COMMUNITY HEALTH
Ramona Stukes Room
Ramona Stukes, Ramona Stukes is a 69-year-old female who had a failed cholecystectomy and
subsequent ileostomy. Ramona was discharged postoperatively to home six weeks ago.
Ramona’s ostomy appliance has been leaking. She is frustrated and overwhelmed with the new
appliance and the fact it is not working properly. Ramona’s neighbor, Shirley, has been assisting
in her care since she has been home because Ramona’s husband is unwilling to assist with her
ostomy care. She is 64 inches tall and weighs 226 pounds. Medications: NKDA. Oxycodone with
acetaminophen (Percocet) 1-2 tablets every four hours as needed for postoperative pain,
gabapentin (Neurontin) 300 mg by mouth three times daily for chronic nerve pain and ketorolac
(Toradol) every 6 hours as needed for breakthrough pain. Medical history: Ramona was diagnosed
with and has been treated for chronic nerve pain. Ramona reports “I have had so much pain
since the surgery. I take all the medicine I can but it still doesn’t help.” Surgical history: positive
for a ruptured appendectomy at age 18 and her recent history of failed cholecystectomy and
subsequent ileostomy. Social history: Ramona lives in a single-family home with her husband.
Both Ramona and her husband are retired. Community Assessment: Ramona and her husband
live in a single- family home in a rural farming community. The town is 4 miles south of their
home and consists of the local 745 VFW, a church, and gas station with a convenience store, and
a small café. The next nearest town, Twin Valley, is 12 miles from their home has a population of
37,000. Twin Valley offers a large discount department store with a pharmacy, two large service
grocery stores and multiple restaurants, places of worship, banks and on and off liquor sales, and
specialty shops. Twin Valley is home to a critical access hospital and an outreach specialty clinic
supported from the major city 37 miles south.
You responded correctly to 7 out of 9 evaluations:
Your
Category response Explanation
Community Increased Ramona requires increased community assessment to identify resources health ca
Assessment acuity ostomy resources.
Culture/Beliefs/Spirituali
Increased There is no indication of Culture/Beliefs/Spirituality concerns in Ramona care.
ty acuity
Disease/Illness Increased Disease and illness prevention include assessment of Ramona’s adaptation to bein
Prevention acuity self-esteem and body image. Assessment of depression and anxiety will be import
Education/Counseling Increased The client and caregivers will have an increased need for education and counselin
acuity be an important consideration for Ramona and her husband especially with his res
her ostomy care can influence the intimacy in their relationship, which can have a
addiction is a concern warranting education and counseling given the potential ad
to manage her chronic pain.
Health Promotion Increased Assessing Ramona home and community environment as well as her spiritual, emo
acuity important contributors to Ramona’s health promotion plan.
Resource Identification Increased Ramona requires resource identification for counseling and education, stoma care,
acuity husband may require additional resource identification to aid in his adjustment to
America, Inc. is a nonprofit organization that supports, empowers, and advocates f
continent diversion surgery. The United Ostomy Association offers support for educ
education and updates.
Risk Reduction Increased Ramona has increased need for risk reduction with the concern of her opioid use a
acuity awareness of her self-esteem, body image, depression, and anxiety, which are legi
Social Determinants of Increased Ramona’s social determinants include her age, elderly (69 years) and living in a lo
Health acuity
Surveillance Increased There is no need for public surveillance of Ramona at this time.
acuity
Scenario 1
,You correctly selected 3 out of 6 actions:
Stat
us Label Explanatio
Ask to speak directly with THIS IS CORRECT. The American Nurses Association (A
Ramona confidentiality are essential to maintaining the trusting
and patients and are integral to professional practice.
individuals, families and communities. The triage nurs
or obtain consent to speak with the Shirley on behalf o
Consult the WOC nurse for a THIS IS CORRECT. It would be appropriate for the triage
plan of care for Ramona of care.
Conduct a telehealth visit over THIS IS INCORRECT. The triage nurse plays a valuable r
the phone needs, evaluating the urgency of care required, directi
providing education and provider consult when needed
nurse to conduct a telehealth visit.
Arrange a home health care THIS IS CORRECT. Arranging a home health visit is an a
nurse visit triage nurse may consult the WOC nurse to determine
how to address other issues. The home health care nur
information to the WOC nurse.
Inform the neighbor that the THIS IS INCORRECT. It would not be appropriate respon
leaking is causing no harm, only or support persons that the leaking appliance is causin
an inconvenience Ramona and her support persons this is temporary and
avoid increased frustration during the adjustment perio
Transport via ambulance back THIS IS INCORRECT. This situation does not require tran
to hospital
Scenario 2
You correctly selected 2 out of 6 actions:
Stat
us Label Exp
Determine that Ramona probably has the THIS IS INCORRECT. It is important the
wrong size ostomy appliance and mail her the ostomy appliance to avoid increased fru
proper size the ostomate.
Arrange a home health nurse visit THIS IS CORRECT. Ramona will benefit f
assist with the management of her osto
Conduct telehealth visit THIS IS CORRECT. It would be appropri
telehealth visit to supplement the hom
Call the surgeon to report symptoms THIS IS INCORRECT. The WOC nurse pla
patient care.The WOC nurse can functio
contact the provider if there are concer
Transport via ambulance back to hospital THIS IS INCORRECT. It would not be app
hospital via ambulance. Her symptoms
managed at home or in the clinic.
Encourage Ramona to continue taking the pain THIS IS INCORRECT. The WOC nurse sho
medication as prescribed for pain management medications prescribed post-operatively
until she is able to be evaluated and III drugs that have potential for phy
Scenario 3
,You correctly selected 3 out of 6 actions:
Stat
us Label Explan
Provide the correct size ostomy THIS IS INCORRECT. After the home health nu
appliance size, the home health nurse should contact th
the appropriate size needed and have it order
Encourage eating small, frequent meals. THIS IS CORRECT. Following ostomy surgery, f
portions at the same time each day will help r
frequently and in smaller quantities will help a
unnecessary gas.
Encourage Ramona to take medication THIS IS INCORRECT. The nurse should avoid br
frequently and as prescribed for pain as prescribed for pain.” The nurse should ass
management and regime and that the client is taking the m
be decreasing as time progresses after surger
management.
Ask Ramona if she feels depressed, have THIS IS CORRECT. It is appropriate for the hom
thoughts of hurting herself or suicidal depression, thoughts of hurting herself or suic
ideations
Review care and application of the THIS IS CORRECT. It is appropriate follow–up a
ostomy appliance application of the ostomy appliance. With the
physically, the nurse may have to reiterate ho
application of the appliance.
Inform Ramona that her ostomy site THIS IS INCORRECT. Adjusting to an ostomy, s
appears normal and the leaking is the is difficult for a new ostomate. The nurse shou
result of improper application of the due to an incorrect size and that she will be a
appliance appliance.
Scenario 4
You correctly selected 5 out of 6 actions:
Stat
us Label Explanation
Dietary THIS IS CORRECT. Appropriate and adequate nutrition is an essential com
assessment Nutritional supplements/meal replacements might be an option for Ramon
appetite. A dietary assessment can help to determine why Ramona is no
Foods hard on digestion such as nuts, seeds, popcorn, dried fruit, and raw
and should be avoided. Encourage plenty of fluids to stay hydrated.
Depression THIS IS CORRECT. It is important to assess for depression in a client who e
behavioral changes following a stoma creation. The change in body functi
the ostomate’s self-esteem and personal identity. A stoma creation can a
engagement in social activities. The nurse should assess for symptoms of
Self-care THIS IS CORRECT. For a new ostomate, self-care is an important part of ad
significant changes in the body’s appearance and functional ability may c
body image and self-concept. Ramona should be reassured she will be ab
management process. The nurse should assess Ramona’s knowledge of b
better understand the role of the ostomy and empower Ramona in taking
Wound Care THIS IS INCORRECT. An ostomy is not a wound and should not be referred
the result of 2 distinctly different phenomena. An ostomy is not a type of
, Stat
us Label Explanation
rectified; it is not a wound that needs to be healed. Ostomies need to be r
procedures.
Pain THIS IS CORRECT. The nurse should assess pain and allow the client to de
management pain. The nurse should avoid broad statements such as “take the pain me
the client’s knowledge of the medication or ensure that the medication i
inquire about all medications- prescription, over the counter, and herbal o
Activity THIS IS CORRECT. The nurse should inquire about Ramona’s activity level
abdominal exercise should be avoided for the first three months or until in
Scenario 5
You correctly selected 1 out of 6 actions:
Stat
us Label Explanation
Call 911 THIS IS CORRECT. The highest priority for the nurse is to call 9
call 911 before individual action is taken. Naloxone is an opioid
antidote used for complete or partial reversal of opioid effects
Naloxone should be administered for a respiratory rate fewer t
intravenously, naloxone begins to reverse opioid initiated CNS
It works by rapidly binding to opioid receptors and blocking the
immediately cause opioid withdrawal symptoms in patients ph
available as an injectable (needle) solution, a hand-held auto-i
(NARCAN® Nasal Spray).
Try to elicit an oriented, THIS IS INCORRECT. It is not a priority to try to arouse Ramona
verbal response from demonstrating signs of respiratory depression.
Ramona
Conduct a thorough THIS IS INCORRECT. After the emergency response system has
physical assessment Ramona by conducting a rapid physical assessment and asses
including vitals administered for a respiratory rate fewer than 10 breaths/minu
Offer juice to increase THIS IS INCORRECT. Ramona does not have a history of diabet
glucose increase her blood glucose would not be an appropriate action
Perform a bed bath and THIS IS INCORRECT. Performing a bed bath and changing the s
change the soiled
sheets
Allow Ramona to THIS IS INCORRECT. Allowing Ramona to rest is not an appropr
continue resting priority is to call 911 so naloxone can be administered as soon
antidote used for complete or partial reversal of opioid stered
breaths/minute.
Scenario 6
You correctly selected 5 out of 6 actions:
Stat
us Label Explanati
Opioid use disorders do not THIS IS CORRECT. Opioid misuse and addiction may o
discriminate by gender, age, or age, regional, ethnic, or racial peoples.
Ramona Stukes Room
Ramona Stukes, Ramona Stukes is a 69-year-old female who had a failed cholecystectomy and
subsequent ileostomy. Ramona was discharged postoperatively to home six weeks ago.
Ramona’s ostomy appliance has been leaking. She is frustrated and overwhelmed with the new
appliance and the fact it is not working properly. Ramona’s neighbor, Shirley, has been assisting
in her care since she has been home because Ramona’s husband is unwilling to assist with her
ostomy care. She is 64 inches tall and weighs 226 pounds. Medications: NKDA. Oxycodone with
acetaminophen (Percocet) 1-2 tablets every four hours as needed for postoperative pain,
gabapentin (Neurontin) 300 mg by mouth three times daily for chronic nerve pain and ketorolac
(Toradol) every 6 hours as needed for breakthrough pain. Medical history: Ramona was diagnosed
with and has been treated for chronic nerve pain. Ramona reports “I have had so much pain
since the surgery. I take all the medicine I can but it still doesn’t help.” Surgical history: positive
for a ruptured appendectomy at age 18 and her recent history of failed cholecystectomy and
subsequent ileostomy. Social history: Ramona lives in a single-family home with her husband.
Both Ramona and her husband are retired. Community Assessment: Ramona and her husband
live in a single- family home in a rural farming community. The town is 4 miles south of their
home and consists of the local 745 VFW, a church, and gas station with a convenience store, and
a small café. The next nearest town, Twin Valley, is 12 miles from their home has a population of
37,000. Twin Valley offers a large discount department store with a pharmacy, two large service
grocery stores and multiple restaurants, places of worship, banks and on and off liquor sales, and
specialty shops. Twin Valley is home to a critical access hospital and an outreach specialty clinic
supported from the major city 37 miles south.
You responded correctly to 7 out of 9 evaluations:
Your
Category response Explanation
Community Increased Ramona requires increased community assessment to identify resources health ca
Assessment acuity ostomy resources.
Culture/Beliefs/Spirituali
Increased There is no indication of Culture/Beliefs/Spirituality concerns in Ramona care.
ty acuity
Disease/Illness Increased Disease and illness prevention include assessment of Ramona’s adaptation to bein
Prevention acuity self-esteem and body image. Assessment of depression and anxiety will be import
Education/Counseling Increased The client and caregivers will have an increased need for education and counselin
acuity be an important consideration for Ramona and her husband especially with his res
her ostomy care can influence the intimacy in their relationship, which can have a
addiction is a concern warranting education and counseling given the potential ad
to manage her chronic pain.
Health Promotion Increased Assessing Ramona home and community environment as well as her spiritual, emo
acuity important contributors to Ramona’s health promotion plan.
Resource Identification Increased Ramona requires resource identification for counseling and education, stoma care,
acuity husband may require additional resource identification to aid in his adjustment to
America, Inc. is a nonprofit organization that supports, empowers, and advocates f
continent diversion surgery. The United Ostomy Association offers support for educ
education and updates.
Risk Reduction Increased Ramona has increased need for risk reduction with the concern of her opioid use a
acuity awareness of her self-esteem, body image, depression, and anxiety, which are legi
Social Determinants of Increased Ramona’s social determinants include her age, elderly (69 years) and living in a lo
Health acuity
Surveillance Increased There is no need for public surveillance of Ramona at this time.
acuity
Scenario 1
,You correctly selected 3 out of 6 actions:
Stat
us Label Explanatio
Ask to speak directly with THIS IS CORRECT. The American Nurses Association (A
Ramona confidentiality are essential to maintaining the trusting
and patients and are integral to professional practice.
individuals, families and communities. The triage nurs
or obtain consent to speak with the Shirley on behalf o
Consult the WOC nurse for a THIS IS CORRECT. It would be appropriate for the triage
plan of care for Ramona of care.
Conduct a telehealth visit over THIS IS INCORRECT. The triage nurse plays a valuable r
the phone needs, evaluating the urgency of care required, directi
providing education and provider consult when needed
nurse to conduct a telehealth visit.
Arrange a home health care THIS IS CORRECT. Arranging a home health visit is an a
nurse visit triage nurse may consult the WOC nurse to determine
how to address other issues. The home health care nur
information to the WOC nurse.
Inform the neighbor that the THIS IS INCORRECT. It would not be appropriate respon
leaking is causing no harm, only or support persons that the leaking appliance is causin
an inconvenience Ramona and her support persons this is temporary and
avoid increased frustration during the adjustment perio
Transport via ambulance back THIS IS INCORRECT. This situation does not require tran
to hospital
Scenario 2
You correctly selected 2 out of 6 actions:
Stat
us Label Exp
Determine that Ramona probably has the THIS IS INCORRECT. It is important the
wrong size ostomy appliance and mail her the ostomy appliance to avoid increased fru
proper size the ostomate.
Arrange a home health nurse visit THIS IS CORRECT. Ramona will benefit f
assist with the management of her osto
Conduct telehealth visit THIS IS CORRECT. It would be appropri
telehealth visit to supplement the hom
Call the surgeon to report symptoms THIS IS INCORRECT. The WOC nurse pla
patient care.The WOC nurse can functio
contact the provider if there are concer
Transport via ambulance back to hospital THIS IS INCORRECT. It would not be app
hospital via ambulance. Her symptoms
managed at home or in the clinic.
Encourage Ramona to continue taking the pain THIS IS INCORRECT. The WOC nurse sho
medication as prescribed for pain management medications prescribed post-operatively
until she is able to be evaluated and III drugs that have potential for phy
Scenario 3
,You correctly selected 3 out of 6 actions:
Stat
us Label Explan
Provide the correct size ostomy THIS IS INCORRECT. After the home health nu
appliance size, the home health nurse should contact th
the appropriate size needed and have it order
Encourage eating small, frequent meals. THIS IS CORRECT. Following ostomy surgery, f
portions at the same time each day will help r
frequently and in smaller quantities will help a
unnecessary gas.
Encourage Ramona to take medication THIS IS INCORRECT. The nurse should avoid br
frequently and as prescribed for pain as prescribed for pain.” The nurse should ass
management and regime and that the client is taking the m
be decreasing as time progresses after surger
management.
Ask Ramona if she feels depressed, have THIS IS CORRECT. It is appropriate for the hom
thoughts of hurting herself or suicidal depression, thoughts of hurting herself or suic
ideations
Review care and application of the THIS IS CORRECT. It is appropriate follow–up a
ostomy appliance application of the ostomy appliance. With the
physically, the nurse may have to reiterate ho
application of the appliance.
Inform Ramona that her ostomy site THIS IS INCORRECT. Adjusting to an ostomy, s
appears normal and the leaking is the is difficult for a new ostomate. The nurse shou
result of improper application of the due to an incorrect size and that she will be a
appliance appliance.
Scenario 4
You correctly selected 5 out of 6 actions:
Stat
us Label Explanation
Dietary THIS IS CORRECT. Appropriate and adequate nutrition is an essential com
assessment Nutritional supplements/meal replacements might be an option for Ramon
appetite. A dietary assessment can help to determine why Ramona is no
Foods hard on digestion such as nuts, seeds, popcorn, dried fruit, and raw
and should be avoided. Encourage plenty of fluids to stay hydrated.
Depression THIS IS CORRECT. It is important to assess for depression in a client who e
behavioral changes following a stoma creation. The change in body functi
the ostomate’s self-esteem and personal identity. A stoma creation can a
engagement in social activities. The nurse should assess for symptoms of
Self-care THIS IS CORRECT. For a new ostomate, self-care is an important part of ad
significant changes in the body’s appearance and functional ability may c
body image and self-concept. Ramona should be reassured she will be ab
management process. The nurse should assess Ramona’s knowledge of b
better understand the role of the ostomy and empower Ramona in taking
Wound Care THIS IS INCORRECT. An ostomy is not a wound and should not be referred
the result of 2 distinctly different phenomena. An ostomy is not a type of
, Stat
us Label Explanation
rectified; it is not a wound that needs to be healed. Ostomies need to be r
procedures.
Pain THIS IS CORRECT. The nurse should assess pain and allow the client to de
management pain. The nurse should avoid broad statements such as “take the pain me
the client’s knowledge of the medication or ensure that the medication i
inquire about all medications- prescription, over the counter, and herbal o
Activity THIS IS CORRECT. The nurse should inquire about Ramona’s activity level
abdominal exercise should be avoided for the first three months or until in
Scenario 5
You correctly selected 1 out of 6 actions:
Stat
us Label Explanation
Call 911 THIS IS CORRECT. The highest priority for the nurse is to call 9
call 911 before individual action is taken. Naloxone is an opioid
antidote used for complete or partial reversal of opioid effects
Naloxone should be administered for a respiratory rate fewer t
intravenously, naloxone begins to reverse opioid initiated CNS
It works by rapidly binding to opioid receptors and blocking the
immediately cause opioid withdrawal symptoms in patients ph
available as an injectable (needle) solution, a hand-held auto-i
(NARCAN® Nasal Spray).
Try to elicit an oriented, THIS IS INCORRECT. It is not a priority to try to arouse Ramona
verbal response from demonstrating signs of respiratory depression.
Ramona
Conduct a thorough THIS IS INCORRECT. After the emergency response system has
physical assessment Ramona by conducting a rapid physical assessment and asses
including vitals administered for a respiratory rate fewer than 10 breaths/minu
Offer juice to increase THIS IS INCORRECT. Ramona does not have a history of diabet
glucose increase her blood glucose would not be an appropriate action
Perform a bed bath and THIS IS INCORRECT. Performing a bed bath and changing the s
change the soiled
sheets
Allow Ramona to THIS IS INCORRECT. Allowing Ramona to rest is not an appropr
continue resting priority is to call 911 so naloxone can be administered as soon
antidote used for complete or partial reversal of opioid stered
breaths/minute.
Scenario 6
You correctly selected 5 out of 6 actions:
Stat
us Label Explanati
Opioid use disorders do not THIS IS CORRECT. Opioid misuse and addiction may o
discriminate by gender, age, or age, regional, ethnic, or racial peoples.
