CASE STUDY 1 An element of nursing care that is of primordial importance is the safety of the client throughout the life

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CASE STUDY 1
An element of nursing care that is of primordial
importance is the safety of the client throughout the life span.
Given the following case, how will you handle the
situation?
A 67 year old client has impaired balanced and
difficulty of walking.
QUESTION: What measures should be implemented to
ensure safety?
CASE STUDY 2
Disaster strikes in the Metro Manila as Typhoon Doleng
destroys a portion of the country. Families are displaced from
their homes. The area is designated as
uninhabitable.
QUESTIONS:
What are some of health effects that have emerged from
the floods?
What is the role of the nurse in the care of
clients before, during and after natural disaster?
CASE STUDY 3
A group of nurses who work in a long term care facility
are alarmed at an increase in pressure ulcers among the patients.
The nurses believe this may be caused by infrequent repositioning
and related to recent staff cuts. The nurses decide to conduct a
study that will examine the cause of increased pressure
ulcers.
QUESTIONS:
What type of reasoning would be used to connect the
increase in pressure ulcer to a specific cause?
How can the nurses used problem solving skills to create
and implement a policy to diminish pressure ulcers in nursing
homes?
CASE STUDY 4
Tony is a 32 year old man with HIV. His first AIDS
defining illness caused his weight to drop from 175 to 116 lbs. due
to intractable diarrhea. The physician thought caloric intake was
of primary importance and urged Tony to eat whatever he wanted. The
physician also prescribed tincture of opium for the diarrhea, but
Tony hated the tincture of opium because it made him feel out of
control. Because Tony was getting worse, his nurse argued that he
needed intravenous nutrition and should eat only bananas, rice,
apple sauce and weak tea until the diarrhea stopped. The nurse
suggested adding other foods one at a time and only as tolerated.
Tony’s family and friends offered to take control of Tony’s food
preparation.
The physician compared AIDS to advanced cancer and
argued he would not prescribed IV nutrition to advanced cancer. The
nurse argued that this was Tony’s first AIDS infection and that the
prognosis was better than someone with advanced cancer. The nurse
primary focus was on stopping the diarrhea and supplementing
nutrition with IV’s. Tony’s friends preferred the nurse’s approach,
but Tony was not as easily convinced.
Guide question:
1.How might Florence Nightingale analyse the
situation?
2.What appear to be the perspective or views represented
by the physician and the nurse ( how might you say they are
defining the metaparadigm)?
RATIONALE:
CONCEPT: NURSING THEORIES AND CONCEPTUAL
FRAMEWORKS
REFERENCES: Fundamentals of Nursing Concepts, Process
and Practice 9th Edition by Audrey Berman and Shirlee Snyder,
Pearson Education Limited Copyright 2014, pp. 67
CASE STUDY 5
Mr. Woo, a 50 year old professional man, has pneumonia
and is currently being treated with antibiotics. He smokes two
packs of cigarettes a day. Since this bout of pneumonia he voices
concern about his smoking and his wonders if he should try to quit
again. He states “I’ve tried everything and nothing works. The
longest I smoke last is about one month.” He admits to being 30lbs.
overweight and state that his wife and he have started walking for
30 minutes every evening. His wife has also started making low fat
meals. He is concerned that if he quits smoking he will gain more
weight.
GUIDE QUESTION:
Each contact between a nurse and a client is an
opportunity for health promotion. Based on the knowledge or key
concepts listed above, what questions would you ask to Mr.
Woo?
RATIONALE: The nurse’s role in health promotion is to
act as a facilitator of the process of
CONCEPT: HEALTH PROMOTION
REFERENCES: Fundamentals of Nursing Concepts, Process
and Practice 9th Edition by Audrey Berman and Shirlee Snyder,
Pearson Education Limited Copyright 2014, pp. 317
CASE STUDY 6
The nurse is examining a patient involved in a car
accident. The patient complains of shortness of breath. The tissue
of the patient’s face,neck and torso gives a crackling sensation
when palpated. The nurse suspects subcutaneous
emphysema.
GUIDE QUESTION:
How can you assess a client suffering from subcutaneous
emphysema?
RATIONALE:
NURSING PROCESS STEP: ASSESSMENT
REFERENCES: Fundamentals of Nursing 2nd Edition by
Elizabeth Ann Archer,RN,MSN and et.al.
CASE STUDY 7
A 76-year old woman has just been diagnosed with breast
cancer. She also has severe cardiovascular disease that limits her
choices of treatment. Her oncologist has recommended a series of
chemotherapy that her cardiologist believes would be fatal. Her
family is urging her to do all what is recommended. The client, who
is in good spirits despite her diagnosis, chooses palliative
care.
GUIDE QUESTION:
Based on her developmental stage, how can you help the
family adjust to her choice?
RATIONALE:
CONCEPT: DEVELOPMENT THEORIES
REFERENCES: Fundamentals of Nursing 6th Edition by
Pottery-Perry pp.158 Copy right 2005 by Mosby, Inc.
CASE STUDY 8
Mr. Vicar has been visiting the clinic for more than a
month. He visits weekly for follow-up care for a chronic venous
stasis ulcer of the left leg. The nurse’s notes at the time of his
first visit contained the following information: “Ulcer with
irregular margins, 4cm wide by 5cm long, approximately 0.5cm deep,
draining foul smelling purulent yellowish drainage. Only
subcutaneous tissue visible. Skin around ulcer, brownish rust in
color. Zinc oxide and calamine gauze applied to ulcer; elastic wrap
bandage applied to gauze. Client instructed to return in 1
week.”
GUIDE QUESTIONS:
As the nurse who is caring for the client on the
follow-up visit, what expected outcomes would you anticipate for
the goal of “Wound will demonstrate healing within 4 weeks”? What
evaluative measures would you use to determine if the wound was
healing?
RATIONALE:
Providing health care in a timely, competent, and cost
effective manner is complex and lor of drainage from the ulcer.
Documentation of evaluative findings allows all members of the
health team to know whether a wound is healing or not. Then the
result of evaluation, a client’s diagnosis, priorities and
interventions may change. Through the continuous evaluation of
care, nurse’s play a key role in the on-going improvement of client
care.
CONCEPT: PLANNING OF NURSING CARE –
EVALUATION
REFERENCES: Fundamentals of Nursing 6th
Edition by Pottery-Perry pp.362-367 Copy
right 2005 by Mosby, Inc.
CASE STUDY 9
Mr. Moore is a 72 years old widower who is recovering
from a fall in which he fractured his lips and underwent surgical
repair 1 week ago. He will be staying with his son for 2 weeks
after he is discharged from the hospital, he is eager to return to
his own home. Once he is home, his son visit nightly after work, he
will receive meals on wheels once a day, and a home health care
attendant will visit weekly to assist him with hygienic care until
he can move independently. Mr. Moore wife died 3 years ago, but he
has remained independent and continued his social functions. He
lives in a small single level house with his dog and cat, and he
enjoys gardening. Prior to fracturing his hip he walked with his
dog daily. So, you will be his home health care nurse.
GUIDE QUESTION:
What do you need to assess in regards to Mr. Moore’s
safety and wht suggesstions can you make for enhancing his
safety?
RATIONALE:
CONCEPT: SAFETY
REFERENCES: Fundamentals of Nursing Concepts, Process
and Practice 9th Edition by Audrey Berman and Shirlee Snyder,
Pearson Education Limited Copyright 2014, pp. 747
CASE STUDY 10
Mrs. Nile is 83 years of age and lives alone. She has
difficulty walking and relies on a church volunteer group to
deliver lunches during the week. Her fixed income limits her
ability to buy food. Last week, Mrs. Niles’s 79 year old sister
died. The two sisters had been very close.
GUIDE QUESTION:
As a home care nurse, explain the factors that might
increase Mrs. Niles’s risk for infection.
RATIONALE:
as those found in a hospital and because of fewer
invasive procedures.
After clients are at home, nurses determine
their compliance with infection control practices. The nurse
educates clients about infection and techniques to prevent or
control its spread.
Client will assume self-care using proper infection
control techniques.
CONCEPT: INFECTION CONTROL
REFERENCES: Fundamentals of Nursing 6th
Edition by Pottery-Perry pp.774 Copy right 2005 by Mosby,
Inc.
CASE STUDY 11
You have been assigned to care for Mr. John, a 74 year
old client being treated for a Urinary Tract disorder. Mr. John
suffered a Cerebrovascular Accident (Stroke) 6 months ago and has
had difficulty ambulating and attending to his own needs because of
right sided weakness. While assessing Mr. John, you note that he is
thin for his height, is incontinent of foul smelling urine, and
deeply reddened areas on his right hip, coccyx and entire
peritoneal area. Mr. John is alert and oriented to person, place
and time, but, he has decreased sensation on his entire right side.
He spends most of his time in bed or sitting at his bedside in a
chair due to his difficulty with ambulation.
GUIDE QUESTION:
What independent measures can you take to protect Mr.
John’s skin from further breakdown?
RATIONALE:
CONCEPT: SKIN INTEGRITY AND WOUND CARE
REFERENCES: Fundamentals of Nursing Concepts, Process
and Practice 9th Edition by Audrey Berman and Shirlee Snyder,
Pearson Education Limited Copyright 2014, pp. 963-964
CASE STUDY 12
Linda is a young mother of three children who has
developed a severe arthritic condition that has affected her
ability to work and adequately care for her family. Her illness has
created a financial hardship for the family and has strained their
roles. Linda and her husband have custody of their children from
marriages as well as a daughter of their own. They are reluctant to
seek assistance from outside sources because they fear interference
from their ex-spouses with regard to their children.
GUIDE QUESTIONS:
Explain why Linda’s family is considered to be in health
crisis when only Linda is experiencing an illness?
RATIONALE:
e sick person and the resolution of the
illness.
CONCEPT: PROMOTING FAMILY HEALTH
REFERENCES: Fundamentals of Nursing Concepts,
Process and Practice 9th Edition by Audrey Berman and Shirlee
Snyder, Pearson Education Limited Copyright 2014, pp.
478-479
CASE STUDY 13
You are a nurse assigned to care for Mr. Marasovitz, a
45-years old man, who will be returning from the recovery room
after undergoing the removal of a mass from his abdomen. While you
are preparing his room for the return, the head nurse and primary
care provider arrive to talk with Mrs. Marasovitz about her
husband’s surgery. The primary care provider explains that the mass
was malignant and invasive. Mr. Marasovitz is a candidate for
chemotherapy, but his prognosis is guarded because of the tumor
growth. Mrs. Marasovitz looks away, closes her eyes and only nods
her head “yes”. As the health care provider leaves, the nurse
approaches Mrs. Marasovitz, who begins to cry. The nurse uses a
soothing voice to tell Mrs. Marasovitz that it is okay to cry and
assures her she will remain with her. The two of the sit in silence
until Mrs. Marasovitz is able to express her feelings. The nurse
offers to listen attentively. Later, the nurse offers to get a cup
of coffee for Mrs. Marasovitz and asks if there is anything she can
do to assist Mrs. Marasovitz at this difficult time.
GUIDE QUESTION:
Interpret Mrs. Marasovitz non-verbal behaviour response
to the news about her husband’s surgery.
RATIONALE:
.
CONCEPT: COMMUNICATION
REFERENCES: Fundamentals of Nursing Concepts, Process
and Practice 9th Edition by Audrey Berman and Shirlee Snyder,
Pearson Education Limited Copyright 2014, pp. 375-376
SELF-EVALUATION
Tabulate evaluation of yourself in terms of your nursing
process competency. Identify skills you possess that help you in
your nursing practice and skills you need to improve on. How do you
apply you critical thinking skills in the care of your
patients?