Nursing

NUR 211

CLINICAL ABSENCE MAKE-UP

Name: ____________________________________ Date: ​​​​​​​​​​​________________

Start Time: ___________ End Time: __________

Directions: Please read the following case studies and respond to the questions. Type directly onto this form, answering each question carefully (there may be multiple sections to each question) and email the completed assignment to your clinical instructor. Incomplete makeup assignments will be returned for revision.

You have just received your day-shift patient assignment for your clinical day in the nursing home setting. You have been assigned the following three residents:

· Room 101 – Mrs. Jones, a 75-year-old female, was admitted to the nursing home two days ago status post right hip fracture after sustaining a fall in her assisted living apartment. She had an acute inpatient stay of four days and a rehabilitation inpatient stay of two weeks. She is admitted for continued rehabilitation secondary to ambulatory dysfunction. During her hospital course, she developed a Stage II decubitus ulcer on her sacrum. Her past medical history includes: Type 2 diabetes mellitus, insulin-treated; hypertension; congestive heart failure, mild dementia; dyslipidemia; morbid obesity; and renal insufficiency. Over the last two days, she has been complaining of generalized muscle pain and weakness.

Social History: She is married x 50 years, three adult children who live out-of-state. Her husband lives in an Alzheimer’s unit on the 3rd floor of the same continuing care community. No past alcohol or tobacco use. Prior to her fall, she enjoyed visiting her husband daily.

Physician Orders:

Physical therapy- evaluate and treat

Diet: Low carb, No Added Salt (NAS), low cholesterol

DNR, RN to pronounce

Medications: Lantus 30 units SC Q HS at 2200, Novolog insulin 10 units SC before meals, Lisinopril 5 mg daily at 0900, Pravastatin 20 mg daily at 1800, Aspirin-EC 81 mg daily at 0900, Carvedilol 25 mg BID at 0900 and 2100, Os-Cal 500 mg BID at 1000 and 2200, Ferrous Sulfate 325 mg BID at 0800 and 1700, Percocet 5mg/325mg every 4 hours as needed for pain.

Treatments: Zinc oxide to sacrum BID and prn, Pressure relief to sacrum, low bed, fall mats, skin assessment weekly on Mondays-dayshift, wound site assessment daily, accuchecks BID and prn.

· Room 102 – Mr. Smith, a 98-year-old male, has been a resident at the continuing care community for 10 years and was recently transferred to the health care center due to his decline in self-care and functional ability. Past medical history includes osteoarthritis and bilateral cataracts.

Social History: widowed x 15 years, no children, closest relative is a niece who lives nearby and visits occasionally. No past alcohol or tobacco use.

Physician Orders:

DNR- RN to pronounce

Diet: Regular with snacks, Ensure 1 can BID between meals

Medications: Colace 100 mg daily at 0900, Multivitamin 1 tab. daily at 0900, Oscal-D 500mg/400iu BID at 0900 and 2100, Ambien 5 mg Q HS prn insomnia

Treatments: low bed, fall mats, ambulate with rolling walker and standby assist for length of hallway as tolerated BID, weekly skin assessments on Tuesdays-evenings.

· Room 103 – Ms. Ford, a 65-year-old female admitted yesterday from a rehabilitation facility status post CVA with left-sided hemiplegia, severe dysphagia, and expressive aphasia. Past medical history includes COPD, obesity, dyslipidemia, hypertension, constipation, depression, recent PEG tube insertion.

Social History: single, no children, closest relative is a nephew who lives out of state who visits infrequently. Tobacco abuse x 35 years, 2 pack per day. Social drinker.

Physician Orders:

Full code

Diet: NPO, Osmolite 1500 ml up at 1600, down at 1000 at 75 ml/hr

Flush PEG with 30ml H2O before and after meds, 5 ml between meds

Check PEG residual Q 4 hrs, hold for > 150 ml

HOB elevated at 60 degrees at all times

O2 at 2L/min via NC

Check O2 sats every shift and adjust up to 5 liters to remain greater than 90%

Medications: Combivent MDI 2 puffs BID at 0900 and 2100, Spiriva daily at 0900, Zoloft 75 mg daily at 0900, Lipitor 10 mg daily at 1800, Senna-S two tabs BID at 0900 and 2100, Toprol XL 50 mg daily at 0900, Norvasc 10mg daily at 0900.

Treatments: O2 at 2L/min via NC, check O2 sats every shift and adjust up to 5 liters to remain greater than 90%, assess PEG site every shift, weekly skin assessment every Monday- dayshift, HOB elevated at 60 degrees at all times.

1. You have just received shift report on these three residents. The night shift nurse stated they were all “fine”. What additional information would you ask the night shift nurse before she leaves the unit?

· Mrs. Jones:

· Mr. Smith:

· Ms. Ford:

2. In order of priority, develop a plan of action for your shift. List time, activity, and rationale for your plan. Make certain that you designate the order of medication administration.

3. You went to give Mrs. Jones her 0900 medications and she is vomiting with abdominal distention and firmness. What actions should you take in this scenario?

4. At 1030 you are making rounds on your residents. You notice that Mr. Smith is still in bed with his breakfast tray untouched. You call for the CNA and in 15 minutes there is no response. You find the CNA in an empty room using her cell phone. What would be your next course of action? Using team management skills how would you counsel the CNA? What team building strategies may be effective in dealing with this situation. (refer to leadership/management concepts)

5. You are giving shift report to the evening shift nurse and the CNA interrupts stating that Ms. Ford just fell out of her chair onto to the floor. She is moaning and saying she is in a lot of pain. You see blood on her head. See images below. What immediate actions would you perform? What would be your follow-up actions? Describe your actions in detail.

6. Document your note here:

7. Discuss your role as the nurse in caring for these residents for the following:

a. Coordinator

b. Advocate

c. Case manager