Question

GERONTOLOGY CLINICAL CARE PLAN Case Study
Mr. M, a 76 year old Hispanic woman has just been admitted to the Dumfries Rehab Nursing Center after undergoing right hip replacement surgery 5 days ago. She has a history of Osteoarthritis, DM II, GERD, Rt Knee replacement surgery 5 years ago. She speaks little English.NKDAMeds--Januvia 100mg daily, Glucophage 1000mg BID, ASA 81mg daily, Calcium 600mg Three times/week, MVI 1 tablet daily, Prilosec 20mg daily.Social--Widow with 10 children, 5 of them in the United states and many grandchildren and great grandchildren, never smoked nor used illicit drugs, occasional alcohol on special occasions; retired housekeeper at age 72, with no pension. Family has raised money for her to be able to able to be in rehab. Patient is on limited social security income. Her husband, who died last year has been the supporting his wife with his own business and had been able to provide health insurance while he was alive. But the business is not doing well at the moment and the children are thinking of closing it down, since no one wants to run it.
Design a nursing care plan for the above patient
--DO NOT USE PAIN AS YOUR NSG DX
--THIS IS INDIVIDUAL WORK; STUDENTS WITH SIMILAR WORK WILL RECEIVE A GRADE OF 0.
--PLEASE TAKE YOUR TIME TO USE YOUR CRITICAL THINKING SKILL TO COMPLETE THIS CARE PLAN.
--2 NSG dx, at least 3 SUBJECTIVE & 3 OBJECTIVE, 6 interventions.

Answer 1

Nursing Care Plan

1) a) Subjective Data:

• I am having difficulty in walking
• I am unable to do activities of daily living independently
• I have pain during mobilisation

b) Objective Data:

• Inability to move purposefully within physical environment, including bed mobility, transfers, and ambulation.
• Inability to perform action as instructed
• Limited ROM
• Reluctance to attempt movement

c) Nursing Diagnosis:

Impaired Physical Mobility related to decrease strength and endurance as evidenced by reluctance to attempt movement.

d) Nursing Interventions:

• Assist patient for muscle exercises as able or when allowed out of bed; execute abdominal-tightening exercises and knee bends; hop on foot; stand on toes.
• Execute passive or active assistive ROM exercises to all extremities.
• Promote and facilitate early ambulation when possible. Aid with each initial change: dangling legs, sitting in chair, ambulation
• Show the use of mobility devices, such as the following: trapeze, crutches, or walkers
• Let the patient accomplish tasks at his or her own pace. Do not hurry the patient. Encourage independent activity as able and safe.
• Give positive reinforcement during activity. Patients may be unwilling to move or initiate new activity because of fear of falling.

2) Subjective Data:

• I am having severe pain on my hips
• I am not able to move due to pain
• I need pain medication

Objective Data:

• Numerical Pain Scale Score: 7
• Increased Heart Rate
• Patient is irritable

Nursing Diagnosis:

Acute Pain related to hip replacement surgery as evidenced by pain scale score of 7.

Nursing Interventions:

Provide measures to relieve pain before it becomes severe:

• Perform a comprehensive assessment of pain to include location, characteristics, onset, duration, frequency, quality, intensity or severity, and precipitating factors of pain.
• Reduce or eliminate factors that precipitate or increase Mr. C.’s pain experience
• Provide nonpharmacologic pain management which includes include physical, cognitive-behavioral strategies, and lifestyle pain management.
• Provide pharmacologic pain management as ordered.
• Provide comfort measures with comfort devices like pillows.
• Heat and cold applications.: Cold works by reducing pain, inflammation, and muscle spasticity by decreasing the release of pain-inducing chemicals and slowing the conduction of pain impulses. Cold is best when applied within the first 24 hours of injury while heat is used to treat the chronic phase of an injury by improving blood flow to the area and through reduction of pain reflexes.
• Distraction: This technique involves heightening one’s concentration upon non-painful stimuli to decrease one’s awareness and experience of pain. Drawing the person’s away from the pain lessens the perception of pain. Examples include reading, watching TV, playing video games, guided imagery.