NURSING 624 Case Study Comm Doc Deleg Mobility/RATED A

NURSING 624 Case Study Comm Doc Deleg Mobility/RATED AMr. Baker is an 84 year old man with a history of insulin dependent diabetes, hypertension, and asthma. He smokes ½ pack of cigarettes per day. He sustained a fall at ...

NURSING 624 Case Study Comm Doc Deleg Mobility/RATED AMr. Baker is an 84 year old man with a history of insulin dependent diabetes, hypertension, and asthma. He smokes ½ pack of cigarettes per day. He sustained a fall at home and has been admitted to your unit with a non-displaced hip fracture. He is ordered for bed rest. 1. What are some risks associated with bed rest that Mr. Baker is particularly prone to and why? 2. What are some interventions to prevent Mr. Baker from developing respiratory complications? 3. What are some interventions to prevent Mr. Baker from developing complications related to blood flow? 4. What are some interventions to prevent Mr. Baker from developing psychosocial complications related to bed rest? 5. What are the recommended guidelines for the use of telephone orders? The person authorizing the orders identifies their self, says the patient’s name and then tells the receiver the order. The receiver documents the order, date, time, prescriber’s name, and repeats the order back. The authorizer then has 24 hours to countersign the order. You transcribe the following are the new orders on Mr. Baker. 9/23/15, 1400 Lispro insulin, 4u subcutaneously prior to meals Aspirin 81.0 mg daily Vitals signs every 4 hours Chest x-ray 5. What are the errors in this documentation? You shouldn’t write u, order must be signed 6. Correct the errors using proper technique. 9/23/15, 1400 Lispro insulin, 4unit subcutaneously prior to meals Aspirin 81.0 mg daily Vitals signs every 4 hours Chest x-ray You receive a call from Radiology requesting Mr. Baker goes down for his x-ray. You send him off the unit and then receive a phone call from his daughter asking how he’s doing. 7. What would be the appropriate nursing action and response? Because of HIPPA I cannot give his daughter any information. Therefore, I would tell his daughter that I am sorry but I can’t disclose information regarding your father because of violating HIPPA. Mr. Baker returns to the unit after the chest x-ray and he is visibly upset. “They made me wait in the waiting area for 20 minutes, and they didn’t even offer me a blanket or something to drink! No one down there would tell me the results of the test, and now I hear that you wouldn’t tell my daughter how I was! I tell my daughter everything, and you made her worry for no reason!” He is shaking his fist and raising his voice. You note that he is breathing rapidly, his color is pale, and he appears sweaty. He tells you he feels lightheaded and is feeling short of breath. 8. What would be your priority action at this time? To take care of the patient and the situation and calm Mr. Baker down. 9. What would be an effective therapeutic communication technique to address Mr. Baker’s concerns? How would you handle this situation? I would first have Mr. Baker sit down, relax, and calm down. Then I would clarify the information about his daughter and what happened and why I couldn’t disclose the information. I would then give him options on how we can make her an authorized person and make him feel comfortable by getting him a blanket and a drink. You assess Mr. Baker’s vital signs and blood glucose, and everything is within normal limits. He states, “I get a little worked up sometimes.” 10. Write a SOAP note on the situation, starting with Mr. Baker’s return from x-ray. S: Subjective lightheaded and short of breath O: Objective breathing rapidly, his color is pale, and he appears sweaty. Normal vital signs and blood glucose level A: Assessment Frustrated, annoyed, and worked up because of situation P: Plan Calming the patient down and making sure he is relax and comfortable Mr. Baker eats his lunch and has a nap, and reports feeling much better. The provider calls to ask you to get Mr. Baker out of bed for dinner for the first time since his injury. You meet with the UAP (unlicensed assistive personnel) assigned to Mr. Baker to organize your afternoon. 11. Complete the chart below to decide which tasks can be delegated to the UAP and which ones should be done by you. Task RN UAP Check a blood glucose RN Administer insulin at 5:00 pm RN Turn and reposition every 2 hours UAP Assess hip incision dressing RN Provide teaching on new hypertensive medication RN Obtain vital signs at 3:00 pm UAP Remove IV fluids at 7:00 pm RN Check respiratory status on client prior to administering narcotic RN Get Mr. Baker out of bed UAP The UAP tells you they haven’t checked a blood glucose on a client since they changed to a new type of glucometer. 12. How should this situation be handled? I would show the UAP how to check the blood glucose using the new glucometer so that they can do it next time if they feel comfortable. You proceed to Mr. Baker’s room to complete the teaching on his new hypertensive medication. 13. Complete the chart below identifying how you would complete this education using the nursing process. Assessment Ask the patient to see how much information he knows about the medication Planning From the information that you reserved from the patient, make a plan to teach the patient about the medication Intervention Tell the patient about the risks, what it does, what not to do while taking the medication, what he can do to help with his hypertension, and if he sees any side effects to give us a call Evaluation Ask the patient if he has any questions and have the patient give me a summary that way I know that he fully understands the information you just went over. If he does not go back and explain the medication again. Mr. Baker appears overwhelmed with the information you have provided. “It’s like every time I turn around, I have a new pill to take. I don’t even know if the doctors talk to each other! One tells me to take the pill, the next doctor takes me off the pill, and I can’t afford to keep filling prescriptions and then throwing them away! And everything has side effects, and I’m sick enough already without more problems!” 14. Choose a communication technique that would be appropriate for this situation, and explain how you would utilize it. Sharing empathy and providing information are the communication techniques that I would use. I would tell the patient that I understand that it is frustrating but I will give you all the information and answer all the questions you have regarding the medications. 15. What are some nursing diagnoses related to Mr. Baker’s entire hospital course? Write at least 2 actual diagnoses and 2 potential (risk-for) diagnoses. Actual diseases include hypertension and asthma and he is at risk for a heart attack related to getting worked up quickly and hypertension and is risk for osteoporosis related to non-displaced hip fracture. 16. Choose one diagnosis and write out a brief care plan using the chart below. Complete the information as if you had actually done the care plan. Assessment Review history, take vital signs, observe the patient, ask him about his heart condition and daily activity Diagnosis Interpret the results from the assessment and look at the heart rate, heart rhythm, and blood pressure, get an EKG examine the chest x-ray and see if hypertension is a diagnosis Planning In order to restore health, we need to monitor the patient’s blood pressure, cholesterol, find ways to control the patient’s frustration and stress levels, and tell the patient the effects of smoking Intervention Document the patients respond to all tests, sees how the patient reacts with the information. Tell the patient the risks if he continues smoking and show him some exercises he can do to help with his heart condition after his hip feels better. Tell the patient to try meditation to try to help with relaxation. Evaluation When the patient returns see if his blood pressure is under control, if his smoking has stopped, and if he has started exercises. Follow up with the patient. If the heart conditions are still not under control, reassess the patient and make a new care plan.