Complete the following Case Study. Return it nolater than the due date. March 17 11:59 pm.
There is partial points only for questions for #1& 3.
Mr. O’Brien GENDER:Male AGE: 81
SETTING: Hospital ETHNICITY: White American
CULTURAL CONSIDERATIONS: Born and raised in New York;moved to Florida 7 years ago.
PREEXISTING CONDITIONS
Atrial fibrillation (AFib); syncope; peripheralvascular disease (PVD)
COEXISTING CONDITION: Hypotension
COMMUNICATION: Verbal
DISABILITY: Ambulates with a walker and oneassist
SOCIOECONOMIC: Resides in a long-term nursing carefacility; financial and social implications of fall-relatedinjuries
SPIRITUAL/RELIGIOUS: Anglican
PHARMACOLOGIC: Acetaminophen; Oxycodone/acetaminophen5/325 (Percocet); ASA; Valerian Roots
Home Medications: brought in by family: Metoprolol ER25mg daily; warfarin 2mg Daily (last INR = 2.9); Rosuvastatin 10mgHS
LEGAL: Fall precautions; incident report (occurrenceor variance report); restraints
ETHICAL: ALTERNATIVE THERAPY
PRIORITIZATION: SAFETY
DELEGATION: Nursing assistant’s role
MUSCULAR SKELETAL SYSTEM: tissue integrity
VASCULAR SYSTEM: coagulation, occlusion,bleeding
Level of difficulty: Moderate
Overview:
This case requires the nurse to identify appropriate interventionsupon learning that a client has fallen. The nurse is asked todiscuss fall precautions and proper documentation of a clientsafety incident. The use of a restraint is considered. The nursemust also assess the client for orthostatic (postural) hypotension,bleeding, cardiac dysrhythmia, potential urgent/emergent event. Theincidence of falls, injuries resulting, fall-related deaths,financial and social implications, and need for long-term carefollowing a fall are reviewed. Improper or lack of medicationreconciliation has been the source of some medication errors.Client Profile Mr. O’Brien is an alert and oriented 81-year-old manadmitted to the hospital with complaints of dizziness and syncope.His blood pressure (BP) on admission is 80/43. At the long-termnursing care facility where he lives, he ambulated with a walkerindependently but, since his episode of syncope, he has complainedof weakness and needs another person to assist while walking as afall precaution.
Case Study:
Mr. O’Brien is admitted with prescriptions that include assessmentof orthostatic vital signs every shift and fall precautions. Thenurse explains to Mr. O’Brien how to use the call light andinstructs him to call before getting out of bed so that someone canassist him with ambulation. The nurse completes a set oforthostatic vital signs. His orthostatic vital signs are lying: BP5 120/84, heart rate (HR) 5 73; sitting: BP 5 114/73, HR 5 83;standing: BP 5 96/61, HR 5 92. When the assessment of orthostaticsis complete, Mr. O’Brien is settled in bed. The nurse raises twoside rails at the head of the bed, and the bed alarm is turned onso that if Mr. O’Brien tries to get out of bed without assistance,an alarm will notify staff. His BP is 110/62, HR is 88, andrespiratory rate (RR) is 16. Mr. O’Brien was assisted back to bedwith a Hoyer lift and two assists. His vital signs remained withinhis baseline throughout the remainder of the shift and he isafebrile. An X-ray of his right hip was negative for a fracture.There is no physical deformity of the right hip or other injuriesapparent, but a moderate amount of ecchymosis of his right hip thatextends around to his lower back and right upper buttock is noted.His health care provider, Dr. Sutton, prescribed one tablet ofoxycodone/acetaminophen 5/325 by mouth (PO) that decreased Mr.O’Brien’s pain to a “2/10” within 45 minutes.
Reporting: At the end of the nurse reporting theincident the physician asks the nurse to resume all homemedications.
While reviewing the incident with the charge nurse,the nurse realizes that the patient has home medications that mighthave been ordered incorrectly and that one particular medicationmight be contributing to the patient’s symptoms. With a backgroundof pharmacology and current chapters covered in class, pleaseanswer the following questions.
Questions & Reverse-Care Plan
Best way to do this type of care plan is to debatethe patient’s diagnosis with someone else.
1. Choose ONE medication each from the six chapters (total 6), besure they are in different classes of drugs. For those medicationsgive their effects, side effects, and any special administrationconsiderations, if any.
2. For the medication chosen in the care plan below, be sure todetail its use, side effects, adverse effects, and administrationconsiderations.
3. Select ONE of the following disease processes (= medicaldiagnosis) studied so far from Medical surgical nursing Chapter17-22. Imagine your patient has ONE of those conditions studied.Give a brief detail about how the new diagnosis may complicate thepatient’s care. Find ONE NURSING DIAGNOSIS that relate to themedical diagnosis. Write a care plan for that condition and be sureto list at least one test that will be performed, one medicationthe patient will be taking, one actual problem the patient has, andone potential problem related to the new disease =diagnosis.
