caes study scenerios

[school28]

am i on the right track

(2) Mr. Jasper and Mr. Stern are client’s experiencing back pain. Mr. Jasper’s pain resulted from a fall from a ladder 48 hours ago. Mr. Stern’s pain has been bothering him for more than 8 months with no known cause.

a.As the nurse caring for both clients, how might you anticipate differences in assessment and treatment?

Mr. Jaspers pain is recent so I’ll give him pain medication, monitor his labs, blood work, Asses his breathing patterns making sure they did not change from bad to worse, be very careful not to cause any more pain for Mr. Jasper due to his recent fall, check with the doctor to see if there is any special precaution I should take with this Pt. As for MR. Stern I would also check lab, possible do ex-ray, ask him when the pain started what activity he was doing could this be deferred pain.

b. What might influence your approach to assessment if Mr. Stern were 39 versus 80 years of age? Mr. Stern could have an infection or possible passing kidneys stones. Maybe his spine is not aliened correctly. It could be deferred pain related to his prostate. He could have picked up something heavy not realizing that he is doing so and not practicing proper body mechanics.

(2) Mr. Jasper and Mr. Stern are client’s experiencing back pain. Mr. Jasper’s pain resulted from a fall from a ladder 48 hours ago. Mr. Stern’s pain has been bothering him for more than 8 months with no known cause.

a.As the nurse caring for both clients, how might you anticipate differences in assessment and treatment?

Mr. Jaspers pain is recent so I’ll give him pain medication, monitor his labs, blood work, Asses his breathing patterns making sure they did not change from bad to worse, be very careful not to cause any more pain for Mr. Jasper due to his recent fall, check with the doctor to see if there is any special precaution I should take with this Pt. As for MR. Stern I would also check lab, possible do ex-ray, ask him when the pain started what activity he was doing could this be deferred pain.

b. What might influence your approach to assessment if Mr. Stern were 39 versus 80 years of age? Mr. Stern could have an infection or possible passing kidneys stones. Maybe his spine is not aliened correctly. It could be deferred pain related to his prostate. He could have picked up something heavy not realizing that he is doing so and not practicing proper body mechanics.

[talaxandra]

That's certainly a solid start. Showing that you've already given some thought to the problems is more likely to get you some help, particularly if you have a specific question (like "is referred prostate pain more common in younger or older men?")

[Daytonite, BSN, RN]

(1) mrs. elliot, an 80-year-old black female, is admitted to a medical unit with a diagnosis of left cva. she has right-sided weakness, and she cannot turn or walk without using her walker and the assistance of another person. she also has difficulty swallowing and has bowel and bladder incontinence. a.what risk factors, if any, for pressure ulcers does this patient have?

if a patient is unable to turn as a result of a stroke, then they are at risk for pressure ulcers over bony prominences because of pressure that causes restrictions to circulation over that area.

b.what characteristics/factors should the nurse assess to monitor for a stage i pressure ulcer?

see these websites:

• http://www.nursingquality.org/ndnqipressureulcertraining/module1/default.aspx
  - pressure ulcer training tutorial (includes photos)
  
  
• http://www.hill-rom.com/usa/pdf/ctg285.pdf
  - guidelines for staging of pressure ulcers
  
  
• http://www.medicaledu.com/staging.htm
  - staging of ulcers
  
  
• http://ame-medical.com/staging_ulcers_guidelines.pdf
  - staging pressure ulcers
  
  
• http://www.medscape.com/viewarticle/581714
  - diagnosis, staging, and treatment of pressure ulcers: an expert interview with carol a. white ms,
  rn
  , anpc, gnpc, dnp©

c. how should this be accomplished?

by doing regular skin assessments.

(2) mr. jasper and mr. stern are client's experiencing back pain. mr. jasper's pain resulted from a fall from a ladder 48 hours ago. mr. stern's pain has been bothering him for more than 8 months with no known cause.

a.as the nurse caring for both clients, how might you anticipate differences in assessment and treatment?

one is younger and more active; the other is older and expected to be moe sedentary. i would look for an 80-year old to have something like arthritis or kidney disease underlying a back pain problem.

b. what might influence your approach to assessment if mr. stern were 39 versus 80 years of age?

a 39-year old will have better hearing and may be more impatient since he has been tolerating this pain for 8 months withour relief. at 39 he has to lead an active life and support himself as compared to an 80-year old who is more sedentary.

(3) mr. wilson is a 51-year-old man who experienced a traumatic injury to his left arm following an industrial accident 24 hours ago. his arm is in a very bulky dressing, and pain is aggravated when he lies on his left side. he has an intravenous line with a continuous infusion of intravenous fluids in his right arm. what nonpharmacological pain relief measures might be helpful for mr. wilson?

elevation and icing of the injured arm. keeping positioned off the left side.

i will ask the moderators to move this thread to the student nurses forum for better responses.

[Silverdragon102, BSN]

Moved to the nursing student assist forum

[Babs0512]

School28. Think logically about the CVA patient. Why would that pt be at greater risk for skin breakdown than say you or I? What are some interventions you could do to minimize her chance of a bed sore?

We could talk about positioning, shearing, nutrition, ROM, appliances, special mattresses, OT / PT Consults, etc... YOu can do this