Mrs Rhonda Green is a 50 year old female, who had a total knee arthroplasty 3 days ago. Rhonda is on 6 hourly observations. The most recent recorded observations were: Temperature =36.5 °C, Respirations =22, HR= 110, BP=170/86mmHg and SpO2=98%, on room air. She is complaining of ‘awful pain’ in her knee and her elevated BP and pulse reflect that.
Mrs Green has been unable to do her routine ROM exercises, due to the pain in her knee. Mrs. Green received opioid analgesia for the first two days post operatively and has reported that she has not opened her bowels since the operation. She requires assistance to perform ADLs and has expressed embarrassment at being assisted in the shower.
She stated in confidence that she is menopausal, has gained weight over the past 2 years, suffers anxiety and has a very poor self-image. She is finding it difficult to adjust to her body now that she is no longer fertile. Mrs Green feels embarrassed at undressing in front of nursing staff and even in front of her own husband. Mrs Green admits to having a strict Catholic upbringing and finds it difficult to identify with her own sexuality.
Socially: Mrs. Green lives with her husband and has three grown up children.
Case Study 2: Mr George Grandin
On 12/6/14 at 1000hrs, you are assigned to admit a new client to your ward.
Mr George Grandin is an 87 year old male of Spanish descent, who was admitted to your ward this morning, following a fall at home. On admission, his wife (Mary) and his daughter (Celeste) are in attendance. He sustained significant bruising and swelling to his right hip and shoulder with a large skin tear to his right forearm. He did not sustain any fractures. He is admitted for pain relief and dressings to his forearm, as well as a physiotherapy review. George’s daughter (Celeste) has requested an interview with the doctor, to determine if her father needs any extra care at home.
On assessment, George has bony prominences on his hips and pelvis and is at risk of developing pressure areas on these bony prominences. Cognitively, George is alert and orientated. George tolerates a small, but nutritious diet at home that includes all aspects of nutrition. He has no reported history of urinary issues and takes Metamucil daily to prevent chronic constipation. George can shower and dress independently and had been ambulating independently prior to the fall, but is to be assessed by a physiotherapist for balance and gait and the need for a walking stick or frame. Medically, George is healthy for his age and other than Metamucil daily, he takes multivitamins and fish oil supplements, but no other medications.
Socially, he lives with his 82 year old wife in an attached flat in their daughter’s home. George attends bowling and church weekly and states that his strong faith and his wife help him cope with his ageing process. George was born in Spain and immigrated to Australia in his late teens and identifies with strong Spanish ties in Australia. George and his wife are practising Catholics, having a strong support network at home and at church.
George’s observations on admission are Temp 36.1, BP 105/68, Respirations 18, Pulse 64, Height: 181cm and Weight: 65kg. George is very thin, with a BMI of 18.
Case Study 1
1. In collaboration with the RN, following State/territory Nursing and Midwifery Regulatory Authority Standards of Practice for the Enrolled Nurse and acting within the Scope of Nursing Practice Framework, develop a nursing care plan for Mrs Green. Incorporating cultural and religious beliefs, provide two (2) actual and two (2) potential nursing diagnoses, including correct terminology, interventions and expected outcomes for each. Use a template.
2. Mrs Green has confided that she has had trouble adjusting to her body image in middle age now that she is no longer fertile. How does her case relate to the sexual development stage experienced in middle age?
3. What could you do to contribute to Mrs Green’s health teaching, to reduce her embarrassment about performing ADL’s with a nurse assisting her?
4. Describe two (2) priority needs to be considered in planning for Mrs. Green’s discharge?
5. Identify one (1) community resource/support service that Mrs Green may need, when discharged?
6. Briefly explain the developmental stage, specifically as it relates to Mrs Green?
7. Case Study 2
Referring to the information provided in George Grandin’s case study, write the nursing admission notes, using appropriate terminology and a holistic approach. Please complete the Admission Notes template provided. Follow the process of documentation, to maintain legal compliance. Students may use a variety of documentation styles. Report any abnormalities and extraordinary findings to the RN.
Please download the following admission notes template, complete it and reupload it to the Blackboard.
8. In collaboration with the client/family member or carer, RN, following State/territory Nursing and Midwifery Regulatory Authority Standards of Practice for the Enrolled Nurse and acting within the Scope of Nursing Practice Framework, develop a nursing care plan for Mr Grandin. Incorporating age specific health needs, cultural and religious beliefs provide two (2) actual and two (2) potential nursing diagnoses, including correct terminology, interventions and expected outcomes for each. Use the template provided.
Please download the following template, complete it and reupload it to the Blackboard. Click here to download the file
9. Following principles of best practice and risk assessment, identify one (1) stress management technique that you would recommend for Mr Grandin’s Nursing Care Plan?
10. Identify one (1) appropriate method used to collect health related data, as a part of the admission process for Mr Grandin.
11. Considering Mr Grandin’s injuries and his low BMI, what regular nursing assessments/charts will George need?
12. Chronic illness, coupled with the changes associated with ageing, must be considered when planning nursing care for an older client. Provide two (2) risk factors for older people in hospital.
13. Identify two (2) community resources or support services that George may need when discharged?
14. Access the relevant websites, to apply one (1) standard from each of the following code/guideline and relevant Act that would be relevant to the case study.
(ANMC Code of Conduct )
15. Access the relevant websites, to apply one (1) standard from each of the following code/guideline and relevant Act, that would be relevant to the case study.
(ANMC Code of Ethics)
16. Access the relevant websites, to apply one (1) standard from each of the following codes/guidelines and relevant Act, that would be relevant to the case study.
ANMC National EN/Div 2 Nurse Competency Standards
17. Access the relevant websites, to apply one (1) standard from each of the following codes/guidelines and relevant Act, that would be relevant to the case study.
State your local, relevant State/territory Nurse Regulatory Nurses Act