1 Case Study Mrs Green (20 marks for general description)
Mrs. Green is a 55 year old female who had a total knee arthoplasty 3 days ago. The client is on 6 hourly observations. The last set of observation are: Temp 36.5 C, RR 22, HR 110, BP 170/86mmHg and SpO2 98% on room air. She has been complaining of ‘awful pain’ in her knee.
She has refused to have a shower and do her routine ROM exercises due to the pain in her knee. She requires assistance to perform ADLs at this stage and expresses feelings of embarrassment and frustration. Mrs. Green has also reported that she has not opened her bowels since the operation.
Socioeconomic status: Mrs. Green lives with a husband and has three grown up children.
1. Write a nursing care plan for Mrs. Green:
Provide two (2) actual and two potential nursing diagnoses include interventions and expected outcomes for each. Use the template provided.
2. What are three (3) gender specific nursing care needs for Mrs. Green? The three gender specific nursing care needs for Mrs Green may be, the need for a female nurse, counselling and education lessons. Although there is gender specific nursing these day
Mrs Green may require a female nurse the nurse will need to gain Mrs Greens trust to help her with her activities of daily living, as she may feel embarrassed getting assistance from a male nurse to help her shower, toileting and getting dressed. This may be why Mrs Green has not had a shower or completed her ADLSas she may feel like her dignity and privacy have been invaded (Crisp and Taylor 2010, pp 303-304) On the other hand counselling may help Mrs Green understand why she is feeling frustrated and may provide ways on how to manage her frustration and stress.
Counselling can provide help Mrs Green with emotional, spiritual and psychological support (Crisp and Taylor 2010, pp 303-304) in terms of her current health status and can often involve just her-self or her family also (Crisp and Taylor 2010, p. 304) In conclusion Educating Mrs Green on how she will be able to help herself and come up with goal related outcomes will help Mrs Green in her daily activities at home, teaching her the exercises that she needs to perform will aid Mrs Green in a faster recovery and may avoid re-hospitalisation (Crisp and Taylor 2010, pp 304-305)
3. Describe two (2) priority needs to be considered in planning for Mrs. Green’s discharge. When planning Mrs Greens discharge the nurse will need to assess Mrs Green’s mobility and whether or not Mrs Green will require to attended rehabilitation for her knee. The discharge process will happen throughout Mrs Green’s hospital stay with an evaluation of the health care needs, this may also require education sessions for herself and her family to provide the health care needs that are required for Mrs Green (Tollefson etal 2012 pp 52-53).
When preparing Mrs Green for discharge the nurse will assess her level of mobility, and find out if there is any hazards or barriers that may hinder her progress, like stairs, accessing the bathroom safely, is their assistance available to help with her activities of daily living (Koutoukidis, Stainton & Hughson 2013, pp 343-344). Along with any rehabilitation that she may require, she might additionally need to go and see a physiotherapist. The physiotherapist will go through exercise that will help her get her mobility back a (Koutoukidis, Stainton & Hughson 2013, pp 343-344).
4. Identify the human developmental stage for Mrs. Green.
The human development stage for Mrs Green is middle aged, this stage begins at forty years of age and continues until sixty five years of age (Koutoukidis, Stainton & Hughson 2013, p.223). The characteristics of this stage, are individuals may be suffering from empty-nest syndrome, they may be grandparents, or it can be a time that the individual may be go through a mid-life crisis or contemplating major life changes, for Mrs Green she may be experiencing the early stages of menopause (Koutoukidis, Stainton & Hughson 2013, p.223).
5. Briefly explain the developmental stages in relation to Mrs Green.
The developmental stage that Mrs Green is in is middle adulthood, in this stage of life there are many physical, cognitive and psychosocial changes (Koutoukidis, Stainton & Hughson 2013, p.224). The physical changes that Mrs Green may be experience are a change in her physical appearance, greying hair, wrinkles, and changes in body as she may be showing signs of menopause. On the other hand her cognitive responses stay the same and be able to manage stress more effectively (Koutoukidis, Stainton & Hughson 2013, p.224). In Erik Erikson theory this stage is “Achieving a sense of generativity while avoiding self-absorption and stagnation (middle-age)” (Crisp and Taylor 2010, p.149). This stage is described as the focus of raising children and to sacrifice their own needs for others. (Crisp and Taylor 2010, p.149). Mrs Green may find that her relationship with her children is stronger, and may have a very active social life as she may be getting ready to retire from work (Koutoukidis, Stainton & Hughson 2013, p.224).
1. Case Study Martin Mc Donald(20 marks for general description)
Martin McDonald is a 31 year old man who has been diagnosed as having a low sperm count, low sperm motility, and a high percentage of abnormal sperm cells. He has been married for six years and his wife has already undergone three unsuccessful attempts at artificial fertilisation and one unsuccessful attempt at in vitro fertilisation (IVF).
On admission, his vital signs are; Temp 37.0 C, RR 18, HR 53, BP 122/66mmHg and SpO2 99% on room air. He appears clean and tidy but lethargic. He does not interact much with the nursing staff unless it is necessary.
Socioeconomic status: He works as a chef in a popular restaurant in the town and works very long hours, 6 days a week. His wife is very caring and supportive with his diagnosis, but becomes emotional when she sees babies in public.
1. Write a nursing care plan for Martin:
Provide two (2) actual and two potential nursing diagnoses include interventions and expected outcomes for each. Use the template provided.
Please see attached
2. Write nursing admission notes for Martin. Use the Progress Notes template provided.
Please see attached
3. Describe the appropriate method to collect health related data as a part of the admission process for Martin. A patient interview will need to be conducted on Martins hospital admission. The nurse will need to get to interview Martin to obtain a complete medical history, his vital signs, blood pressure, temperature, oxygen saturation, pulse and respiratory rate, these can be completed at the bed side with Martins permission and need to be documented appropriately (Koutoukidis, Stainton & Hughson 2013, p.274). The method that the nurse can use is SOAPIE or ADPIE this will have subjective and objective data along with assessment, plan and implementation both methods can provide the an accurate indication of the best health care plan for Martin (Koutoukidis, Stainton & Hughson 2013, p.274). On the other hand E-Health can also provide the nurse with an accurate history, provide that martin has an E-Health account (Australian Government Health Department 2014)
4. Discuss the possible impact of infertility on Martin and his wife.
The impacts on infertility on couples initially is denial, followed by shock, disbelief, anger and depression. The impact of infertility on couples can differ from couple to couple and can depend on how important it is to the couple to having a family (Women’s health Queensland, 2011). Infertility can put a strain on the couple’s relationship especially if the diagnosis only relates to one partner. In this case study, Martin and his wife have had failed attempts of IVF this can cause disagreements and put a strain on the couple’s marriage, sex life and finances. On the other hand some couples
have found that the inability of being able to have children has brought them come closer together as a couple (Women’s Health Queensland, 2011).
5. Summarise the developmental stages of early adulthood.
The early adulthood development stages have reach their full potential between the age of twenty five to thirty years of age this includes their physical, cognitive and psychosocial (Koutoukidis, Stainton & Hughson 2013, p. 218). The early adult has reach maturity with their maximum height reached and their physical strength has increased to its peek level along with their sexual responsiveness. For some men, male patterned baldness may appear (Koutoukidis, Stainton & Hughson 2013, p. 218). With the brain completely developed the early adults cognitive abilities have maximised and their memory increases, this gives the early adult the ability to problem solve and finding a happy balance in their life (Koutoukidis, Stainton & Hughson 2013, p. 218).
Psychosocial development for the early adult is about emotional development and according to Erik Erickson this is the stage of “intimacy, solidarity and isolation” (Koutoukidis, Stainton & Hughson 2013, p. 218). This means that the early adult is looking for meaningful relationships and gaining the independence and career to establish the goals for the future (Koutoukidis, Stainton & Hughson 2013, p. 218).
1. Describe two (2) physical changes that occur in older adults.
Two physical changes that can occur in older adults are brittle or decreased bone density and a decrease in vision. These changes occur due to the effects of aging on the body and the body’s organs (Koutoukidis, Stainton & Hughson 2013, pp 332-334). As an individual ages their vision may become blurred and their ability to focus might decrease, this can be due to cataracts, peripheral vision can be affected or the individual may have macular degeneration. All of these vision problems can make the older adult more susceptible to falls and fractures. Furthermore along with a decrease in bone density and the brittleness of the bones the falls may often lead to hospitalisation (Koutoukidis, Stainton & Hughson 2013, pp 332-334).
2. Identify two (2) specific health needs for older adults due to the physical changes identified in Question one (1)
Two specific heath care needs for the older adults are vision and hearing tests. This may also include a health assessment for older adults (Koutoukidis, Stainton & Hughson 2013, p.241). For the older adult, regular vison and hearing tests will identify and assist in any areas that may require treatment. This may include wearing of glasses or hearing aids to assist the individual in maintaining their independence (Koutoukidis, Stainton & Hughson 2013, p.241). If the older adult is at risk of falls they may be referred to a physiotherapist for a falls risk assessment or be assessed by an aged care assessment team, this can be a self-referral by the family or by their doctor. This assessment will determine if the individual requires high or low care needs and the appropriate measures can be made based on the assessment (Koutoukidis, Stainton & Hughson 2013, pp 241-242).
3. Describe two (2) socioeconomic activities usually associated with early and middle adulthood. Socioeconomic status in early adulthood may focus on gaining the qualifications for the career path that they have chosen and is not uncommon for the early adult to changes jobs if career progression is unavailable. On the other hand we are seeing more young adults living with their parents while they gain their qualifications or even in the first few years of marriage (Koutoukidis, Stainton & Hughson 2013, pp 219-220). In middle adult hood their career is well established and their children are growing up and may also be looking after their aging parents this is called the sandwich generation (Koutoukidis, Stainton & Hughson 2013, p.224) The middle aged adult may be looking at cutting down their working hours to focus more on social activities or even retirement, generally they have paid off their mortgage and can be financially stable (Koutoukidis, Stainton & Hughson 2013, p.224).
4. Describe two (2) growth and development changes seen in middle adolescence.
Middle adolescence is between fourteen to seventeen years of age. This is a period where the adolescent it trying to establish their own identity and personality, as well as a changing relationship with their parents and peers. In this age group they can often have feelings detachment and their own self-importance (Koutoukidis, Stainton & Hughson 2013, p202). When the adolescent is establishing their identity they can become very self-centred and their behaviour may become erratic as they are trying to fit in with their peers. This may lead the adolescent to rebel against their parents and give in to peer pressure, where they may experiment with different drugs or substance abuse, alcohol and engage in unsafe sexual activities (Raising children network Australia, 2011).
The relationship that the adolescent has with their parents may suffer as they are trying to be independent and wanting control over what they can and can’t do. This can often lead to a communication break down with the parents thus leading to rebellious behaviours, thus resulting in the parent(s) loosing trust in the adolescent. For the parent(s) to keep a stable relationship with the adolescent they will need to communicate openly as to what is acceptable and set boundaries (Raising children network Australia, 2011).
5. Discuss two (2) common issues associated with adolescents during growth and development. Two common issues in adolescence are body image and eating disorders, these two issue can effect both male and female adolescents, this is due to what is considered to be normal by media, as well as what the adolescent considers acceptable by themselves and their peers (Koutoukidis, Stainton & Hughson 2013, pp 208-209). There are many changes to the body that the adolescent will go through till they mature fully, this includes the development of breasts in females, facial hair for males and pubic hair for both sexes, and it can be a difficult and awkward stage of their life (Koutoukidis, Stainton & Hughson 2013, p. 210). It can be a time that fad diets, excessive exercising and weight lifting in the adolescent becomes their main focus due to what is portrayed by the media as to what is considered normal, this in turn can lead to eating disorders like anorexia and bulimia nervosa which can have long lasting psychological effects. These disorders don’t discriminate and can affect both males and females where they have an overwhelming fear of gaining weight (Koutoukidis, Stainton & Hughson 2013, p. 210).
6. Hospitalisation of children impacts on the child and family significantly.
Discuss two (2) possible impacts of hospitalisation on the child and family.
When a child is hospitalised it can be a very difficult time for both the child and the family. Both the family and the child may experience times of fear, anxiety, stress and not understanding what is happening (Koutoukidis, Stainton & Hughson 2013, p. 334). The child’s fears and anxiety may generally be caused by being in an unfamiliar place with different sounds, smells and people. Also being separated from their family and friends without having too many comforts from home. The family will also be going through similar emotions as they are concerned for the child’s health and the fear of not knowing or understanding what is happening to their child. The parent(s) may feel they are neglecting their parental role with other children and partner, as they try to divide their time between work, and going to and from the hospital or in other instances they may have to stop working to be with the child full time depending on the situation (Koutoukidis, Stainton & Hughson 2013, p. 334
7. Describe two (2) methods or techniques that nurses can specifically use when working with families to increase the family’s involvement in their child’s care during hospitalisation.
When a child is hospitalised the nurse needs the family to be engaged and assist with the child’s care. This can help the child have a faster recovery. Building a therapeutic relationship with the child and family, as well as educating the parents, these are two techniques that could increase the family’s involvement (Paediatric Nursing, 2010). Effective communication to build a therapeutic relationship with the family, is a way that a nurse can gain the trust of the family, by actively listening to their concerns for the child and giving medical advice on how the family can help with the hospitalised child.
This in turn will help get the family actively involved with the child’s daily care needs (Koutoukidis, Stainton & Hughson 2013, pp 107-112). Educating the parent on how they can assist with the child’s care, this could include the importance of therapeutic play, which can help the child act out how they are feeling in a positive way, helping to relive the stress and getting the family involved (Koutoukidis, Stainton & Hughson 2013, pp 334-335). .
8. Describe two (2) factors that influence human growth and development.
Genetics and environment influences growth and development, this can also be known as nature and nurture, these work in conjunction with each other and are not easily separated. (Koutoukidis, Stainton & Hughson 2013, pp 191-192). From before we are born the genetic structure are pre-programed from fertilisation this means that physical characteristics, our hair colour, eyes colour, sex , height and skin colour are already determined as well as parts of our psychological make up for example our attitudes. Nurture or environmental factors are how we are raised, what we are exposed to, who we have contact with and what experience we have this will influence the individuals beliefs, values and attitudes (Koutoukidis, Stainton & Hughson 2013, pp 191-192).
9. What are two (2) religious or cultural dietary needs to be considered for a Muslim client in the healthcare environment?
When caring for a Muslim client the Enrolled Nurse should find out the patients religious and dietary requirements, as the patient may not be currently participating in their religion. The dietary needs for a Muslim patient are; they don’t eat pork or pork by-products and other meats must be halal, this means that the animal is blessed before being slaughter (Koutoukidis, Stainton & Hughson 2013, and p.654). Another cultural dietary need that should be considered is Ramadan this means the patient will not eat or drink between sunrise to sunset, this means that the patient is nil by mouth in the holy month (Islamic council of Victoria 2014).
10. Provide an example of how nurses must protect the patient’s confidentiality and privacy in the health care environment.
When caring for a patient the Enrolled Nurse must maintain the patient’s privacy and confidentiality, this means that all information about the patient is only disclosed to those involved in the patients direct care or with the consent of the patient. This can be done by locking away patient records and always seeking consent before disclosing information to other practitioners or family member. (Koutoukidis, Stainton & Hughson 2013, p. 29). This means that it is legally and ethically wrong to disclose their information to a third party unless the nurse has gained consent from the patient to do so. The only time that a patients private and confidential information will be discussed is with the patient, or if it falls within her professional duties and is only discussed with other health care professionals (Koutoukidis, Stainton & Hughson 2013, p. 29).
Australian Government Health Department 2014, about e-health, viewed 28th August, 2014 < www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/home>
Crisp, J & Taylor, C, 2010, Potter and Perry’s: Fundamentals of Nursing, 3rd edn, Elsevier Australia, NSW.
Islamic Council of Victoria2014, what does Ramadan mean, viewed 26th August www.icv.org.au/index.php/background-info/ramadan
Koutoukidis, Stainton & Hughson 2013, Tabbner’s Nursing Care: Theory and Practise, 6th edn, Elsevier Australia, NSW.
Paediatric nursing 2010, how can a nurse help the family when child is hospitalised, viewed 25th August
Raising children network Australia 2011,Peer pressure and the middle adolescent, viewed 23rd August
Womens health Queensland 2011, Infertility in couples, viewed 19th August