Nursing Case Management Assignment 3: Case Study Mrs. D is a 3 week post colectomy patient that has been readmitted to the hospital with severe dehydration. She has been struggling with proper nutrition and ostomy care since her discharge post-surgery. Our goal with Mrs. D should be to rehydrate her and provide her with patient education on the importance of proper nutrition and on ostomy care. After she has been rehydrated with intravenous fluids and proper nutrition she could benefit from possibly skilled nursing facility placement for continued education for proper nutrition and ostomy care depending of her activity level and if she can tolerate making her own meals or do her own ostomy care she may could benefit from home health care
This patient is a 35 y/o young women with a new diagnosis of breast cancer. Problems are the diagnosis of breast cancer, dehydration, and depression. Her depression is affecting her nutritional intake which is causing her malnutrition and poor intake. As an RN, I would encourage her to increase her daily intake and encourage
I am currently studying HNC Health Care and as part of my course I have to complete a graded unit, this will entail three stages; Planning, development and evaluation. This will be carried out while on placement within a hospital setting, within the planning stage I have to choose a patient and assist them with a nursing activity. I have chosen to follow Roper Logan and Tierney twelve activities of daily living the reason for this is that I find it to be the nursing model that is most effective as each activity has its own importance to the survival of life; also it follows the objectives of my graded unit. I have chosen the AL of eating and drinking as the patient I have chosen has severe Rheumatoid arthritis and has lost the use of her
Past Medical History: Although the patient is Hispanic, she can speak English and provides her history to the nurse. She reports that two weeks ago she was in the hospital for a femoralpopliteal bypass graft that was performed on her right leg. She noted some drainage coming from her incision and thought she should have it checked out. She has a history of diabetes, for which she takes insulin.
According to the Wound, Ostomy, and Continence Nurses Society, (WOCN), before focusing on the ostomy care, the nurse should establish a relationship with the patient and their family. A comprehensive assessment should be performed that focuses on all aspects of the patient’s wellness; physical, psychosocial, cultural and spiritual. The nurse informs the patient about dietary needs, bathing/showering, and returning to work (Cronin, 2005). In doing so, the nurse gains the patient’s trust and confidence helping ease them throughout the intervention process. The assessment allows the nurse to fully recognize the patient not as another client needing a procedure but as a person who is going to have questions, concerns, and needs (WOCN, 2010).
The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)
This essay discusses and reflects upon patient care in the post anaesthetic care unit (PACU) and is linked to my experiences on placement. It discusses how my approach to patient care has been challenged and analyses how evidence based practice can create a change in the way patients are cared for. It reviews the processes of managing the perioperative environment and evaluates the implications for practice when applying a change in healthcare. Wicker and O’Neill (2010) state that “The lack of immediate medical support in the recovery room means that practitioners work in a more autonomous role than any other area of the operating department” (p.379). By reflecting upon my experiences I am able to link practical and theoretical aspects of the operating department practitioner (ODP) job role. This will provide me with a greater understanding of professional practice and it will develop my personal knowledge and self-awareness (Forrest, 2008). Using a model of reflection is important as it provides a framework that can be systematically followed and acts as a guide through the process of reflection. For this essay I have chosen to use the Gibbs’ Reflective Cycle (1988) as it provides a methodical guide to reflection using a series of ordered questions that each lead to the next stage of the cycle (Forrest, 2008).
Over a seven hour period including set up and breakdown of the clinic process on any given day the team can see up to 100 patients. The team will see all patients that have registered at the beginning of the day. The clinic is a process where a patient is registered on arrival, waits in the designated area, is allocated seen and seen by a clinician, assessed by clinician, given either education or medication or both, a health plan and discharged. If need be the patient can be admitted into the LTL patient portal for follow up if team wants to continue care post clinic. The product that is output by the process is healthcare.
In 2003 during the last semester of nursing school, my life was devastated as my ex-husband was arrested as a serial rapist. This was overbearing and I thought this as being impossible to recover from. A breaking point came as I approached a red light deciding whether to deliberately run my minivan into oncoming traffic with my two young children to end our lives. Only days later, I once again felt that I was at the lowest point in my life as the reality of this event truly hit during a medical-surgical examination.
This assignment will critically discuss the nurse’s role in assessment and care planning for a patient in a case study. Confidentiality which is required by the NMC (Nursing Midwifery Council, 2008) and the Data protection Act (1998) will not be broken through out the assignment because the case study used is a scenario not a fictional character. The care plan will focus on Jean’s incontinence needs using The Roper, Logan and Tierney model (2000).
A nurse’s primary role is to safeguard and care for their patients. They are responsible and accountable for providing safe, evidence based and patient centred care, and to maintain the dignity and respect for their patients at all times. They must show professionalism and integrity and a work with in their legal and ethical frameworks and in partnership with a multi- disciplinary team of professionals’ and also with their patient and their family/friends/carers. (Hall,C., Ritchie,D., 2013)
Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.
Jones is a 64 year old well nourished man with a history of long-standing non-insulin dependent diabetes mellitus (NIDDM). He had an open heart -surgery bypass graft 7 weeks ago. The graft site got infected and had to undergo an emergency surgery to improve circulation to his left lower limb. Mr. Jones is relieved that his leg was saved and he is now being prepared for discharge. He wants to regain his strength so that he can start doing the things he loves. Currently Mr. Jones needs moderate assistance depending on his level of pain or fatigue and ambulates with a walker. Mr. Jones still needs help with activities of daily living. He has urinary and bowel control problems as side effects from multiple antibiotics. Mr. Jones is married and has 4 grown children that provide him with love, care, and support. The nursing staff is teaching Mrs. Jones how to perform sterile wound care for her husband as he will need dressing changes three times a day, blood glucose monitoring and a healthy diet. Social service is helping to keep communication channels open between Mr. Jones, his family and the nursing staff to maintain psychological and emotional health.
The significance of community hospitals such as Community Hospital in Monmouth County, New Jersey, is greater than one may expect for primary and secondary care services provided to the local communities around the United States. Community Hospital’s mission is to provide exceptional primary care. However, with the declination of profitability in primary care, Community Hospital has had to compete with Shore University Medical Center (SUMC) and University Hospital (UH) for revenue restoration. The decline of Medicare and Medicaid reimbursements and the steady progression toward specialty care vs. primary care require a core alteration to the mission statement to adjust to the changes within the current healthcare system. A newly modified mission and vision statement will prove that Community Hospital has the ability to regain its relevance within the healthcare industry as a leading primary care provider in the community and increase its revenue. The implementation of the new mission and vision for Community Hospital is expected to be upheld without compromising the core values of compassion, advancement, reputation, efficiency, and physician integration. A few proposed strategies to help Community Hospital create a new and improved business model, may seem cumbersome and challenging, however could greatly improve the overall direction of Community Hospital.
A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional
Laparoscopic approach results in a shorter length of stay, fewer complications, and lower in-hospital mortality compared to open colectomy.( ) Emergency colectomy is associated with significant morbidity, such as pneumonia (25%), respiratory failure (15%), myocardial infarction (12%) and increased mortality in older persons.[ ] Furthermore a systematic review concluded that resection with primary anastomosis in selected patients is equally safe procedure to Hartmann’s approach.[