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Nursing Care Plan For Mrs. Rhonda Green

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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.

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 priority needs to be Considered in planning for Mrs. Green’s discharge? 

5.Identify one 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.Referring to the information provided in George Grandin’s case study, write the nursing admission notes, using appropriate terminology and a holistic approach.

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.

9.Following principles of best practice and risk assessment, identify one Stress Management technique that you would recommend for Mr Grandin’s Nursing Care Plan?

10.Identify one 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 Risk Factors for Older people in Hospital.

13.Identify two Community resources or support Services that George may need when discharged?

14.Access the relevant websites, to apply one standard from each of the following code/guideline and relevant Act that would be relevant to the Case Study.

15.Access the relevant websites, to apply one standard from each of the following code/guideline and relevant Act, that would be relevant to the Case Study.

16.Access the relevant websites, to apply one Standard from each of the following codes/guidelines and relevant Act, that would be relevant to the Case Study.

17.Access the relevant websites, to apply one standard from each of the following codes/guidelines and relevant Act, that would be relevant to the Case Study. 








 Mrs. Rhonda Green


50 yrs








Recently gained weight due to menopause



Weak in coping up with the natural phenomenon



Lives with her husband, have three children



Need counselling, ADLs treatment for the knee replacement operation


  • DIET

DIET:  light healthy food, fruits and vehgetables






Her husband need to take excess care to Mrs. Green and provide her with the moral support


  • T
  • P
  • R
  • BP
  • BMI


36.5 degree celcius



170/86 Hg/mm




(sign off with name, signature and delegation at the end of the notes)

Special care based on counselling must be given to the patient.



Nursing Care Plan for Mrs. Rhonda Green

Nursing diagnosis

(patient's need)


(Nursing intervention Required)

Expected Outcome





Temperature- 36.5 degree Celsius,


Heart rate- 110,

BP- 170/86m mmHg

SPO2- 98%

  • Maintaining of proper position of the extremity of the operated zone (Lentz and Luther 2017)


  • Providing proper measures for the activities that are diverse in nature
  • Encouraging for managing the stress




  • Medication is an important activity on a regular schedule basis (Doenges, Moorhouse and Murr 2014)
  • Investigating the reports of the joint pains, chest pain and restlessness
  • Applying ice packs when required
  • Extremity is mobilized that is to be maintained and must be initiated (Gulanick and Myers 2013)
  • It helps in the reduction of the pain, spasm of the muscles
  • Helps in the reduction of the tension of the muscles, need to promote the sense of control and can focus on the enhancing with the abilities for coping up with the pain
  • Reduction of muscle tension , increases comfort and participation must be facilitated
  • Prior recognition before the  breakage of the dislocation of prosthetics, providing opportunity mainly for the intervention that is prompt in general
  • It helps in the pain that may arise due to the post operative method



  • Psychological traumas after menopause (Ang?n, Erden and Can 2015)
  • Depression for sexual activity
  • Counselling
  • Medication, if required
  • Psychotherapy


2.Counseling the best way out for her to recover from the present situation she is facing from. It is the process that can help Mrs. Green to recover herself from the traumatized situation by the process of empathy and guiding her to the normal life style. Counseling can also provide her with spiritual, emotional and psychological supports in the aspect of the present health status as she is facing so that she can completely participate in her family issues as she always used to be (Gulanick and Myers 2013).

Making Mrs. Green learn about herself that she can come up with the activities she always used to be in at home, making her teach about the exercises that she need to do for the arthroplasty or for the knee replacement that can help her in overcoming and recover from her present mental and physical status that can lead the avoidance for the re-hospitalization (Butchet et al. 2013).


Menopause leads to the clinical depression, erratic behavior and severe anxiety. It is observed that most of the women entered in the menopause phase without going through a disorder in food.
Menopause at the same time leads to the fluctuations in hormone, stresses in life and trouble in sleep at night. It also leads to the concern of the body images, infertility as well as aging which contributes for the mood swing and emotional distress in life of women (Snow et al. 2014). It also leads to severe cases of depression. It is observed that women reported about the symptons like stress, anxiety and depressed moods. The sense also decreases at this time. This factors are not at all surprising as physical changes like infertility contributes for the rising of question like purpose and direction of lives for the mid aged women. The women who are deprived from having a child find this phase to be the troubling phase.

Depression, Mood, and Sex:

The complicated relationship exists between sexuality and mood depression (Doenges, Moorhouse and Murr 2014).   Depression might be the reason and inference of sexual problem. Considering an example, the loss of desire in woman leads to the depression and might view that the desire is declining due to the depression in life. It is also been observed that emotion is been affected by mood that causes issues in relationship and finally have an impact in sex life.
Low desire in women us the frequent side effect observed due to depression and anxiety. The orgasm is also difficult to happen during phase of depression (Potdar and Shinde 2014).

Sexual Side Effects of Antidepressant Drugs: 

Women suffer from moderate or severe depression as well as anxiety is often been prescribed for the famous antidepressant drug SSRIs (selective serotonin reuptake inhibitors). This dtug is effective for curing the phase of depression (Siddiqui et al. 2016). The drug have sexual side effect that eliminate sexual desire, achieving arousal and maintaining it and difficulty in achieving orgasm. The half of the patients taking SSRIs includes fluoxetine (Prozac), sertraline (Zoloft), paraoxetine (Paxil) and Celexa contributes for sexual problem and dysfunction (Kingsberg and Woodard 2015).


Substance Abuse and Sex

Both Depression and anxiety contributes for substance abuse and the sex regulated with the life changes.

The significant reasons for avoiding usage of illegal drugs and excessive alcohol should be followed. They posses threat to the health and the relationship and can affect the sexual functionality (Kurpius et al. 2016). The intake of drugs and alcohol leads to the depressant effect that reduces sexual response by affecting the nervous system.    

3.Mrs. Green will require a female nurse who will help her for gaining her confidence back for her daily activities of her life for the living If a male nurse is allotted to her, she might not overcome with the embarrassment that she might face if a male nurse assist her during the shower, toileting and getting dressed daily. This may be the reason for Mrs. Green that she skipped daily shower or kept ADLS incomplete. This may made her feel frustrated and she supported it with several ways for escaping the issue from frustrations and the stress she was facing.

4.The two main priorities that Mrs. Green may require are as follows (Ang?n, Erden and Can 2015):

  • She requires urgent counseling forwarded with the medicinal treatment or rehabilitation if required to make her recover from the situation she is facing due to the menopausal condition that she cannot accept.
  • The other priority that can be arranged for Mrs. Green is to take excess of family care and support that can be given by her husband and the support can be given her by her children as well. She need to be given time for the moral support as she is facing the menopause where sexual activities may hamper as per to the view of Mrs. Green.

5.The nurse needs to assess mobility of Mrs. Green before discharging her from the hospital. The nurse also requires for assessing that whether Mrs. Green needs for attending the rehabilitation due to her knee issue (Browne et al. 2014).


The process of discharging will occur with the evaluation of healthcare required during her entire stay in the hospital. The education session is also required for her and family for providing the healthcare attention that are needed for her. The discharging of patient will require the nurse to assess her mobility and observed if there are any barriers that might obstruct her progress in stairs, accessing the washroom with safety and the availability of the assistance for helping the activities of her daily life. Besides, rehabilitation she also requires to visit the physiotherapists for going through the exercise and regaining the mobility back.

6.The developmental stage that Mrs. Green is facing are Perimenopause or Pre menopause. It is the stage in which the hormone levels begin to drop down. It takes place just after the age of 40 years. In this phase estrogen levels drop down. In this phase she is being disturbed, mood swings takes place, vagina starts drying up so sexual intercourse becomes a practice of discomfort along with the urinary issues.





 Mr.George Grandin


87 yrs








Practices Catholics, have strong support network at home and the church



Need for Metamucil with multivitamins with fish oil supplements



Lives with his wife, daughter got married



Need to take Metamucil with multivitamins and fish oil supplements


  • DIET

DIET:  light healthy food, fruits and vegetables






He need family support with some physiotherapy for walking and balancing


  • T
  • P
  • R
  • BP
  • BMI


36.1 degree Celcius



170/86 Hg/mm

181 cm

65 kg



(sign off with name, signature and delegation at the end of the notes)

Special care must be given to Mr. George and regular physiotherapy must be required. He need to take multivitamins and fish oil supplements


Nursing diagnosis

(patient's need)


(Nursing intervention Required)

Expected Outcome


Actual diagnosis

The patient had suffered a fall and suffers from constipation

·         He has to go through physiotherapy treatment in order to reduce pain and also take medicines

·          He should include fibre in his diet beside the medicine he takes

·         His pain will effectively subside (Howcroft, Kofman and Lemaire 2013)

·         His problem of constipation can be removed

Actual diagnosis

The patient had suffered several bruises

·         The wounded areas have to be properly dressed, otherwise it may lead to infection

·         Properly dressed wound will be healed rapidly and there will be less chance of infection

Potential diagnosis

He has a chance of developing pressure ulcer

·         Proper air filled mattresses should be used in order to prevent the chances of ulcers and also his positions should be changed constantly.

·         Pressure ulcers will not occur.

Potential diagnosis

He may be subjected to fall in the future and may

·         Proper risk assessments are to be done

·         He should be careful while movements should take a properly balanced diet to prevent any deficiency disorders in future.

·         By proper risk assessments and important steps taken, he may thereby reduce his chances to fall.

9.The stress management technique, that can be recommended for Mr. Grandin are as follows (Ackley,Ladwig and Makic, 2016):

  • The cause of the stress need to be identified, made the things written, and definitely to find the tentative solution for putting it up at the mind easily
  • Mr. Grandin must read books or the particular stories that may inspirers him and he gets enjoyment, pleasure or spiritual healing
  • He needs to learn to meditate. Practicing deep breathing until he is feeling relaxed. Meditation will help him to calm him down and deep breathing makes a person to be calm
  • Mr. Grandin can keep pet at his place, with whom he can spend some time, as cuddling, playing or spending time with pet is a part of pet therapy program for the elderly people
  • He can visit nearby malls for a change of the regular daily routine and can enjoy different ambience due to the colorful and various stores
  • Mr. Grandin needs to be focused on his own healthcare and mood for refreshing his spirit.

10.In order to collect health related data, a responsible nurse need to undertake the duty of performing the measurement of the vital signs of the patient. This gives a preliminary idea about the patients’ present condition and the emergency treatments that he will require. Vitals signs basically provide the measurements for the basic functions of the body like body temperature, pulse rate, respiration rate and also blood pressure (Storm et al. 2014). The nurse may check the body temperature orally, rectally, axially, by ear and also by skin. Normal temperature of the body usually remains 97.8 degree F and above that, the temperature mainly signifies ill health. The normal pulse rate of an individual would be 60 to 100 beats and presence of any disorder or illness make the pulse rate fluctuate calling for emergency attention. Respiration rate of the individual is the number of breaths that a person can take in one minute and that usually varies from 12 to 16 breaths per minutes. The respiration rate is found to increase with medical conditions providing a cue of ill health. The blood pressure is the pressure exerted by blood on artery all and mainly accounts for 120 mm HG for the systolic pressure and the 80 mm Hg for the diastolic pressure (Berchill, Anderson and o’connor 2015). A high or low pressure will help the nurse to quickly take steps necessary for saving the person from distress.

11.The nurse has to be careful for a number of factors and therefore she should maintain a chart that will mainly act as a consort and also as checklist. First of all, as the patient is aged, and has already had a serious fall accident, therefore the nurse should undertake fall risk assessment in order to reduce the risk off fall for the patient in the future (Hill et al. 2016). Moreover he has a number of injuries and therefore proper dressing is very necessary. Wound dressing is a skilled intervention that needs to be properly done for the wound to get well soon. Improper wound dressing may lead to septic issue harming the health of the individual. The patient also has a chance of pressure ulcers and therefore he has to be applied on proper air filled mattresses so that the pressure may get equally distributed and hence can prevent pressure ulcer (Visvanathan 2014). Besides, his issue of constipation can be treated by medication and also fibers and roughage should be included in his diet to make him relieve from the disorder.

12.The factors that increase the risk of older person staying in the hospital are:

  • Increase in the physical problems like heart diseases, stroke.
  • Chronic pain that leads to fatal causes

13.Treatment of older patients in hospitals are often challenging as nurses often report of more pressure in handling old patients than young adults. Old patients usually have less strength in their movements and often have the risks to loss their balance (Evans et al. 2014). Therefore they are at a higher risk of fall which may cause fracture or even replacements and others. This results in severe pain and loss of quality life.  Another risk that closely remains associated with old age is the occurrence of mental disorders like depressions. An old patient often loses her confidence in him as he requires assistance in most of his ADL and therefore often suffers from depression. This in turn leads to harmful effect on both the mental condition which is also reflected in the physical condition of the patient (Singh 2015). Therefore the nurse needs to take the assessment of the risks and prevent patients from getting affected by them.

14.According to the large number of codes of conduct that had been described in the NMCA, the one code that can be truly applicable for the patient is that the nurse should practice her work in safe and competent manner the patient is old and already have suffered a fall. Therefore the nurse should be very much careful in her interventions so that can properly assess the risks in her activities and effectively avoids them. Nurses are personally accountable for the provision of safe as well as competent nursing care. It depends upon the nurse to determine the necessary steps required for complete recovery of the patients and should implement her skills, knowledge, and expertise for providing best service to patients. If a nurse is not sure of the steps she has to take, she should completely disclose it to the supervisor and should never make the patients’ life at risk (New-Code-of-Professional-Conduct-for-Nurses 2017). If the health of the nurse is not suitable for her to practice her skills, she should immediately seek assistance to redress their health needs. If she has to delegate, she should ensure that the diligence should not affect the patient health. If a nurse practices her skills in safe and secured manner, her patient will be in the best of health.

15.According to the case provided, the code of ethics that can be applied to the case is the value statement 3 which says that nurses should value the diversity of the people. The nurse should not only respect the patients’ diversity but also pay importance to the patients’ culture, language and also the backgrounds but should also value her own feelings, thoughts and beliefs about her own cultural similarities and dissimilarities. They should prepare themselves in such a way so that they can develop various cultural knowledge as well as awareness for greater responsiveness to the language spoken (_New-Code-of-Ethics-for-Nurses-August-2008.PDF, 2017). The patient here is very particular about his culture and therefore if the yrse pays importance to his language, he would be very much satisfied and would respond well to the treatment. Besides, playing importance to different communities without discriminating is also very important for her career. Similar behavior should also be practiced by the nurse among her colleagues so that she can maintain harmony among them as well.


16.The enrolled nurse should also follow the rule of contribution of the formulation of the care plans in collaboration with the registered nurse, individuals and groups. As in case of the patient in the case, the nurse should properly collect and then report the data regarding the functional status and also the health of the individuals and groups (Nursing and Midwifery Board - Competency Standards For The Enrolled Nurse - October 2002). She should also participate with the registered nurse and also the individuals and also groups for the identification of the expected health care outcomes. She should also participate with the RN to evaluate the progress of her patient towards expected outcomes as that had been guided by the RN.

17.The health Practitioner Regulation National Law of Western Australia Act in the year 2010 have been amended and has stated that a nurse could only practice her skills if her name is registered under the Health Practitioner Regulation National Law (Western Australia) in the nursing and midwifery profession and her name should be incorporated under the Register of Nurses which is kept under law (Australian Health Practitioner Regulation Agency - Legislation, 2010). The nurse in the case study should perform her activities only if she is a registered nurse. This is mainly done so that chances of error by inexperienced novice nurses can be avoided.



Ackley, B.J., Ladwig, G.B. and Makic, M.B.F., 2016. Nursing diagnosis handbook: an evidence-based guide to planning care. Elsevier Health Sciences.

Ang?n, E., Erden, Z. and Can, F., 2015. The effects of clinical pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis. Journal of Back and Musculoskeletal Rehabilitation, 28(4), pp.849-858. 2017. Australian Health Practitioner Regulation Agency - Legislation. [online] Available at: [Accessed 24 Feb. 2017].

Browne, J.A., Sandberg, B.F., D'Apuzzo, M.R. and Novicoff, W.M., 2014. Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study. The Journal of arthroplasty, 29(3), pp.481-483.

Burchill, C., Anderson, B. and O'connor, P.C., 2015. Exploration of nurse practices and attitudes related to postoperative vital signs. MedSurg Nursing, 24(4), pp.249-256.

Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2013. Nursing interventions classification (NIC). Elsevier Health Sciences.

Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2014. Nursing care plans: Guidelines for individualizing client care across the life span. FA Davis.

Evans, S.J., Sayers, M., Mitnitski, A. and Rockwood, K., 2014. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age and ageing, 43(1), pp.127-132.

Gulanick, M. and Myers, J.L., 2013. Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Hill, K.D., Flicker, L., Logiudice, D., Smith, K., Atkinson, D., Hyde, Z., Fenner, S., Skeaf, L., Malay, R. and Boyle, E., 2016. Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians. Australian and New Zealand journal of public health, 40(6), pp.553-558.

Howcroft, J., Kofman, J. and Lemaire, E.D., 2013. Review of fall risk assessment in geriatric populations using inertial sensors. Journal of neuroengineering and rehabilitation, 10(1), p.91.

Kingsberg, S.A. and Woodard, T., 2015. Female sexual dysfunction: focus on low desire. Obstetrics & Gynecology, 125(2), pp.477-486.

Kurpius, S.E.R., Hassert, S. and Nicpon, M.F., 2016. 18 Counseling Women at Midlife: A Biopsychosocial Perspective. Handbook of Counseling Women.

Lentz, S. and Luther, B., 2017. Nursing Care Management: Influence on Bundled Payments. Orthopaedic Nursing, 36(1), pp.28-33.

New-Code-of-Ethics-for-Nurses-August-2008%20(2). 2017. Code of Ethics for Nurses in Australia. [online] Available at: https://file:///C:/Users/user00/Downloads/5_New-Code-of-Ethics-for-Nurses-August-2008%20(2).PDF [Accessed 24 Feb. 2017].

6_New-Code-of-Professional-Conduct-for-Nurses-August-2008-1-%20(2).. 201). Code of Professional Conduct for Nurses in Australia. [online] Available at: https://file:///C:/Users/user00/Downloads/6_New-Code-of-Professional-Conduct-for-Nurses-August-2008-1-%20(2).PDF [Accessed 24 Feb. 2017].

_EN-Competency-Standards-August-2008--new-format-%20(1). 2017. national competency standards for the enrolled nurse. [online] Available at: https://file:///C:/Users/user00/Downloads/2_EN-Competency-Standards-August-2008--new-format-%20(1).PDF [Accessed 24 Feb. 2017].

Potdar, N. and Shinde, M., 2014. Psychological problems and coping strategies adopted by post menopausal women. International Journal of Science and Research (IJSR), 3(2), pp.293-300.

Siddiqui, F.A., Parveen, N., Mashooque Siddiqui, S. and Shah, I., 2016. DEPRESSION: THE PSYCHOLOGICAL EFFECT OF MENOPAUSE ON WOMEN. Women (1997-2032), 8(8).

Singh, S.D., 2015. Loneliness, depression and sociability in old age. The International Journal of Indian Psychology, Volume 2, Issue 2, No. 2, p.73.

Snow, R., Granata, J., Ruhil, A.V., Vogel, K., McShane, M. and Wasielewski, R., 2014. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am, 96(19), p.e165.

Storm?Versloot, M.N., Verweij, L., Lucas, C., Ludikhuize, J., Goslings, J.C., Legemate, D.A. and Vermeulen, H., 2014. Clinical relevance of routinely measured vital signs in hospitalized patients: a systematic review. Journal of Nursing Scholarship, 46(1), pp.39-49.

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