Yanick Jean ASN program Fundamentals of Nursing Case Studies

Chapter 1 1.Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are pleased with the care she receives in the hospital. Describe the quality performance tools that may be used to demonstrate that the care and treatment rendered are both cost-efficient and of high quality. COPD is a long course of chronic disease that is characterized by repeated exacerbations and remissions. This Chronic Obstructive Pulmonary Disease usually leads to a clear and steady decline if not well monitored and cared for. The quality performance tools that may be used to demonstrate the care and treatment that rendered the effort both cost –efficient and of high quality, ranging from health insurance, bed capacity of a hospital and the number of nurses with advanced training and the high-quality treatment team. Also, the utilized symptom measurement tool and the mechanical ventilation and suction machines, contributed effectively; (Brunner & Suddarth’s p.621) Describe the quality performance tools that may be used to demonstrate that the nursing care utilized is evidence-based care and high quality, resulting in patient satisfaction and good patient outcomes. The quality performance tools that is used to demonstrate that the nursing care utilized is evidence-based care and high-quality ranging from the treatment teams focusing their energies and resources on symptom control contributed to the effectiveness of her wellbeing. Patient assessment skills are of vital importance. They recognized symptoms and provide adequate relief of symptom such as promptly applying ventilations to improve breathing. They also monitored the effective need to suction the patient in case of increase secretions to maintain a patent air way and also minimize risk for SOB. Also, the effective medication regime adjusted during hospitalization, all resulted in patient satisfaction and good patient outcomes; (Brunner & Suddarth’s p.621- 630) 2. The Registered Nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of a case manager will be included in the presentation. The Nurse plans on using care of the patient with congestive heart failure as a template and prepares sample clinical pathways, care, maps, and multidisciplinary action plans. A. Describe how clinical pathways are used to coordinate care of caseloads of patients? Yanick Jean ASN program Fundamentals of Nursing Case Studies Clinical Pathways are devices that help formulate a road toward positive results for a patient with the goal being not to have a readmission to the hospital after discharge. This is all being done with a specific time frame in mind. Case specific education upon and post discharge is essential. Medications geared toward recovery and management of a patient’s condition(s) and setting up consultations with various team members who are all focused on the recovery of the patient; (Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith) B. What is the role of the case manager in evaluating a patient’s progress? Case Manager- It is the coordination of care across the health care system. It aims for the continuity of services and quality care among specifically identified clienteles, in a context of efficient, effective and human resource management. Case management is among the changes which enhance the role of the nurse. The case manager sets goals with the patient, monitors the cost of the care, and works with all providers to eliminate duplication of service and evaluate outcomes of care; (Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith). C. What are examples of evidence-based practice tools used for planning patient care? Examples of evidence-based practice tools for planning patient care are algorithms, clinical guidelines, outcome assessments, and current literature and research. Chapt 2 Case Study, Community-Based Nursing Practice 1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of O-degrees extend n worn when walking with crutches (no weight-bearing post discharge day 1 and may begin weight-bearing post discharge Jay 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. e orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plan stays with him for several weeks to assist him with meals and household chores and take him to physical therapy and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a church (Learning Objective 4) What preparation should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged? 1 After a knee replacement surgery, the patient will have a lot of difficulties to complete her tasks. A post op education needs to be done. Yanick Jean ASN program Fundamentals of Nursing Case Studies 2 The nurse should identify a home health care provider who will assist the patient in performing ADL. The provider could be a family member or a home health aide who will assist in the activities of the patient should also participate in the education program. 3 A physical therapist will be needed to check patient at home for the safe environment of the patient and to train him to adjust his activities according to his condition. 4 Medication teaching needs to be done and help the patient identify drugs interactions and side effects. 5 The nurse should teach the patient about his medication intake and should demonstrate how to administer Enoxaparin subcutaneously 6 Patient needs to be educated about safety because she is at risk of falling. Patient needs to be aware of how to make the home environment safe so as to reduce event of falls. All the things should be made available at the patient easy reach 7 Patient needs to be educated about crutches 8 Patient needs to be educated about healthy diet. 9 Patient needs to be instructed about his wound site for any signs of infection and to do dressing in an aseptic way. Instruct him when the stitches have to be removed. 10 Instruct the patient when to call his doctor 11 Patient should be given adequate information on use of walking aids (Kathryn Cadenhead Colgrove, Ray A. Hargrove-Hutte, Med-Surg Success)