Mr Furfas Case Study

Many patients admitted to the stroke and orthopedic rehabilitation unit have impaired physical mobility. The length of time in rehabilitation is ten to fourteen days. Many times nurses, patients and family members form bonds that last long after the discharge. I recently had the opportunity to take care of a patient I will never forget. Mrs. C was admitted to the rehabilitation unit following recent hip surgery. She is eighty years old and had fallen raking leaves in her front yard. Mrs. C has a history of hypertension, arthritis and gout. Medications include aspirin, metoprolol and allopurinol as needed. Prior to admission Mrs. C lived independently and has two children who checked on her routinely. No cognitive or mental deficits are noted. Key parts of this paper include the introduction, NANDA, NIC and NOC elements, data, information, knowledge and wisdom and the conclusion.

Maintaining a secure surrounding is a reflection of the organizational culture and an indicator of the level of compassion and vigilance that the organization has for the workers and the welfare of the patients. The management needs to improve safety and assess the causes of error during the handling of patients. As a matter of fact, the stakeholders and the policymakers need to intense their efforts to establish and structure conditions and process that will promote healthy working conditions and improve the patient safety. Health care staff need to be trained in the proper skills of handling patients with terminal and highly infectious diseases. The workers and the management should ensure that the workers are provided with the relevant protective gears while handling a patient. The cases of nonlethal activity injuries are the main reasons for sickness among the staff. Purchase and use of patient transfer and lifting facilities are the key elements of an efficient program to manage the danger of injury to patients and employees related to lifting, moving, locating or movement of patients. It will also show the level of management commitment to implement a secure patient handling program and to supply the health workers with applicable measures to avoid manual handling. The education and coaching of aid staff ought to be in gear towards assessment of hazards within the assistance work setting, choice and use of the acceptable patient lifting instrumentation and devices, and review of research-based practices of safe patient

Ronald X is a self-sufficient man who values his liberty. After he broke his leg, everything changed. The free and autonomous life that he was enjoying was now going to change. His medical comorbidity of artheriosclerosis causes him to be confused at times. The doctor and his children did not want him to be discharged home until they found an appropriate nursing home. Ronald X is aware of his problems and

John Doe, a 70 years old Caucasian male admitted to the acute rehab unit after Ischemic CVA of the right pareito-occipital region. He has left hemiparesis and newly diagnosed Type II Diabetes. He is a school teacher, and teaches Art and paintings. He is alert and oriented times four. His past medical history is Essential Hypertension, GERD, and Hyperlipidemia. He is non-compliant with his medications, he did not take his blood pressor medication properly. He is overweight and does not exercise. He lives with his wife, and have two sons and four grandchildren. His current medications include, Cozaar, Norvasc, Pepcid, Lipitor and he takes Aleve for pain. He has blood sugar checks before meals and at bedtime with a sliding scale coverage of Humalog insulin subcutaneously. His diet is Carbohydrate consistent, Fat Cholesterol modified, 2 gm Sodium.

Independent and out of bed as tolerated, the client was ambulating well. J.S. was considered a fall risk because of her decreased level of consciousness upon arrival to the unit and possibility of decreased blood

It was noted that the patient has made significant gains in the HELP functional restoration program attaining his goals. He is still unable to return to work but is determined to do so. He is certainly not regressed in any way. He continues in a positive direction in his home exercise program despite occasional flares. He has made some medication reductions since he has left the

Mr. Rasak is working very hard in therapy especially since his dizziness seems to have subsided. He was able to hop 3 times today with parallel bars. He is able to use a slide board with stand by assistance. He needs help with moving the leg due to the external device being very cumbersome. They are starting to train him in using a walker and being able to non weight bear with the right leg.

Mr. Borbely was driving and his car hit a brick wall and the vehicle rolled. He had a positive loss of consciousness and reported sternal pain and right chest wall with rib discomfort. There was an extrication of 10 minutes. EMS transported Mr. Borbely to McLaren Oakland Hospital. While in the emergency room he was evaluated by trauma and diagnostic testing were completed. Intravenous fluid and a Foley catheter were inserted. He was later admitted to the hospital for care and observation. It was mentioned by the physician he did have some atrial fibrillation in the hospital and was placed on oxygen. He was mildly confused. After five days he was consulted by Dr. Richter, PM&R for transferred to the inpatient rehabilitation floor. Dr. Richter had consulted trauma and Dr. Minter, Internal Medicine. Dr. Richter felt Mr. Borbely had a decline in function and he was basically independent before the accident and now required moderate assistance. While on the rehabilitation floor he had PT, OT and Speech therapy which were increased to 2 hours per day and as he made progress the hours were increased.

At today’s visit she is found sitting in her room in her wheelchair. She is awake, alert and oriented. She reports that she has had multiple falls over the weekend. She denies pain, shortness of breath and chest pain. The facility staff reports that she has had multiple falls and seems to be falling more lately. The patient uses a wheelchair;

For this reason, the new policy of fall prevention, based on the evidence –based practice, was introduced and a few changes were implemented and are constantly evaluated. The Hendrich II Fall Risk Assessment Tool is used on each patient to assess patient risk for falls and appropriate score is given. Next, the nurse complete and document a fall risk assessment and reassess during each initial assessment, at change in level of care, after any fall occurrence and as needed per nursing judgment. Based on the Hendrich score, each patient and his family are educated about steps to prevent the fall.. Next, patient is oriented to room and instructed to call for assistance. The nurse makes sure that hourly rounding is marked on the patient’s board and assistive equipment is available in patient’s room. The regular nonskid socks are provided for each patient with score from 1-4. If the Hendrich score is above 5 each patient receives a yellow armband, yellow nonskid socks, and fall risk sign is placed outside the door. The door is keep open all the time, and, if room is available, patient is kept close to the nursing station. Bed alarm is utilized and kept activated at all times while patient is in the bed. If patient is transferred to chair, then the portable chair alarm is provided for the patient. If the patient has a need for toileting, someone from the staffing must be present with patient all

This project will describe the case of patient M.B and her family, as well as a projected plan of care. Approximately, 1 year ago, M.B. reported “numbness” in her bilateral lower extremities, episodes of fainting, muscle weakness, along with other vague symptoms to her Primary Care Manager. Soon she was being seen in the Emergency Room and clinic weekly due to increased weakness with continued falls; eventually she needed a walker because of her unsteady gait. She underwent a multitude of tests with fairly benign results, but still she had no solid answers. Then she started experiencing irretractable nausea and vomiting; medications would only work for a short duration and this illness led to even more hospitalizations and clinic visits. Physicians could only treat the symptoms; it was recognizable that this patient would benefit from specialists.

My recommendation for the care plan of Mr. J would include restraint alternatives consisting of bed alarm, active listening, rounding at least hourly by nurse or CNA, toileting assistance and repositioning every two hours, and reassurance or redirection as needed if confused. I would encourage family visits if possible, and even suggest that if a family member felt comfortable rooming in with patient for reassurance all effort would be made to accomplish that scenario. It is common for patients with dementia to become more confused and distressed in the later evening hours, so having family or a one-to-one sitter would be a very effective way to reduce the chance of fall and to reassure and redirect as needed. Also, the CNA should not have ignored the growing sign of skin breakdown on Mr. J’s lower spine. The depressed, reddened area is a precursor to a stage one pressure ulcer. Due to his age, injury, and lack of mobility, a pressure ulcer prevention care plan should have been initiated on admission. When the evidence was brought to the attention of the CNA , she should have immediately informed the primary care nurse of her findings. Following the evidence-based practice of frequent repositioning, padding bony prominences, and the use of products designed specifically for prevention and healing of compromised skin areas will dramatically reduced the incidence of

In preventing injury clients in the hospital or long term care facility will be oriented to the environment. Call bell will be placed within reach and demonstrate how to call for help. If clients get dizzy when getting up due to orthostatic hypotential they will be taught methods on how to decrease the dizziness. Clients will be refered to physical therapy for strengthening exercises and for ambulation and transfer and occupational therapy for ADLs. In the home setting the environment will be accessed for safety e.g. clutter free, remove rugs for impaired mobility, remove hazardous material like knives, matches, household cleaning agents, medication from children and clients with dementia etc. I will always be on guard on ways to prevent injury and

His condition has worsened over the last six weeks and the family state they can no longer look after his needs at home. He is an 84 year old gentleman and is a very pleasant man. He lives with his wife Mary and he has one son who lives nearby. John has had a hip replacement in 2007. He also has had a coronary artery bypass graft in 1994.He has had his left earlobe removed due to cancer in 2006 and is non insulin dependent diabetic. He is currently on the following medications.(Appendix 1).John is unable to give the author much information as his cognitive ability has decreased greatly over the last number of weeks. His wife and son gives the author most of the information. He has times of lucidness where he can give some information but when asked how he is he says ‘fine and what am I doing here, let me out the fire has to be put out’. When asked does he know where he is he states ‘I am at home’. When asked who his wife is he says ‘she is my mother’.

Mr. Comer was admitted to his local community hospital for respite care. He has suffered multiple, acute strokes in the past, which has left him with severe disabilities. These include paralysis rendering him immobile, aphasia (speech loss) and dysphagia (swallowing difficulties). He relies on carers for all normal activities required for daily living (Roper et al 1996) and is advised to have a pureed diet and thickened fluids.