Case Study: Immobility

Write at least a one-sentence rationale.

Martha Simmons is a 78-year-old patient who fell and broke her right hip yesterday evening at her home. She is on the orthopedic unit with Buck's traction on her right leg. She is scheduled for surgery tomorrow morning. She is married and has five children. Mrs. Simmons is obese but ambulates independently. She is active in her church and enjoys watching her grandchildren. Mr. Simmons does much of the cleaning and cooking at home. He is a very doting husband. Dana is a nursing student who is assigned to Mrs. Simmons for the next 3 days. She is 45 years old and has been a nursing assistant for the past 10 years. As Dana enters the room, Mr. Simmons is telling his wife that she must eat all of her breakfast and is helping her eat.

1. After assessing Mrs. Simmons, Dana gets ready to administer a bed bath because Mrs. Simmons is in Buck's traction. Mrs. Simmons tells Dana that she is not dirty and does not want to be moved around because it will hurt. Dana wants to respond by letting Mrs. Simmons know how important it is to be active even while she is in traction. What are the consequences of bed rest that Dana will need to tell Mrs. Simmons about? (Select all that apply.)

A. Pneumonia
B. Muscle atrophy
C. Loose bowels
D. Thrombus formation
E. Pressure ulcers
F. Renal calculi
G. Contractures

2. Dana reviews Mrs. Simmons' orders and sees that she is to have elastic stockings and a sequential compression device (SCD) on her lower extremities. Mrs. Simmons asks Dana why she must put those on. How should Dana reply?

3. Dana explains to Mrs. Simmons that another way to prevent complications from immobility is to perform range-of-motion (ROM) exercises. What types of ROM exercises should Dana perform with Mrs. Simmons to be most effective?

4. On the day after Mrs. Simmons' surgery, Dana notices that Mrs. Simmons has scooted down in the bed and appears uncomfortable. How many staff members should she get to help her reposition Mrs. Simmons?

A. None
B. One more staff member
C. Three to four staff members

5. The doctor has ordered Mrs. Simmons to get up in a chair on the day after surgery. What is the best way for Dana to get Mrs. Simmons up?

Case Study: Infection Control

Write at least a one-sentence rationale.

Jane Martin, a 75-year-old widow, is admitted to the hospital for treatment of a postoperative infection of her left knee. She had total knee replacement surgery 3 weeks ago and went to her orthopedic surgeon with a complaint of pain, redness, and swelling in the operative joint. The incision is draining a purulent drainage. Her vital signs are blood pressure, 130/80 mm Hg; temperature, 101° F orally; pulse, 108 beats/min; and respirations, 18 breaths/min. She rates the pain in her left knee as a 6 on a scale from 1 to 10. Mrs. Martin has type 2 diabetes and has controlled her disease with oral antihyperglycemic agents. She has not had much of an appetite since her surgery and has lost 4 lb. Mary, a senior student nurse, is assigned to begin admitting Mrs. Martin.

1. Mary knows that the most important way to prevent infection is how?

2. The surgeon has ordered that Mrs. Martin be placed in isolation. Which type of isolation is most appropriate, and what precautions are included in this type of isolation?

3. Mrs. Martin asks Mary why some of the staff members wash their hands at the sink and others just wipe their hands with the stuff in the container. How should Mary respond so that Mrs. Martin knows when it is appropriate to not wash hands with soap and water?

4. Mrs. Martin's physician has decided to put in a peripherally inserted central catheter (PICC) line so she can receive intravenous antibiotics for 3 weeks. What type of preparation should Mary anticipate for this invasive procedure?

5. Mrs. Martin's son visits her and asks Mary what could have contributed to his mother getting an infection. Mary bases her answer on knowing that Mrs. Martin has a higher risk for developing an infection. What factors make Mrs. Martin more susceptible to infection? (Select all that apply.)

A. Gender
B. Age
C. Poor nutrition
D. Low blood sugar
E. Stress