Nursing case studies

In addition, they helps in supporting the clinical management, resource management both clinical and non-clinical, financial management and the clinical audit. The clinical pathway provide a detailed protocol which needs to be followed in every stage of patient management which includes interventions and treatments offered to the patient over a specific period of time, the progress and outcome of the management is also included. The clinical pathways help in supporting training, empowering patients and also improving communication and collaboration between different sectors in healthcare setting. In addition, they ensure that high-quality care is offered to the patients and reducing risks. What is the role of the case manager in evaluating a patient’s progress? Once the patient has been recognized and the assessment which they receive on the admission has been conducted, the case manager begins the step 3; the aim of this stage is to create a case management plan for the patient.

Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process What ethical dilemma exists? An “absolute” or “pure” ethical dilemma. As the ethical standards to be applied in the situation are in conflict with each other. Who are the stakeholders and what gains or losses do each have? Mrs. Elle. Her wishes not to undergo an amputation of her right foot may see her not live long enough. Be able to justify the decision with sound arguments Case Study, Chapter 4, Health Education and Health Promotion What further assessment does the nurse need to make before designing a teaching plan? Assessing the teaching methods and teaching materials Programmed instruction, One-on-one sessions, Demonstration and return demonstration, Small group discussions and support groups.

Teaching materials Computer, models, pamphlets, posters, brochures and videos What topics does the nurse need to include for Mr. Smith based on current medical recommendations? 1. The plasticity of the aging process 2. The high incidence of chronic disease and illness among the elderly 3. 6^2 =28 Calculate her ideal body weight. What is your assessment of her BMI and weight? For her height, less than 63 kilograms is ideal. She is overweight for her weight Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment. First event in response to injury is vasodilation of arterioles around the injured area. Increased vascular permeability. After tissue injury, the permeability of blood vessels in the injured area increases, consequently plasma proteins, leukocytes and more fluid from the blood exude into tissue space.

Leucocyte, exudation, chemotaxis, neutrophils, and monocyte come out of the blood and accumulate in vast numbers in injured area. Neutrophils predominate in the first 6 to 24 hrs. This is one of various ways in which a disorder trait can be passed or inherited through a line of families. It is referred to as autosomal dominant disease when you inherit a gene which is abnormal form one parent; you have high chances of acquiring the disease. Most of the times one of the parents is found to have the disease. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. Acute pain, self-care deficit, and peripheral neurovascular dysfunction. Case Study, Chapter 11, Health Care of the Older Adult What factors may be contributing to the urinary incontinence? The age of the patient, Mrs.

Jones if 78 years old Women are more prone to urine incontinence Family history of urine incontinence Other systemic diseases Some medications can also cause incontinence of urine How should the nurse respond to Mrs. Jones? Teaching the patient of instructions of toileting, ensuring that the patient is given adequate fluid intake, adequate fiber dietary and facilitating the patient medical review. Case Study, Chapter 12, Pain Management Considering the patient’s age, what medication administration considerations should the nurse incorporate into the pain management plan and why? Improving the treatment patterns Involving the family members of the patient in management of pain Assessing the effectiveness of the management and making adjustments if needed What measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring? Reducing the dose of the opioid medication that the patient is on, this is because opioids are metabolized by the life and excreted in urine and old people has decreased renal and hepatic function.

The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication? Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? The patient is having multiple organ dysfunction syndromes. The nurse should also include medications which will counter the diarrhea. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include? Extravasation is defined as the leakage of fluid from intravascular to extravascular space during the intravenous infusion of fluids. The leakage of fluid can occur in elderly patients whose veins are very brittle, through access through a previous venepuncture and also can occur through devices which have been put wrongly.

Some symptoms which nurses need to be very keen about is inflammation, irritation, pain and other critical signs such as erythema, warmth, and tenderness. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program? • Low platelets count (Thrombocytopenia) • Decreased white blood cells (Leukopenia) • Decreased red blood cells (Anemia) Case Study, Chapter 16, End-of-Life Care What are the underlying principles of hospice? • Death of the patient must be accepted by the family members • Terminal illness and pain must be managed • Education and research should be conducted • It is necessary to provide home care to the dying patients • Interdisciplinary team is vital when taking care of the patient To be eligible for Medicare and Medicaid Hospice benefits, what information needs to be provided by Ms’ Williams’ physician? The criteria of eligibility for the hospice vary depending on the program which has been put in place by the hospice.

But in all cases, patients must be having progressive, illness which is irreversible, limited life expectancy and scheduled for palliative care. Explain the role of the nurse when implementing the immediate preoperative preparation the day before surgery and the morning of the surgery? Reducing fear and anxiety of the patient, this is done by the nurse providing psychological support to patients. Managing nutrition status and fluid levels of the patient, this is ordered by the nurse in order to ensure that there is no deficiency of nutrients during surgery. Promoting optimum cardiovascular and respiratory status of the patient, this is accomplished by assessing if the patient has any underlying respiratory or cardiovascular system disease. Hepatic and renal function support. Promoting active body movement of the patient.

Nurse’s care during intraoperative period is very vital; this is because the patients spiritual, safety, psychological, physical and psychological needs depends on the nurse care. Case study 19 Postoperative Nursing Management Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed. In the first hours after admission in the clinical unit, it is important to ensure adequate hydration, ventilation, neurological status, taking care of the incisional pain, protecting the integrity of the surgical site and nausea and vomiting. In the immediate period of postoperative care, it is the responsibility of the nurse to ensure that the patient is well ventilated in order to prevent hypercapnia and hypoxemia. The two can occur as a result of an obstructed airway.

Elderly patients are also prone to hypothermia and so it is critical for the nurse to ensure that they are kept in warm places. Explain the wound healing process according to the phase of Mr. Smith’s wound? The incision and drainage is needed in order to remove the exudates and would clean to prevent occurrence of infections. These types of wounds heal by secondary intentions. This type describes those wounds whose edges cannot be estimated. The nurse pulls the end of the iodoform strip out of the bottle using sterile forceps and allows the assistant to put the cap on the bottle with the iodoform strip sticking out once a sufficient amount of it has been removed. The gauze is cut 2 or 3 cm from the cap with sterile scissors.