NURS 261 Case_Study_3 Final_Summer_1_(2020) - Virginia Commonwealth University | NURS261 Case_Study_3 Final_Summer_1_2020 updated

Virginia Commonwealth University School of Nursing NURS261 – Health Assessment for Nursing Practice Summer 2020 - Case Study #3 Group Number & Names: Group 4: Olivia Ledwith, Emma Yokois, Kara Preville, Sarah Carlan, ...

Virginia Commonwealth University School of Nursing NURS261 – Health Assessment for Nursing Practice Summer 2020 - Case Study #3 Group Number & Names: Group 4: Olivia Ledwith, Emma Yokois, Kara Preville, Sarah Carlan, Mary Appiah, Cecilia Gonzales, and Andry Erwin NOTE: SAME DIRECTIONS AS PREVIOUS GROUP CASE STUDIES! Initial each question that you read and edited, indicate who is the lead for each question, what is the page number in the text where you got the information from? CASE Mike Hazlett is a 26-year-old soccer player and graduate student. He is single and lives in a one-bedroom apartment with her golden retriever, Misty. Mike is a full-time graduate student in a very rigorous program, and has additional commitments to soccer, Mike says he has good friends that are supportive, and “help me stay sane”. As an athlete, Mike was proud of his healthy body, and denies the use of any substances (tobacco, alcohol, recreational drugs). But eats “a little more” nowadays since He is not currently participating in sports, but still gets plenty of water and protein on a daily basis. Mike missed fall soccer camp because he injured his right anterior cruciate ligament (ACL) in the spring. Mike was playing striker and had planted his left foot for a kick on goal when a member of the opposing team ran into his. He felt his right knee twist and “pop” as he was falling. He put his hands out to try to catch himself before hitting the ground and ended up dislocating his left shoulder. Mike is getting ready to return to active participation in soccer and comes to the clinic for a complete health assessment. HEALTH ASSESSMENT Reason for Seeking Care: Clearance to return to playing soccer Past Medical History: No serious illnesses. Experienced “multiple” sports-related injuries, such as sprains and “pulled muscles” over the years; no broken bones; appendectomy six months ago. Up to date on all immunizations. Family History: Parents alive, father 56, with hypertension, hypercholesteremia, osteoarthritis in both knees; mother 57 with migraine headaches, post-menopausal osteoporosis. Two younger siblings are alive and well. Maternal grandmother, 82, with breast cancer and osteoporosis; paternal grandmother, 83, alive and well. Both grandfathers died in their late 70s with heart disease. Health Habits: Denies tobacco, ETOH, and recreational drugs. Eats low carb, high protein diet, and participates in vigorous activity for 2 hours, 5-7 days per week. Review of Systems: General Symptoms: Feels well, eager to return to full participation in sports Integument: Denies problems or changes in skin, hair or nails. Frequent sun exposure due to sports activities, does use sunscreen. HEENT: Denies headaches, hearing loss, difficulty chewing or swallowing.Lungs and Respiratory: Denies chest tightness, cough, SOB, DOE, and frequent URIs. Uses albuterol inhaler for exercise-induced asthma, has not used any since before ACL injury. Heart and Vascular System: Denies chest pain, edema, claudication, and varicose veins. Abdomen and Gastrointestinal System: Denies abdominal pain, nausea, indigestion, or food intolerance. No change in bowel or bladder patterns, no incontinence, or sequelae from appendectomy. Musculoskeletal System: + pain and stiffness in right knee since ACL injury. Reports a “catch” in the left shoulder at times. Neurological System: Denies syncope, seizures, and cognitive changes. + for episodes of loss of consciousness after collisions in sports. - - - - - - - - - - - - - - - - - - - - - - - - All of the above movements are needed for proper running and kicking techniques. Due to his right anterior cruciate ligament (ACL) injury and subsequent limp and limited flexion, Mr. Hazlett may have difficulty resuming his position as striker on his soccer team. Both the limp and limited flexion may impact Mr. Hazlett’s ability to run at a certain speed, run with proper coordination and balance, as well as kick the soccer ball a required distance. It is also possible that if Mr. Hazlett does attempt to actively participate in soccer again, he may cause more damage to his knee and/or other joints. 6. Mr. Hazlett is planning to visit his grandmother, the one with osteoporosis. Mr. Hazlett has been worried about her, because his grandmother needs help with getting in and out of the bathtub and has trouble with buttons and snaps on her clothes. “Grandma does OK with getting to and from the bathroom, with no accident”, and moves around her apartment easily. Mr. Hazlett says his grandmother has no problems eating, “but it might be better for her if she missed a meal or two!” The grandmother does her grocery shopping online with home delivery, prepares her own meals, and pays all her bills on time. She is reliable in taking her medications and pays careful attention to her grooming and dressing; she is always clean and neat, with carefully combed hair. The grandmother has a group of very good friends, and talks with them on cellphone or Facebook, and they all go to a movie once a week. One of the grandmother’s friends drives “the girls” when they go out, as no one else still drives. When out of the house, the grandmother uses a walker for extra stability, and has not had any trips or falls. The house is not as neat as it was in Mr. Hazlett’s youth, but it is clean and without safety hazards. Calculate the Katz-and Lawton IADL scores (both are posted on blackboard) for Mr. Hazlett’s grandmother, and explain your score. (15 points) (Kara) EY, AE, OL, SC, MA,CG Lawton Instrumental Activities of Daily Living Scale A. Ability to use Telephone: Operates telephone on own initiative, looks up and dials numbers=1 E Laundry: Does personal laundry completely =1 B. Shopping: takes care of all shopping needs independently = 1 F. Mode of Transportation: Travel limited to taxi or automobile with assistance of another= 0 C. Food Preparation: plan, prepares, and serves adequate meals independently= 1 G. Responsibility of own medication: Is responsible for taking medications in correct dosages at correct time= 1D. Housekeeping: Maintains house alone with occasional assistance (heavy Work)= 1 H. Ability to Handle Finances: Manages financial matters independently( budget, pays rent and bills, goes to bank = 1 Total score = 7~ High Function Independent The Lawton instrumental activities of daily living scale is an instrument used to identify how a person is functioning at the present time and for identifying improvement or deterioration over time. Mr. Hazlett’s grandmother scores a 7 on the Lawton instrumental Activities of Daily living scale. She often speaks with her friends on the cellular phone and is able to operate the device correctly on her own accord. She conducts her shopping online independently and is able to prepare her own meals. Although the home is not as neat, she is able to maintain cleanliness and safety without assistance. She is a woman who cares about her appearance and ensures that she is personally clean and well groomed. This can translate to her ability to clean herself and clean her clothing. She meets her friends once per week to go to the movies, she is given a ride to the movies, as she cannot drive herself. She takes her medications on time at the right dosage independently and can handle her financial affairs on her own. Her score of 7 confirms she is a high functioning independent woman. Katz Index of Independence in activities of Daily living Bathing 0-Dependent Dressing 0-Dependent Toileting 1- Independent Transferring 1-Independent Continence 1- independent Feeding 1- Independent Total = 4The Katz Index of independence in activities of daily living is an instrument to assess functional status as a measurement of the client’s ability to perform activities of daily living independently. Mr. Hazlett’s grandmother scores a 4 on the Katz IADL scale. She is dependent when she performs bathing activities, needing assistance in and out of the bathtub. She further is dependent upon assistance for dressing, having trouble with snaps and buttons on clothing. She is independent for toileting, she “does ok, with getting to and from the bathroom” She is independent in movement throughout her home, however does use a walker when outside the home. She is independent in continence, having complete self-control over urination and defecation and “Gets to and from bathroom without accident” Mr. Hazlett’s grandmother is independent in her ability to feed herself. She prepares her meals independently and is able to get food from the plate into her mouth without help. With her score of 4/6 She is able to perform activities of daily living independently. 7. What are the differences between rheumatoid arthritis and osteoarthritis? What specific questions would you ask to help differentiate the two? (10 points) (Emma) (EY, AE, OL, SC, KP, MA,CG) Rheumatoid arthritis and osteoarthritis both affect the joints, but have major differences on a pathophysiology scale. Rheumatoid arthritis is an autoimmune disorder, where the body mistakes the tissue surrounding your joints as a foreign invader and attacks it. This causes an inflammatory response at the joint site. In comparison, osteoarthritis is more degenerative in nature. Osteoarthritis causes the joints to completely break down, which can eventually cause friction between the bones of that joint site (i.e. femur and tibia). OSteoarthritis risk increases with age. By 85, a person has one in two chances of developing OA. Gender, weight, occupation, and joint injury also play a role in the development of osteoarthritis (pg. 279, 280). In order to differentiate the two in a clinical setting, questions to ask a patient are listed as follows: ● “Did the pain occur suddenly? When during the day did you feel it?” Sudden onset of pain, erythema in the great toe, pain from rheumatoid arthritis may awaken the patient, especially when they are lying on the affected limb(s). Patients with OA experience pain with weight bearing, which is relieved by rest. ● “What makes the pain worse? Does it change according to the weather?” Learning what makes the pain worse may help to diagnose the disorder. Arthritis pain may become worse with changes in barometric pressure. Movement usually makes joint pain worse, EXCEPT in RA, which movement may reduce pain. ● “How long have you had problems with movement? Is the movement in your joints limited? Are your joints swollen, red, or hot to the touch?Acute inflammation such as RA produces edema, erythema, and warmth. Decreased range of motion occurs with injury to the cartilage or capsule or edema. ● Have you had a sore throat? Joint pain that occurs 10-14 days after a sore throat may be associated with rheumatic fever ● Have you noticed your knees or ankles giving way when you put pressure on them? If yes, when does it occur? How often does it occur? This may indicate joint instability that may occur from chronic inflammation or joint trauma. Safety must be a concern of the patient when a joint gives way. ● Have your joints felt as if they are locked and will not move? If yes, when does it occur? How often does it occur? What relieves the locking? What makes it worse? This may indicate joint instability that may occur from chronic inflammation or joint trauma. Data from the symptom analysis helps determine the cause of the movement disorder. Safety must be a concern of the patient when a joint gives way. ● Use symptom analysis (OLDCARTS) as a differentiating factor to ultimately decide if it is RA or OA 8. Would you give Mr. Hazlett clearance to return to soccer? Yes or No? Why? (5 POINTS) (Emma) (EY, OL, SC, MA,CG, AE, KP) I would not give Mr. Hazlett clearance to return to soccer because he continues to report stiffness and pain in his right knee since his ACL injury six months ago and a “catch in the left shoulder at times”. On examination, he has a limp on the right side, and limited ROM in the right knee and left shoulder. On flexing the right knee, he had limited ROM and associated pain with movement. His left shoulder was also limited in ROM when adducting at 90 degrees and had pain associated with this movement. Suggesting pain management strategies such as cold pack, taking supplements for joint and bone health, (educating on diet and nutrition such as increasing Calcium rich foods and Glucosamine tablets) and low impact exercises to increase range of motion in his shoulder and knee before returning to full contact sports. Also referring him to his PCP to discuss options for further interventions such as physical therapy or other appropriations before returning to soccer.