Melva Stone Case for CJSIM, Summaries of Health sciences

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Melva Stone: 72 Years

Nursing 3n5 0940 Name: Melva Stone Age: 72 years Provider: K. Nisser MD Full C Admit Wt: 132 Ibs (60 kg) BMI: 24.9 |, TPN, NURSING ASSESSMENT & NOTES Nursing Note: Focus of visit was for home assessment, determining Melva's home care needs, and setting up a plan of care. Discharge healthcare provider from rehabilitation center conferred with home care healthcare provider. Prescriptions in chart. Melva is a 72-year-old female, sustained an embolic/ischemic stroke 4 weeks ago. Spent one week in acute care and 3 weeks in rehabilitation center. Discharge three days ago to the daughter's hone where she has lived for 6 years. PT and OT to see client. Client uses a rolling walker to ambulate. Discharge nurses expressed some concern about medications. Melva stated, “I have plenty of medicines at home, | don’t need to learn about any more drugs.” Question 1 Partially correct Mark 20.84 out of 33.34 Before answering this question, review the client's health information in the EHR. Identify the information from the client's medical history presents concern for the nurse about Melva's care. Select one option in each row. Isaconcern Is nota concern History of hypertension v Details about the history of her births v Management of arthritis pain History of ovarian cysts Appropriateness of the medications for client Client knowledge about the medication Client's socioeconomic status 4 CS K[ x] <[ ex) < Use of medications available in her home Your answer is partially correct. Debriefing: Several issues concern the nurse. Use of home medications may be unsafe; it is unknown what medications she has or their age or status. Her current pain is a concern that must be managed and her knowledge about the medications. Her history of hypertension is critical because hypertension may increase her risk for stroke. The history of ovarian cysts and her birth histories are not relevant. There is no indication of socioeconomic stressors, although this should be assessed. The medications that are prescribed are appropriate for clients after a stroke. Consider: 1, What is the relationship of hypertension with stroke? 2. Research the medications preset effects, and side effects of each? ed for Melva. What are the indications, therapeutic 3. What medications are often used to manage the chronic pain of arthritis? Question 2 Partially correct Mark 28.57 out of 33.33 Before answering this question, review the client's health information in the EHR. Determine the findings in the home assessment that need to be considered first in planning Melva's care. Click on one correct answer per row. Need to be Does not need to be considered in care considered in care Ability to navigate the steps into the ¥ v kitchen Abi it bility to attend healthcare provider v v visits Ability to manage personal hygiene v v Family's socioeconomic status v na Risk for sacial isolation v v Home renovations to ensure client x v x can meet personal care needs Role transition after the stroke v v Your answer is partially correct. Debriefing: There is no indication of stressors with the family's socioeconomic status, ability to manage her hygiene, or visit the healthcare provider. The home appears to meet the client's needs, including the bathroom and bedroom. The client's ability to manage the steps with the walker into the kitchen will allow the client to go into the kitchen, assist with preparing meals, and clean up after the meals. it will also assist the client in meeting her nutritional needs. Consider: 1. What role does social interaction play in the growth and development of the human spirit? 2. The client drinks coffee all day. What impact does this have on the client's health status? 3. Consider the client's financial status. Is it adequate to meet the client's needs? Question 1 Correct Mark 33.24 out of 33.34 Before answering this question, review the client’s health information in the EHR. During the first visit, the nurse asks questions about Melva's health history. Melva appears to become defensive, as noted in this image. Identify appropriate responses for the nurse. Select all that apply. "1 think you'd be better o’f if you would have taken better care of yourself” “Do you have any concems right now?" "Why would you not go to the dentist or eye doctor?" "Is there any other information you would like me to know so | can better mest your W needs?" “How has your life changed since your stroke?” 7 “What are you using to manage your arthritis pain" w "Can you tell me more about your hypertension?" v “Let's discuss way you didn’t go to healti re providers.” Your answer is correct. Debriefing: Tre aopropriate answers are focused on the client's needs and open communication with the client. Items that ask why may make the client deiensve. ‘Asking clients how one can help them with their concerns, current management strategies, and life changes may be helpful. Providing advice is not helpful anc is not appropriate for professional relatiorshirs. Consider: 1. What metheds cf communication may open communication with clisnts? 2. What barriers may inhibi: communication? 3. What rright faciitate communication with clients? The correct answers are: “ls there eny cther information you ‘would like me to know so | can better meet your naeds?”, “Do you have any concerns right now?", “What are you using to manage your arthritis pain?" “Can you ‘ell me more about your hypertension? “How has your life changed since your stroke?” Question 2 Correct Mark 33.33 out of 33.33 Before answering this question, review the client's health information in the EHR. The nurse is concerned about several medications in Melva's medication cabinet. Select the medications that require adcitional investigation, Select one in each row. Requires additional Does not require additional investigation investigation Fluoxetine v ‘Acetaminophen Ibuprofen Lisinopril Antacids Tetracycline Levothyroxine Clopidogrel ASA i SS SS SS Se Se SS Celecoxib Your answer is correct. Debriefing: The client is prescribed 81 mg of ASA, not 325 mg, this could lead to an overdose of medication. The acetaminophen is prescribed 500 mg twice daily, difficult to administer with 325 mg tablets. Ibuprofen is contraindicated as it may potentiate the clopidogrel. The nurse should be concerned about the levothyroxine and whether the client needs to be tested for continued hypothyroidism. The tetracycline is of concern because there is evidence that, when expired, some of the medication components may be toxic. It is of concern that the client has been home for 3 days, and none of the clopidogrel or lisinopril have been taken. There is also concern about antacids since NSAIDS and celecoxib may be linked to gastric ulceration. The celecoxib is a strong NSAID which a healthcare provider should monitor; it also interacts with ASA. All medications, including the unused fluoxetine, should be evaluated for currency and interactions and disposed of correctly, Consider: 1. What role does nursing play in ensuring safe medication storage and use? 2. Research potential drug interactions between the medications in Melva's medicine cabinet. 3. What methods exist to promote safe medication use in clients?