoting smoking cessation while respecting a patient’s autonomy and self-determination (Darabseh et al., 2023). For Mr. Smith, the nurse should adopt a nonjudgmental and empathetic approach to initiate discussions about the impact of smoking on his recovery. Providing evidence-based information on how smoking delays bone healing and increases the risk of complications can empower him to make informed decisions. At the same time, the nurse must respect Mr. Smith’s right to make his own healthcare choices. Shared decision-making can be employed to collaborate on setting realistic goals for smoking cessation without imposing rigid expectations. Motivational interviewing techniques can help explore his willingness to quit and address any ambivalence or resistance. By creating a supportive and patient-centered environment, the nurse can encourage behavior change while maintaining trust and ensuring that Mr. Smith feels respected and involved in his care decisions.
Psychosocial and Spiritual Considerations
Addressing the patient’s psychosocial and spiritual needs.	Providing holistic care for Mr. Smith involves addressing his psychosocial and spiritual needs alongside his physical recovery. The nurse can support his psychosocial well-being by fostering a supportive and nonjudgmental relationship. Acknowledging his history of PTSD and depression, the nurse should collaborate with the psychiatric nurse practitioner to implement interventions like trauma-informed care and therapeutic communication (Aji et al., 2023). Encouraging Mr. Smith to express his feelings about the accident and his current condition can help alleviate emotional distress. Engaging his family, particularly his mother, as active participants in his care plan can also provide emotional support and strengthen his coping mechanisms. To address his spiritual needs, the nurse can explore his beliefs and values by asking open-ended questions about what brings him comfort or hope during difficult times. If appropriate, the nurse can facilitate access to a chaplain or spiritual counselor who aligns with Mr. Smith’s beliefs. Recognizing the potential role of spirituality in healing, the nurse can encourage practices like prayer, meditation, or reflection if these resonate with him (Aji et al., 2023). By addressing his psychosocial and spiritual needs, the nurse helps foster resilience, enhance his sense of purpose, and promote overall well-being during his recovery journey.
Care Planning and Insurance
Involving Key Stakeholders if the Patient Is Uninsured	If Mr. Smith is uninsured, it is essential to involve a multidisciplinary team to address his financial and care planning needs. A social worker or case manager should be engaged to assess his financial situation, explore available resources, and help identify government or community programs that could cover his medical expenses (Cheng et al., 2023). For example, they can assist in applying for Medicaid, veterans’ benefits, or charity care programs, given his status as a former active military service member. Financial counselors within the hospital can also collaborate to create payment plans or provide guidance on affordable healthcare options. Additionally, outreach to veteran-specific organizations and nonprofits specializing in assisting uninsured patients can be crucial. The care team may also need to involve his family to discuss support options and ensure continuity of care post-discharge (Cheng et al., 2023). Coordinated communication between these stakeholders will ensure that Mr. Smith’s financial barriers are addressed without compromising his recovery.
Impact on Socioeconomic Aspects of Care Planning	The lack of insurance can significantly influence the socioeconomic aspects of Mr. Smith’s care planning, necessitating adjustments to balance cost-efficiency with optimal care. Uninsured patients often face limited access to medications, follow-up appointments, and rehabilitation services, which could delay or compromise recovery (Kurniawan et al., 2023). The care plan must focus on prioritizing essential treatments and identifying cost-effective alternatives. For instance, generic medications or outpatient wound care services could reduce costs while maintaining quality care. Additionally, the team would need to consider his ability to afford durable medical equipment or transportation for follow-up appointments. Rehabilitation services, such as physical therapy, might need to transition to home-based exercises or community-funded programs. Socioeconomic factors also require the nurse to focus on educating Mr. Smith and his family about cost-conscious self-care techniques and available resources (Kurniawan et al., 2023). These efforts ensure that Mr. Smith’s complex care needs are met despite financial limitations, promoting his recovery and reducing the risk of readmissions.
References Aji, L. M., Muhammad, A. B., & Abubakar, H. (2023). Psychosocial Care. In Tertiary Care-Medical, Psychosocial, and Environmental Aspects. IntechOpen. https://doi.org/10.5772/intechopen.112016 Cheng, A. L., Anderson, J., Didehbani, N., Fine, J. S., Fleming, T. K., Karnik, R., … & Kurylo, M. (2023). Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of mental health symptoms in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC). PM & R: Journal of Injury, Function & Rehabilitation, 15(12). https://doi.org/10.1002/pmrj.13085 Convertino, A. D., & Mendoza, R. R. (2023). Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. International Journal of Eating Disorders, 56(6), 1055-1074. https://doi.org/10.1002/eat.23933 Darabseh, M. Z., Aburub, A., & Fayed, E. E. (2023, January). The role of physiotherapists in smoking cessation management: A scoping review. In Healthcare (Vol. 11, No. 3, p. 336). MDPI. https://doi.org/10.3390/healthcare11030336 Hamad, A. M., Aldossari, M. M. M., Alotaibi, T. A., & Al Aradi, H. S. (2024). The Role of Nurses in Rehabilitation Services: A Holistic Approach to Enhancing Recovery and Promoting Independence. Journal of International Crisis and Risk Communication Research, 1114-1117. http://jicrcr.com/index.php/jicrcr/article/view/1527 Kurniawan, K., Iskandar, Y., & Sarastika, T. (2023). Study of Socio-Economic Aspect and Community Perception on The Development of The Agricultural Area Shrimp Ponds in Pasir mendit and Pasir Kadilangu. West Science Journal Economic and Entrepreneurship, 1(01), 28-36. https://wsj.westscience-press.com/index.php/wsee/article/view/25 Leyde, S., Price, C. J., Colgan, D. D., Pike, K. C., Tsui, J. I., & Merrill, J. O. (2024). Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone. Substance Use & Addiction Journal, 29767342241227402. https://doi.org/10.1177/29767342241227402 Pezel, T., Dillinger, J. G., Trimaille, A., Delmas, C., Piliero, N., Bouleti, C., … & Henry, P. (2023). Prevalence and impact of recreational drug use in patients with acute cardiovascular events. Heart, 109(21), 1608-1616. https://doi.org/10.1136/heartjnl-2023-322520 Predko, V., Schabus, M., & Danyliuk, I. (2023). Psychological characteristics of the relationship between mental health and hardiness of Ukrainians during the war. Frontiers in Psychology, 14, 1282326. https://doi.org/10.3389/fpsyg.2023.1282326 Purwasih, G. D., Dewi, Y. A. S., & Miftahillah, M. (2023). Stabilizing assistance for individuals with mental disorders alongside mental health professionals. Jurnal Inovasi Dan Pengembangan Hasil Pengabdian Masyarakat, 1(2), 80-89. https://journal.assyfa.com/index.php/jip-dimas/article/view/218

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.
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.
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.
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.
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.
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.
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.
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.
2. How might Mr. Smith’s past usage of recreational drugs impact his pain management? Your response should be a minimum of 150 words.
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.
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.
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.
How would this impact the socioeconomic aspect of Mr. Smith’s care planning moving forward? Your response should be a minimum of 150 words.
References (Please include working hyperlinks)

NRS-460 Benchmark – Case Study: Timothy Smith – Medical Surgical Unit

Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith’s primary care nurse.

NRS-460 Benchmark – Case Study: Timothy Smith – Medical Surgical Unit

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Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith’s primary care nurse.

NRS-460 Benchmark – Case Study: Timothy Smith – Medical Surgical Unit

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