Question

The client is a 72 year old gentleman who lives with his wife and is a part-time crossing guard at the local elementary school. He is in relatively good health. His only complaint is osteoarthritis in his hands and knees for which he takes NSAIDs prn. He fell walking up the stairs to his bedroom at home. He presented to the ER with a fracture of the right hip and underwent on open reduction and internal fixation repair (ORIF). He has been discharged from the PACU and is now on the orthopedic surgery floor to recover from surgery prior to discharge to a rehab facility. Currently, his vital signs are stable, his dressing is dry and intact, his pain is controlled well with the prescribed narcotic analgesics, and he is continent of bowel and bladder. He is alert but confused and disoriented to place and time. His wife states that he never had this problem before surgery.

After 4 days in the hospital, the client is ready for discharge to the skilled nursing facility for rehabilitation. His incision is healing well; it still has staples and a dry dressing. His pain is controlled with oral narcotics. He has recovered from the surgery without complications. The only change from the previous assessment is his mental status. He is now oriented but has a short term memory deficit. 1.Compose an SBAR report to the charge nurse who will receive the client at the SNF. 2. How will the focus of his care change now that he has been discharged for the hospital and has been admitted to the SNF? 3. List three nursing diagnoses specifically written for this client that will apply to his care in rehab. Which do you consider the priority for care and why? Discuss how there might there be competing priorities. 4 Choose 1 diagnosis, write an outcome statement, and list at least three individualized nursing interventions with rationales.

Answer 1

1. SBAR report

S- SITUATION DESCRIPTION	name of client: age: 72yrs sex: male medication: previously taken NSAIDS prn chief complain: pain in hand and hip. and got a fracture in hip. surgery: open reduction and internal fixation repair (ORIF)
B- BACKGROUND OF CLIENT	the cliet previously had osteoarthritis. and he was taking NSAIDS prn. because of fracture he got a surgery of ORIF. after 4-days of surgery the surgical wound healed up. but staples not removed. the client taking oral NSAIDS. he is recovered from the surgery without any complication. but because of short term memory loss he is discharged to SNF.
A- ASSESSMENT	all vitals are stable, dressing is dry and intact pain is controlled, improved bowel and bladder habit, after surgery he is confused and disoriented to place and time. after 4-days of surgery he is having short term memory deficit.
R- RECOMMENDATION	as per the assessment of the client. the doctor prescribed for rehabilitation. so the client is discharge to your SNF. FOR ANY QUERRY REGARDING THE CLIENT PLEASE FEEL FREE TO DISCUSS WITH ME AND ALSO YOU CAN CONTACT ME.

2. the focus of care changed because the client developed short term memory loss and the main point is the client did not have it earlier but develop it after surgery. which is more priority to meet the need.

3. nursing diagnosis:

1. stress related to hospital staying as it have impact on his earning process as evidenced by client verbalisation.
2. depression related to loss of job as evidenced by client verbalisation.
3. loss of short term memory related to excessive stress as evidenced by client assessment.

4. among the 3-diagnosis the first one is more priority. because the client is more stressfor his earning capacity. which makes him unable to recall things. age is also a point to develop memory loss. so coping and relaxation technique is essential.

5.

assessment	nursing diagnosis	nursing goal	intervention	rational	outcome
obj. assess. the client says how will i earn i am tensed leave me alone sub. assess. depressed aloof irritability angry	stress related to hospital staying as it have impact on his earning process as evidenced by client verbalisation	to reduce the level of stress	assess the client stress level find out the stress triggering factors. appraise the impact of clients life on his family. use calm reassuring approach. provide the client relaxation technique.	to provide corrective treatment. by appraising the client will increase his level of confidence. calm and reassurance aproach will make the individual stress free and divert his mind. relaxation technique will make him calmand develop positive attitude towards life.	now the client feel better and well verbalising with his wife.