FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
Case Study Principles and Practices of Rehabilitation
1. Mrs. Adams, 72 years of age, is admitted to the rehab unit with the diagnosis of stroke.
The stroke affected the limbic area in the brain, which has caused the patient to have
emotional labiality (her mood changes rapidly because she misinterprets situations). As a
result of the emotional labiality, she sometimes refuses to be repositioned or to
participate in physical or occupational therapy. She sometimes also refuses to eat and
drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right
side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that
do not go away with repositioning. She is incontinent of urine and stool. She has
problems with communication called global aphasia (difficulties understanding speech
and the written word and difficulties with speaking and writing). She is 5 feet tall and
weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin, and
she has several bandages on her arms. The family states they are concerned because the
staff on the previous medical-surgical unit would drag their mother up in bed when she
slid down. The staff would chart when their mother refused to be repositioned and then
would not reposition her for hours. (Learning Objectives 2 and 4)
a. Explain the pathophysiology of the risk factors that predispose Mrs. Adams
to developing pressure ulcers?
b. What nursing measures need to be instituted for Mrs. Adams based on
the information presented in the case study?
2. You are assigned to care for David Ramsey, a 22-year-old male patient who sustained
a back injury secondary to being thrown from a motorcycle. He did not damage the
spinal cord, but the computed tomography revealed a compression fracture at L-2
(lumbar area). David complains of severe lower back pain with numbness and tingling in
the lower extremities. You identify the following nursing diagnosis: Impaired Physical
Mobility. (Learning Objective 4)
,FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
a. What assessments are indicated based on this nursing diagnosis?
b. List other major nursing diagnoses based on David’s clinical presentation.
Case Study, Chapter 2, 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 0-degrees extension worn
when walking
,FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing
postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the
day after discharge at an orthopedic center. The orders will be faxed to the center. The
following medications with prescriptions attached include: Lovenox (enoxaparin) 70 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 plans to stay 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 local church. (Learning Objective 4)
a. What preparations should the nurse make in advance before attaining necessary
community resources and referrals before the patient is discharged?
b. What necessary community resources and referrals will the patient need?
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)
a. What would be involved in setting up the first home care visit?
b. Describe the nursing assessments and management that would occur during the
visit.
Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing
Process
, FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
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 to 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
OF REHABILITATION Q & A
Case Study Principles and Practices of Rehabilitation
1. Mrs. Adams, 72 years of age, is admitted to the rehab unit with the diagnosis of stroke.
The stroke affected the limbic area in the brain, which has caused the patient to have
emotional labiality (her mood changes rapidly because she misinterprets situations). As a
result of the emotional labiality, she sometimes refuses to be repositioned or to
participate in physical or occupational therapy. She sometimes also refuses to eat and
drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right
side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that
do not go away with repositioning. She is incontinent of urine and stool. She has
problems with communication called global aphasia (difficulties understanding speech
and the written word and difficulties with speaking and writing). She is 5 feet tall and
weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin, and
she has several bandages on her arms. The family states they are concerned because the
staff on the previous medical-surgical unit would drag their mother up in bed when she
slid down. The staff would chart when their mother refused to be repositioned and then
would not reposition her for hours. (Learning Objectives 2 and 4)
a. Explain the pathophysiology of the risk factors that predispose Mrs. Adams
to developing pressure ulcers?
b. What nursing measures need to be instituted for Mrs. Adams based on
the information presented in the case study?
2. You are assigned to care for David Ramsey, a 22-year-old male patient who sustained
a back injury secondary to being thrown from a motorcycle. He did not damage the
spinal cord, but the computed tomography revealed a compression fracture at L-2
(lumbar area). David complains of severe lower back pain with numbness and tingling in
the lower extremities. You identify the following nursing diagnosis: Impaired Physical
Mobility. (Learning Objective 4)
,FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
a. What assessments are indicated based on this nursing diagnosis?
b. List other major nursing diagnoses based on David’s clinical presentation.
Case Study, Chapter 2, 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 0-degrees extension worn
when walking
,FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing
postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the
day after discharge at an orthopedic center. The orders will be faxed to the center. The
following medications with prescriptions attached include: Lovenox (enoxaparin) 70 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 plans to stay 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 local church. (Learning Objective 4)
a. What preparations should the nurse make in advance before attaining necessary
community resources and referrals before the patient is discharged?
b. What necessary community resources and referrals will the patient need?
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)
a. What would be involved in setting up the first home care visit?
b. Describe the nursing assessments and management that would occur during the
visit.
Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing
Process
, FUNDAMENTAL CASE STUDY IN PRINCIPLES AND PRACTICES
OF REHABILITATION Q & A
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 to 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
