Question

Case Study, Chapter 2, Community-Based Nursing Practice

1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plans to stay with him for several weeks to assist him with meals and household chores, and take him to physical therapy and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a local church.

1. What preparations should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged?

2. What necessary community resources and referrals will the patient need?

2. Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5)

1. What would be involved in setting up the first home care visit?

2. Describe the nursing assessments and management that would occur during the visit.

Answer 1

1. a)Nurse being a case manager , she should assess the individual needs of the patient and also communicate with the physician/health care provider to evaluate the specific requirements necessary for Mr.Jones. Plan short term and long term goals for the patient.

Nurse has to evaluate the needs of patient, the environment of his home , the family members , his abilities to carry out his self care needs and take note of the services Mr.Jones needs.

b)The nurse should inform the home health nurse, physical therapist and the social worker in Mr.Jones 's locality to make available the necessary community resources . As Mr.Jones is taking enoxaparin he is to be monitored for PT , APTT, INR values .Also he may be at risk for developing deep vein thrombosis, pulmonary embolism ,so physical therapy is necessary and thromboembolic stockings and crutches should be provided . He is also on Vicodin which is an opioid drug for pain relief.

Counselling services also should be provided.

Nurse also has to book a follow up appointment after 3 weeks with orthopedic surgeon .

2. a) The home health nurse during her first home visit will introduce herself , build rapport, encourage the patient and family members to communicate freely , explain the plan of care which is to be provided to the patient and also give support to connect with all specific community resources.

b)The nurse will assess the vital signs especially oxygen saturation of the patient . The nurse will assess the wound ,provide dressing according to physician orders and administer IV Zosyn and note for any allergies / complications. Nurse will also check for availability of home oxygen .

Nurse will also assess the general condition of the patient along with her diet needs & self care needs. Nurse will also provide moral support to Mrs.Johnson .