Unit-5 clinical practice: Preparing for Clinical Practice

Patient Safety and Quality

Ms. Cohen is hospitalized for repair of a fractured hip after a fall at home. She requires intravenous (IV) antibiotics after surgery. Shortly after the first dose she became restless and started picking at her IV line and frequently tried to get out of bed. Several restraint alternatives were attempted; but, because of her restlessness, she was successful at pulling out her IV line and getting out of bed. It becomes necessary to restrain Ms. Cohen.

1. You know that a health care provider’s order is required for the restraint. What are essential components of the restraint order?

2. Which assessments do you need to perform on Ms. Cohen while she is restrained?

3. The physician orders a belt restraint. Your assessment of Ms. Cohen the next day reveals that during the day she is alert and pleasantly confused but not attempting to get out of bed. Do you continue use of the restraint? Explain.

Immobility

Ms. Cavallo, 97 years of age, has been a resident at the rehabilitation unit for 6 weeks. She has been receiving rehabilitation therapy following the repair of her fractured left hip. The nursing assistive personnel (NAP) tells you that Ms. Cavallo has not been finishing her meals over the past 2 days because of poor appetite. As you enter her room with a food tray today, she states, “Go away and take that tray of food with you. I’m tired of all of this, and I just want to stay in bed today.” You explore why she feels this way. You discover that she does not like the foods that are being prepared for her and she does not feel strong enough to use her walker. She states, “I’m afraid that I’m going to fall because I don’t feel strong enough to get out of bed and use my walker.”

1. On the basis of these data, you develop a nursing diagnosis of Deficient Knowledge (Imbalanced Nutrition: Less Than Body Requirements) related to lack of information. Identify one goal, two expected outcomes, and three related nursing interventions with rationales that will help her meet the identified goal and outcomes.

2. You finish teaching Ms. Cavallo about the importance of a balanced diet and how it will help her regain strength to ambulate. As you are doing her morning assessment, you notice that she has a reddened area on her coccyx.

a. Which risk factors contribute to this finding?

b. In addition to a balanced diet, which other nursing interventions would be good to include in her plan of care?

3. You convince Ms. Cavallo to eat a balanced diet of three meals and two snacks high in protein. Describe the decision-making process you use to ensure that Ms. Cavallo continues to recognize the importance of a balanced diet. Include essential assessment data that you need to ensure that she continues to have an intake of proper foods.

Complementary and Alternative Therapies

1. Margaret Thompson is a 76-year-old Catholic woman who was diagnosed with a slow-growing renal tumor. She is scheduled for surgery. You are responsible for the admission assessment and initial care for this patient. Which assessment questions about complementary and alternative therapies will you include during this preoperative period?

2. During the initial assessment Ms. Thompson asks many questions. “Is it cancer? Will the surgery result in a disability? What can I expect? Will I have to be in the intensive care unit (ICU)?” You conclude that she is afraid of both the surgical procedure and the outcome. Which types of specific nursing-accessible complementary therapies will you offer her during the preoperative period to reduce her anxiety and help her prepare for surgery?

3. In the days following surgery you are assigned to care for Ms. Thompson. Although physically she is recovering quite well from the procedure, you note that she is becoming more despondent and depressed. Preparing for discharge, which complementary and alternative medicine (CAM) therapies do you recommend to help her deal with her depression and cancer diagnosis?