Roberts Case StudyYou are a Registered Nurse employed by the Great Lakes Medical Center in the Float Pool. Today, you are working on 3N which is a postoperative unit that cares for a variety of surgical (i.e. broken bones, abdominal, genitourinary, etc.) patients. As you return from your lunch break, 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. Roberts Case Study – Part 1In this lesson, we will look more closely at Maria Roberts and her associated health issues. At 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. QUESTIONS1. Samantha’s approach to managing Maria’s arthritis pain was to create a “homemade” heat pack. Considering your readings, outline a plan to manage Maria’s pain based on the Chronic Care Model (https://www.kpwashingtonresearch.org/our-research/research-areas/chronic-illness-management/improving-chronic-illness-care). Address each model component (community, the health system, self-management support, delivery system design, decision support, and clinical information system) clearly in your response. NOTE: More information about the different elements of the model is can be found at https://www.kpwashingtonresearch.org/our-research/research-areas/chronic-illness-management/improving-chronic-illness-care/chronic-care-model-change-concepts 2. Describe all instances of communication failure in the situation above. For each failure described, identify communication strategies that 1) are expected of all health professionals and 2) communication options that, while not required, would improve communication and understanding of the patient situation.3. List and defend your choice for the top 3 most critical time points during which there was an opportunity to avoid the negative outcomes for this patient.4. What are the implications of Maria’s current situation? Be sure to think holistically!5. What solutions would you propose to avoid having patients in this situation in the future? Support your solutions with a discussion of the process you would use to make the necessary changes in the institution.6. Considering Maria’s health and sensory concerns, describe the strategies nursing should consider to prevent further negative health outcomes. Cite sources should be within 5 years old, citations on every question, in-text citations, and reference pages needed. Health Science Science Nursing NURS 451W Share QuestionEmailCopy link Comments (0)
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