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5.6 Learning Activities

Learning Activities

Mental Health Concepts Case Study[1]

Please use the following information to answer question 1-5.

Name Age Gender DOB Code Allergies Weight BMI
Maria Hernandez 80 Female 04/15/1943 Full Code Penicillin 72 kg 28.7

Handoff Report

0017: This is the nurse giving report on Ms. Hernandez, a pleasant 80-year-old female who is post-op Day #1 status post right total knee arthroplasty. Ms. Hernandez has been increasingly anxious today regarding her discharge planned for tomorrow morning, as she is the sole caregiver for her husband at home who has moderate Alzheimer’s disease. She has voiced concerns about managing his care, in addition to her own recovery. She has a history of hypertension, hyperlipidemia, and GERD, all of which are medically managed. Her surgical site is clean, dry, and intact with good approximation. She has been tolerating her diet and has been ambulating with physical therapy today with her walker and assistance. Her pain has been controlled on her scheduled medications with no additional needs. However, she appears visibly upset and tearful, her voice shaky while discussing her concerns about discharge, and she has been increasingly restless this shift. Vitals signs have been stable overall, with her most recent vital signs at 0700 of BP 140/88, HR 96, RR 20, Temp 98.4 F, and SpO2 98% on room air. Recommendations for the upcoming shift include assessing Ms. Hernandez’s anxiety level and providing support and education regarding discharge planning. Explore available resources for caregiver support and stress management. Continue to monitor her pain level and provide reassurance and emotional support.

History & Physical

History

  • Client underwent right total knee arthroplasty due to severe osteoarthritis and decreased mobility.
  • History of hypertension, hyperlipidemia, and GERD.
  • No history of smoking or alcohol use.

Physical Findings

  • Right knee surgical site: Clean, dry, intact, with good approximation.
  • Minimal edema noted at surgical site.
  • No signs of infection observed.
  • Normal bowel and bladder function.
  • Lung sounds clear bilaterally.
  • Normal heart sounds, regular rhythm.

Diagnoses

  • Post-operative pain related to surgical intervention.
  • Anxiety related to discharge planning and caregiver burden.
  • Risk for caregiver burnout related to demanding caregiving responsibilities.

Plan

  • Administer pain medications as prescribed and assess effectiveness.
  • Encourage and assist with ambulation as tolerated.
  • Provide education on wound care, activity restrictions, and fall prevention strategies.
  • Assess and address client’s anxiety and concerns related to discharge.
  • Provide emotional support and explore available resources for caregiver support.

Progress Notes

  • 01/08/2024 1300 – Client reports feeling anxious about going home and caring for her husband with Alzheimer’s disease. Discussed her concerns and provided reassurance. Educated on the importance of self-care and provided information on local caregiver support groups. Client seemed calmer after our conversation, but still voiced feelings of being overwhelmed. Will continue to monitor. – Sally Smith, RN

Vital Signs

Date/Time BP HR RR Temp SpO2
01/07/24 2000 130/82 88 18 98.0 F 99%
01/08/24 0300 135/86 92 18 98.2 F 98%
01/08/24 0700 140/88 96 20 98.4 F 98%

Lab/Diagnostic Results

Test Date/Time Results
X-ray (right knee) 01/07/24 2100 Right total knee arthroplasty components in good alignment. No acute bony abnormalities.

Provider Orders

Order Date/Time
Right total knee arthroplasty 01/07/2024 0700
Regular diet 01/07/2024 1000
Physical therapy consult – evaluate and treat 01/07/2024 1100
Occupational therapy consult – evaluate and treat 01/07/2024 1400
Discharge home when stable with home health 01/09/2024 0900

Medication Administration Report (MAR)

Scheduled

Medication Dose Route Frequency Time
Hydrochlorothiazide 25 mg PO Daily 0900
Atorvastatin 20 mg PO Daily 2100
Omeprazole 20 mg PO Daily 0900
Docusate Sodium 100 mg PO BID 0800, 2000

PRN

Medication Dose Route Frequency Time
Acetaminophen 500mg-325mg (2 tabs) 1000mg-650mg PO Every 6 hours PRN pain PRN
Oxycodone 5mg-325mg (1 tab) 5mg-325mg PO Every 4 hours PRN pain PRN
  1. During your initial assessment of Ms. Hernandez, you find her to be visibly upset, tearful, and voicing concerns about her discharge tomorrow and caring for her husband. What is the priority nursing action?

a. Assess Ms. Hernandez’s pain level and administer pain medication as ordered.

b. Review Ms. Hernandez’s home medications and reconcile with her home medication list.

c. Address Ms. Hernandez’s concerns regarding discharge and her husband’s care.

d. Delegate ambulation assistance to the unlicensed assistive personnel (UAP).

2. You are analyzing Ms. Hernandez’s most recent vital signs: BP 140/88, HR 96, RR 20, Temp 98.4 F, and SpO2 98% on room air. What is the most likely explanation for these findings?

a.  Pain

b.  Stress Response

c.  Infection

d. Hypoglycemia

3. When planning care for Ms. Hernandez, which of the following interventions will best address her chronic stress related to her role as a caregiver for her husband?

a. Encourage Ms. Hernandez to express her feelings and concerns.

b. Administer Ms. Hernandez’s prescribed PRN anti anxiety medication.

c. Educate Ms. Hernandez on the importance of adhering to her medication regimen.

d. Have Ms. Hernandez demonstrate the use of her incentive spirometer.

4. Ms. Hernandez asks you for more information about available resources for caregivers of people with Alzheimer’s disease. Which of the following resources would be most helpful to Ms. Hernandez at this time?

a.  Information on applying for Medicare and Medicaid benefits.

b. A brochure on the stages of Alzheimer’s disease and expected progression.

c. Contact information for the local chapter of the Alzheimer’s Association.

d. A pamphlet on healthy diet and exercise tips for seniors.

5. One hour after providing Ms. Hernandez with information on local support groups and resources for Alzheimer’s caregivers, you notice she is calmer, engaging in conversation with her husband who has arrived to help her get settled at home, and expresses feeling better equipped to handle her responsibilities. What is the best evaluation of these findings?

a. Ms. Hernandez’s stress is fully resolved.

b. Ms. Hernandez no longer requires support or resources.

c. Ms. Hernandez’s stress level has decreased, and she is demonstrating improved coping mechanisms.

d.  Ms. Hernandez needs a referral to a psychiatrist for further evaluation.

 

[2]

[3]

[4]

Next Gen RN LogoTest your knowledge using this NCLEX Next Generation Question. You may reset and resubmit your answers to this question an unlimited number of times.[5]

Next Gen RN LogoTest your knowledge using this NCLEX Next Generation Case Study. You may reset and resubmit your answers to this question an unlimited number of times.[6]

  1. Mental Health Concepts Case Study by OpenRN is licensed under CC BY-NC 4.0 ↵
  2. HP Mental Health Concepts Glossary Cards by OpenRN is licensed under CC BY-NC 4.0 ↵
  3. HP Mental Health Concepts Question Set 1 by OpenRN is licensed under CC BY-NC 4.0 ↵
  4. HP Mental Health Concepts Question Set 2 by OpenRN is licensed under CC BY-NC 4.0 ↵
  5. “HP Chapter 5  Question 1" for OpenRN is licensed under CC BY-NC 4.0 ↵
  6. “HP Chapter 5  Case Study B" by Kathy Sell for OpenRN is licensed under CC BY-NC 4.0 ↵

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