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Case Studies to Review the Nursing Process

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Alyssa Zweifel

on 17 October 2015

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Transcript of Case Studies to Review the Nursing Process

Case Studies To Review The Nursing Process
Case Study 1
Diagnosing

Which nursing diagnoses would you expect to be applicable regarding the medical procedures in this situation?

Case Study 1
Outcome & Planning
What would be some expected patient outcomes?


Case Study 1
Case Study 1
Assessing
• Risk for Infection related to surgical procedure
• Risk for Impaired Physical Mobility related to femur fracture
• Risk for Pain related to surgical procedure
• Risk for Impaired Breathing Pattern related to effects of anesthesia

Objective data: Vital signs, incision/dressing site (monitor bleeding), skin color and temperature, Iv site, I&O's

Subjective data: Pain, how patient feels, nausea if any, dizziness, other personal needs, medical history.
Assessing, Diagnosing, Planning, Implementing, & Evaluating
You are a nurse preparing to receive a new patient, fresh from surgery, to your unit. The patient is a 71-year-old man who underwent a surgical repair of a fractured femur. As you receive a report from the recovery unit, you learn that his medical history includes hypertension, 40 years of smoking, and COPD. His surgical repair was successful but complicated by excessive bleeding, and he is receiving IV fluids to compensate. He is widowed, and has three children that are scattered throughout the United States. He lives alone, receives Meals on Wheels, and
pays a cleaning service to keep his
home clean.
• Goals not met related to breathing might involve the patient acquiring pneumonia or becoming hemodynamically unstable.

• Goals partially met would be if patient had improved caloric intake, but did not fully meet the goal.

• Goals met would be if patient verbalized decreased loneliness, or fluid balance was achieved.

Pertinent data include:
• The patient is admitted to the hospital unit from the emergency department.
• The patient has shortness of breath and recent weight loss.
• The patient is receiving oxygen via a nasal cannula.
• The patient seems to be comfortable.
• The patient’s shortness of breath increases with speaking.

Conditions addressable by nursing diagnoses include:

• Patient’s ineffective breathing pattern
• Patient’s impaired gas exchange
• Patient’s imbalanced nutrition
• Patient’s ineffective coping
• Patient’s activity intolerance
• Patient’s family coping, readiness for enhanced
• Patient’s ineffective therapeutic regimen
• Patient’s impaired comfort

Case Study 2
Evaluation
General outcomes could include:
• The patient will experience easier, more effective breathing.
• The patient will obtain/maintain healthy weight.
• The patient will strengthen/maintain healthy family relationships.
• The patient will improve/maintain coping skills.
• The patient will experience decreased anxiety.


• More effective breathing-Monitor 02 Sats, frequent rest period, deep breathing exercises.
•Maintain healthy weight- daily weights, monitor I&0's, evaluate dietary intake/calorie needs.
• Maintain healthy family relationships-Keep family involved and updated, allow time for family conferences and alone time.
• Maintain coping skills-Have patient set goals and interventions on coping, provide encouragement.
• Decreased anxiety-Monitor anxiety attaches and breathing patterns. Offer reassurance and relaxation measures.

Factors that could prevent the attainment of outcomes include:

• Nurse variables—the nurse in this scenario could have:
o Unrealistic outcomes written
o Insufficient specificity in outcome
o Untimely evaluation of interventions
o Lack of timely plan of care revisions

• Patient variables
o Patient noncompliance
o Patient passivity
o Patient lack of knowledge
o Patient lack of motivation

• Health care system variables
o Inadequate staffing
o Inadequate resources

Case Study 1
Evaluating

How would you evaluate the outcome of your interventions in this case?

What is your important assessment data in this scenario?

Objective?
Subjective?
List potential plan of care revisions available to nurses.

Case Study 2
You are a nurse admitting Mrs. A. to the hospital from the emergency department (ED) with shortness of breath and recent weight loss. After receiving a report from the ED nurse, you ready the patient’s room according to unit specifications and collect the necessary equipment and forms. When the patient arrives, she is using oxygen via a nasal cannula and seems to be comfortable. As you begin your admission activities and paperwork, you note that her shortness of breath slightly increases as she answers your questions. Accompanying Mrs. A. is her daughter, who comments, “This is the fourth time she’s been admitted to this hospital in the past year.” The patient and her daughter demonstrate a close, loving relationship. The daughter not only encourages her mother, but also sets boundaries regarding her mother’s anxiety.
Case Study 2
Assessing
What are some other potential collaborative problems?
• Fear
• Acute Pain
• Risk for Shock
• Impaired Gas Exchange
• Impaired Skin Integrity
• Impaired Mobility
• Risk for Bleeding
• Risk for Deficient Fluid Volume
• Risk for Self-Care Deficit
• Knowledge Deficit
• Risk for Constipation

• Improved breathing
• Adequate pain control
• Improved skin integrity
• Fluid balance
• Adequate caloric intake
• Improved mobility
• Decreased loneliness

• Improved breathing-ambulate, rest, oxygen

• Adequate pain control-scheduled pain meds, treat before therapy and dressing changes

• Improved skin integrity-reposition, move often, keep skin dry, avoid friction sheering.

• Fluid balance-encourage fluids, watch I&O's, potential IV fluids

• Adequate caloric intake-supplements-ensure, healthy snack

• Improved mobility-frequent therapy and walks

• Decreased loneliness-family, friends, nurse visits (listening.


Evaluation of intervention outcomes includes:
written statements, which identify if and how the goal was met, partially met, or was not met.

If goals were not met, revision recommendations are included in the statement.

Case Study 2
Diagnosing
Case Study 2
Planning
Case Study 1
Implementing
Describe factors that could derail the attainment of expected patient outcomes.

Remember that the Nursing Process is always changing for your patient's needs!!
Establish patient GOALS!
What is your plan as the nurse to achieve these outcomes (how do you implement the cares)?
What is the pertinent data in this scenario?
Case Study 2
Implementing
What conditions could be addressed by nursing diagnosis?
Are these measurable?
How can you make them measurable?
What are some goals & outcomes for Mrs. A. ?
What interventions will you carry out to achieve desired outcome?
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