case stud
Yanick Jean ASN program Fundamentals of Nursing Case Studies
Health care delivery and evidenced based nursing practice
Chapter 1
1.Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on
mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is
extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted
during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are
pleased with the care she receives in the hospital.
Describe the quality performance tools that may be used to demonstrate that the care and
treatment rendered are both cost-efficient and of high quality.
COPD is a long course of chronic disease that is characterized by repeated exacerbations and
remissions. This Chronic Obstructive Pulmonary Disease usually leads to a clear and steady
decline if not well monitored and cared for. The quality performance tools that may be used to
demonstrate the care and treatment that rendered the effort both cost –efficient and of high
quality, ranging from health insurance, bed capacity of a hospital and the number of nurses with
advanced training and the high-quality treatment team. Also, the utilized symptom measurement
tool and the mechanical ventilation and suction machines, contributed effectively; (Brunner &
Suddarth’s p.621)
Describe the quality performance tools that may be used to demonstrate that the nursing
care utilized is evidence-based care and high quality, resulting in patient satisfaction and
good patient outcomes.
The quality performance tools that is used to demonstrate that the nursing care utilized is
evidence-based care and high-quality ranging from the treatment teams focusing their energies
and resources on symptom control contributed to the effectiveness of her wellbeing. Patient
assessment skills are of vital importance. They recognized symptoms and provide adequate
relief of symptom such as promptly applying ventilations to improve breathing. They also
monitored the effective need to suction the patient in case of increase secretions to maintain a
patent air way and also minimize risk for SOB. Also, the effective medication regime adjusted
during hospitalization, all resulted in patient satisfaction and good patient outcomes; (Brunner &
Suddarth’s p.621- 630)
2. The Registered Nurse working in the cardiac care clinic is tasked with implementing quality
improvement measures. To educate the clinic staff the nurse plans an in-service program to
introduce concepts of quality improvement and evidence-based practice. Additionally, the role of
a case manager will be included in the presentation. The Nurse plans on using care of the patient
with congestive heart failure as a template and prepares sample clinical pathways, care, maps,
and multidisciplinary action plans.
A. Describe how clinical pathways are used to coordinate care of caseloads of patients?
,Yanick Jean ASN program Fundamentals of Nursing Case Studies
Clinical Pathways are devices that help formulate a road toward positive results for a patient with
the goal being not to have a readmission to the hospital after discharge. This is all being done
with a specific time frame in mind. Case specific education upon and post discharge is essential.
Medications geared toward recovery and management of a patient’s condition(s) and setting up
consultations with various team members who are all focused on the recovery of the patient;
(Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith)
B. What is the role of the case manager in evaluating a patient’s progress?
Case Manager- It is the coordination of care across the health care system. It aims for the
continuity of services and quality care among specifically identified clienteles, in a context of
efficient, effective and human resource management. Case management is among the changes
which enhance the role of the nurse. The case manager sets goals with the patient, monitors the
cost of the care, and works with all providers to eliminate duplication of service and evaluate
outcomes of care; (Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith).
C. What are examples of evidence-based practice tools used for planning patient care?
Examples of evidence-based practice tools for planning patient care are algorithms, clinical
guidelines, outcome assessments, and current literature and research.
Chapt 2 Case Study, Community-Based Nursing Practice
1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee
replacement. The discharge orders from the orthopedic surgeon include: continuous
passive motion (CPM) at the current setting of O-degrees extend n worn when walking
with crutches (no weight-bearing post discharge day 1 and may begin weight-bearing
post discharge Jay 2); and home nurse visits, as needed. Physical therapy should begin
the day after discharge at an orthopedic center. e orders will be faxed to the center. The
following medications with prescriptions attached include: Lovenox (enoxaparin) mg
subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4
hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up
with the orthopedic surgeon in 3 weeks. His daughter plan stays with him for several
weeks to assist him with meals and household chores and take him to physical therapy
and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in
other states. He is a widower and attends a church (Learning Objective 4)
What preparation should the nurse make in advance before attaining necessary community
resources and referrals before the patient is discharged?
1 After a knee replacement surgery, the patient will have a lot of difficulties to complete her
tasks. A post op education needs to be done.
,Yanick Jean ASN program Fundamentals of Nursing Case Studies
2 The nurse should identify a home health care provider who will assist the patient in
performing ADL. The provider could be a family member or a home health aide who will
assist in the activities of the patient should also participate in the education program.
3 A physical therapist will be needed to check patient at home for the safe environment of
the patient and to train him to adjust his activities according to his condition.
4 Medication teaching needs to be done and help the patient identify drugs interactions and
side effects.
5 The nurse should teach the patient about his medication intake and should demonstrate
how to administer Enoxaparin subcutaneously
6 Patient needs to be educated about safety because she is at risk of falling. Patient needs
to be aware of how to make the home environment safe so as to reduce event of falls. All
the things should be made available at the patient easy reach
7 Patient needs to be educated about crutches
8 Patient needs to be educated about healthy diet.
9 Patient needs to be instructed about his wound site for any signs of infection and to do
dressing in an aseptic way. Instruct him when the stitches have to be removed.
10 Instruct the patient when to call his doctor
11 Patient should be given adequate information on use of walking aids (Kathryn Cadenhead
Colgrove, Ray A. Hargrove-Hutte, Med-Surg Success)
What necessary community resources and referrals will the patient need?
1 After discharge, the patient will require various rehabilitative services such as
physiotherapist, nutritionist etc. The rehabilitation will improve the strength and gait of
the patient. It will help to recover the range of motion. The patient can access the
community physiotherapy clinics, regional home and community care services, private
rehabilitation clinics. The community resources include the supply of medical equipment
needed for assistance like crutches, canes and wheel chairs etc. (Kathryn Cadenhead
Colgrove, Ray A. Hargrove-Hutte, Med-Surg Success)
2 Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital
following an admission for COPD. She has a past medical history of a colon resection related to
acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry
wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her
care at home, home care visits were ordered. (Learning Objective 5)
What would be involved in setting up the first home care visit?
During the first visit, the nurse will explain all the details of the plan of care, including which
other VNSNY professionals, including physical therapists, social workers, registered dietitians,
and home health aides, are part of the home care team and how often Mr Johnson will see them.
, Yanick Jean ASN program Fundamentals of Nursing Case Studies
Describe the nursing assessments and management that would occur during the visit.
A. For the first home care visit, they should set up items for wound care, equipment for
monitoring vital signs and pulsometer, items for cannulation, dressing materials, surgical gloves,
and sterile gloves, also requires item for collection wound sample. If possible, also arrange
materials for health education.
B. The nursing assessment at the first home care visit would be:
- Assessment of airway, oxygen saturation and breathing pattern.
- Assess the condition of wound, check for any furthering of infection, check the dressing
of wound discharges.
- Assess the general condition of Mrs. Johnson, vital signs, ability to follow instruction.
Nursing management would be wound care and change of dressing, insertion of new I've
access if required, adjust the flow of oxygen according to (Kathryn Cadenhead Colgrove,
Ray A. Hargrove-Hutte).
Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing
Process
1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of
the small intestine. She is currently receiving comfort measures only in hospice. She has
gangrene of her right foot and has a history of diabetes controlled with oral agents. She is
confused and the physician has determined that she is unable to make her own informed
decisions. The hospice nurse, not realizing that the weekly order for CBC and renal
profile had been discontinued, obtained the labs and sent them to the nearby laboratory
for processing. The abnormal lab results obtained later that day revealed that the patient
needed a blood transfusion. The hospice nurse updated the patient's medical power of
attorney who was distressed at the report. The patient's wishes were to die peacefully and
do not have to undergo an amputation of her right foot. But if the patient receives the
blood transfusion, she may live long enough to need the amputation. The patient's
physician had previously informed the medical power of attorney that the patient would
most likely not be able to survive the amputation. The patient's medical power of attorney
had made the request to cease all labs so that the patient would receive comfort measures
until she died. The patient has no complaint of shortness of breath or discomfort.
(Learning Objective 4)
1. The hospital is faced with the medical responsibility of respecting the wishes of
the patient to die peacefully, including not to undergo amputation of her right foot
and giving a blood transfusion
b. Who are the stakeholders and what gains or losses do each have?
Yanick Jean ASN program Fundamentals of Nursing Case Studies
Health care delivery and evidenced based nursing practice
Chapter 1
1.Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on
mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is
extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted
during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are
pleased with the care she receives in the hospital.
Describe the quality performance tools that may be used to demonstrate that the care and
treatment rendered are both cost-efficient and of high quality.
COPD is a long course of chronic disease that is characterized by repeated exacerbations and
remissions. This Chronic Obstructive Pulmonary Disease usually leads to a clear and steady
decline if not well monitored and cared for. The quality performance tools that may be used to
demonstrate the care and treatment that rendered the effort both cost –efficient and of high
quality, ranging from health insurance, bed capacity of a hospital and the number of nurses with
advanced training and the high-quality treatment team. Also, the utilized symptom measurement
tool and the mechanical ventilation and suction machines, contributed effectively; (Brunner &
Suddarth’s p.621)
Describe the quality performance tools that may be used to demonstrate that the nursing
care utilized is evidence-based care and high quality, resulting in patient satisfaction and
good patient outcomes.
The quality performance tools that is used to demonstrate that the nursing care utilized is
evidence-based care and high-quality ranging from the treatment teams focusing their energies
and resources on symptom control contributed to the effectiveness of her wellbeing. Patient
assessment skills are of vital importance. They recognized symptoms and provide adequate
relief of symptom such as promptly applying ventilations to improve breathing. They also
monitored the effective need to suction the patient in case of increase secretions to maintain a
patent air way and also minimize risk for SOB. Also, the effective medication regime adjusted
during hospitalization, all resulted in patient satisfaction and good patient outcomes; (Brunner &
Suddarth’s p.621- 630)
2. The Registered Nurse working in the cardiac care clinic is tasked with implementing quality
improvement measures. To educate the clinic staff the nurse plans an in-service program to
introduce concepts of quality improvement and evidence-based practice. Additionally, the role of
a case manager will be included in the presentation. The Nurse plans on using care of the patient
with congestive heart failure as a template and prepares sample clinical pathways, care, maps,
and multidisciplinary action plans.
A. Describe how clinical pathways are used to coordinate care of caseloads of patients?
,Yanick Jean ASN program Fundamentals of Nursing Case Studies
Clinical Pathways are devices that help formulate a road toward positive results for a patient with
the goal being not to have a readmission to the hospital after discharge. This is all being done
with a specific time frame in mind. Case specific education upon and post discharge is essential.
Medications geared toward recovery and management of a patient’s condition(s) and setting up
consultations with various team members who are all focused on the recovery of the patient;
(Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith)
B. What is the role of the case manager in evaluating a patient’s progress?
Case Manager- It is the coordination of care across the health care system. It aims for the
continuity of services and quality care among specifically identified clienteles, in a context of
efficient, effective and human resource management. Case management is among the changes
which enhance the role of the nurse. The case manager sets goals with the patient, monitors the
cost of the care, and works with all providers to eliminate duplication of service and evaluate
outcomes of care; (Judith M Wilkinson, Leslie S Treas, Karen L. Barnett, Mable H. Smith).
C. What are examples of evidence-based practice tools used for planning patient care?
Examples of evidence-based practice tools for planning patient care are algorithms, clinical
guidelines, outcome assessments, and current literature and research.
Chapt 2 Case Study, Community-Based Nursing Practice
1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee
replacement. The discharge orders from the orthopedic surgeon include: continuous
passive motion (CPM) at the current setting of O-degrees extend n worn when walking
with crutches (no weight-bearing post discharge day 1 and may begin weight-bearing
post discharge Jay 2); and home nurse visits, as needed. Physical therapy should begin
the day after discharge at an orthopedic center. e orders will be faxed to the center. The
following medications with prescriptions attached include: Lovenox (enoxaparin) mg
subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4
hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up
with the orthopedic surgeon in 3 weeks. His daughter plan stays with him for several
weeks to assist him with meals and household chores and take him to physical therapy
and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in
other states. He is a widower and attends a church (Learning Objective 4)
What preparation should the nurse make in advance before attaining necessary community
resources and referrals before the patient is discharged?
1 After a knee replacement surgery, the patient will have a lot of difficulties to complete her
tasks. A post op education needs to be done.
,Yanick Jean ASN program Fundamentals of Nursing Case Studies
2 The nurse should identify a home health care provider who will assist the patient in
performing ADL. The provider could be a family member or a home health aide who will
assist in the activities of the patient should also participate in the education program.
3 A physical therapist will be needed to check patient at home for the safe environment of
the patient and to train him to adjust his activities according to his condition.
4 Medication teaching needs to be done and help the patient identify drugs interactions and
side effects.
5 The nurse should teach the patient about his medication intake and should demonstrate
how to administer Enoxaparin subcutaneously
6 Patient needs to be educated about safety because she is at risk of falling. Patient needs
to be aware of how to make the home environment safe so as to reduce event of falls. All
the things should be made available at the patient easy reach
7 Patient needs to be educated about crutches
8 Patient needs to be educated about healthy diet.
9 Patient needs to be instructed about his wound site for any signs of infection and to do
dressing in an aseptic way. Instruct him when the stitches have to be removed.
10 Instruct the patient when to call his doctor
11 Patient should be given adequate information on use of walking aids (Kathryn Cadenhead
Colgrove, Ray A. Hargrove-Hutte, Med-Surg Success)
What necessary community resources and referrals will the patient need?
1 After discharge, the patient will require various rehabilitative services such as
physiotherapist, nutritionist etc. The rehabilitation will improve the strength and gait of
the patient. It will help to recover the range of motion. The patient can access the
community physiotherapy clinics, regional home and community care services, private
rehabilitation clinics. The community resources include the supply of medical equipment
needed for assistance like crutches, canes and wheel chairs etc. (Kathryn Cadenhead
Colgrove, Ray A. Hargrove-Hutte, Med-Surg Success)
2 Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital
following an admission for COPD. She has a past medical history of a colon resection related to
acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry
wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her
care at home, home care visits were ordered. (Learning Objective 5)
What would be involved in setting up the first home care visit?
During the first visit, the nurse will explain all the details of the plan of care, including which
other VNSNY professionals, including physical therapists, social workers, registered dietitians,
and home health aides, are part of the home care team and how often Mr Johnson will see them.
, Yanick Jean ASN program Fundamentals of Nursing Case Studies
Describe the nursing assessments and management that would occur during the visit.
A. For the first home care visit, they should set up items for wound care, equipment for
monitoring vital signs and pulsometer, items for cannulation, dressing materials, surgical gloves,
and sterile gloves, also requires item for collection wound sample. If possible, also arrange
materials for health education.
B. The nursing assessment at the first home care visit would be:
- Assessment of airway, oxygen saturation and breathing pattern.
- Assess the condition of wound, check for any furthering of infection, check the dressing
of wound discharges.
- Assess the general condition of Mrs. Johnson, vital signs, ability to follow instruction.
Nursing management would be wound care and change of dressing, insertion of new I've
access if required, adjust the flow of oxygen according to (Kathryn Cadenhead Colgrove,
Ray A. Hargrove-Hutte).
Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing
Process
1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of
the small intestine. She is currently receiving comfort measures only in hospice. She has
gangrene of her right foot and has a history of diabetes controlled with oral agents. She is
confused and the physician has determined that she is unable to make her own informed
decisions. The hospice nurse, not realizing that the weekly order for CBC and renal
profile had been discontinued, obtained the labs and sent them to the nearby laboratory
for processing. The abnormal lab results obtained later that day revealed that the patient
needed a blood transfusion. The hospice nurse updated the patient's medical power of
attorney who was distressed at the report. The patient's wishes were to die peacefully and
do not have to undergo an amputation of her right foot. But if the patient receives the
blood transfusion, she may live long enough to need the amputation. The patient's
physician had previously informed the medical power of attorney that the patient would
most likely not be able to survive the amputation. The patient's medical power of attorney
had made the request to cease all labs so that the patient would receive comfort measures
until she died. The patient has no complaint of shortness of breath or discomfort.
(Learning Objective 4)
1. The hospital is faced with the medical responsibility of respecting the wishes of
the patient to die peacefully, including not to undergo amputation of her right foot
and giving a blood transfusion
b. Who are the stakeholders and what gains or losses do each have?
