Roberts Case StudyYou are an RN, the charge nurse hands you the following report on a new patient, M

Roberts Case StudyYou are an RN, the charge nurse hands you the following report on a new patient, Maria Roberts, that should be arriving momentarily: History of Present Illness: Maria Roberts, an 80-year-old female, who underwent exploratory laparotomy with colon resection and colostomy earlier today (Thursday). She has an epidural for pain management in place. The PACU nurse reports that Maria’s blood pressure has been “lower than usual”.  Maria’s history also indicates she has Type 2 diabetes mellitus, which is generally well-controlled, osteoarthritis, and that she is hard of hearing but doesn’t wear hearing aids.Personal/Social History: Mrs. Roberts is a widow who lives in her own home. She resides with her only child, Simon, who is 60 years old. Simon has Down’s syndrome and is developmentally delayed; however, he tries very hard to be helpful to his mother. They live in a small farming community about an hour from the hospital. Mrs. Roberts arrives on the nursing unit and is transferred to a patient bed.Part 2At the end of the shift, Maria asks Samantha, the nurse, for a heating pad as her shoulder and back hurt due to her osteoarthritis. Despite already giving report to Nancy, the oncoming nurse, Samantha checks the chart and notes that there is no order for a heating pad. As Nancy is admitting another patient, she decides to make a heat pack using washcloths and water from the coffee pot. While unknown at the time, later assessment revealed the temperature of the water from the coffee pot was 174°F. The washcloths are placed in two plastic bags and a pillowcase and placed between Maria’s shoulder and her lower back. As she leaves the unit, Samantha reports the heat pack to Nancy, who was a traveling RN. However, she is in a rush to pick up her children, so she doesn’t chart the heat pack in the Electronic Health Record (EHR). Nancy performs a skin assessment but does not see a heat pack as she was looking for an aqua K-pad, which is the only sort of heat pack she even knew existed. She saw no machine; therefore, she didn’t give this another thought. Because Maria can turn herself, no request was made, or effort initiated to reposition her every 2 hours. In addition, no further skin assessments were done beyond the one at the beginning of the shift.The following day (Friday), the nurse, Sean, performed a skin assessment as part of his head-to-toe assessment. Sean stated the patient sat up so the epidural site could be assessed. “Part of a blister” was noticed on the patient’s lower back; there were no blisters in the shoulder area, but no further assessment of the area (lower back) was performed. The Wound Care Nurse arrived on the unit later in the day to perform an admission skin assessment and ostomy referral. The Wound Care Nurse rolled Maria to assess the skin on the back and noted an area on the patient’s buttocks had blisters present. Sean was notified by the Wound Care Nurse of the blisters and told to call the physician. When the Wound Care Nurse returned on Monday, she observed that the physician was never called, so she called the physician Monday morning and obtained orders to treat the burn.Part 3Maria had planned to be discharged home on Wednesday. Because of the burns, she will need dressing changes. As Maria doesn’t have any family other than Simon, she is transferred to a skilled nursing floor on Wednesday. After several days on the unit, the staff noted that Maria is not eating much and that she had stopped socializing with her roommate and with the staff. During an assessment, Maria indicates all she wants to do is go home and resume her life. She is also concerned about her son and how he is coping with her extended stay. After the nurse consults with the physician regarding Maria’s condition and concerns, a decision is made to discharge her with home health support. Simon will serve as Maria’s primary caregiver, with the home health nurse checking in periodically. Part 4Maria is discharged home on Monday with daily home health visits for dressing changes.On Friday, you are assigned to work in the Emergency Room. Shortly before lunch, Maria arrives via an ambulance. When the visiting nurse arrived earlier in the day, Maria was not sure what day it was and was very weak. An ambulance was called for transport to the hospital. Your physical assessment reveals the following:Vital Signs:Temperature101.5 F/38.8 C (oral)Pulse110 (supine) & 132 (standing); pulse is regular regardless of positionRespirations22 (Regular)Blood pressure103/50 (supine) w/ MAP = 6896/42 (standing) w/ MAP = 6002 sat97% (room air)PainRight flank achiness, rates it a 5/10, continuous, nothing seems to make it better or worseCurrent Assessment:General appearance – resting quietly, no obvious distress noted, becomes fatigued with minimal activityRespiratory – Breath sounds clear and equal bilaterally, respirations are not laboredCardiac – pulses strong and equal with palpation, no edema noted, regular S1 & S2,Neuro – Alert & oriented x2. Patient not consistently oriented to date and place, c/o dizziness when she sits up.GI – abdomen soft & nontender to palpation. Positive bowel sounds in all four quadrants.GU -Upon palpation, right flank tenderness noted. Increased frequency of urination noted.Skin – Other than the surgical site, her skin integrity is intact, although her lips and oral mucosa are dry.Surgical wound – Edges of the wound are closely approximated and slightly red in color. Staples present. No drainage or foul odor noted.Lab Results:LabCurrentRecent ValueSodium (135 – 145 mEq/L)141138Potassium (3.5 – 5.0 mEq/L)3.93.8Glucose (70 – 110 mg/dL)192122Creatinine (0.6 – 1.2 mg/dL)1.61.0WBC (5 – 10 3/µl)13.28.5Neutrophil % (42 – 72%)9870Hgb (12 – 16 g/dL)14.414.2Platelets (150 – 450 x 103/µl)262150Lactate (0.5 – 2.2 mEq/L)3.3n/aMg (1.7 – 2.2 mg/dL)1.72.0Chest x-rayNo change from previous report.No infiltrates or other abnormalities noted.UrinalysisYellow cloudy urine. Specific gravity = 1.032. +2 protein.          + nitrite & RBCs. WBCs > 100. Few epithelial cells.n/aQUESTIONS1. What data from the assessment are relevant? What clinical significance to the nurse do they have? Incorporate sources.Relevant Assessment DataClinical Significance         2.  How can you engage with this patient and demonstrate that she matters to you as a person3.  What physician orders should the nurse anticipate for this patient? 4. What are at least five additional nursing assessments you, as the nurse, would want to perform? Why are these critical to perform?  In-text citation, and reference. Sources within 5 years old.Health ScienceScienceNursing NURS 451W Share QuestionEmailCopy linkComments (0)

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