Nursing Case Studies

Nursing Case Studies

Nursing case studies examine theoretical and philosophical perspectives of caring and various ways of exploring the meaning and practices of nursing by using examples of patients who have undergone different health isues.  Nursing students should go through many case studies to boost creativity and critical thinking. This article aims to shed light on various case studies that will help nurses deveop solutions during critical times.

Case Study 1

This is a nursing case study of a 41-year-old female dental hygienist.

Patient Profile

This is a nursing case study of B.N., a 41-year-old female who is a dental hygienist who has had several surgeries due to a knee injury over the past five years. She presents to the outpatient surgery department today for her last reconstructive surgery. Her past medical history indicates she had asthma as a child and had one occurrence of contact dermatitis. However, she tells you she has no known drug allergies.

You start B.N.’s IV and perform a saline flush. Within three minutes, B.N. states that her IV site itches, and a few minutes later, she begins to complain of tightness in her throat.

Subjective Data of the Nursing Case Study

States IV site itches

States throat and neck feel tight and says, “I feel like I can’t breathe.”

Objective Data of the Nursing Case Study

Vital signs: Temp 98.8° F, Heart rate 120, Respiratory rate 32, Blood pressure 100/60

Oxygen saturation 85%

Wheezing in all lung fields

Restless

Swelling at IV site

What type of altered immune response is B.N. experiencing?

What is the apparent causative factor, and what were potential sources of exposure?

The patient had an allergic reaction, possibly from the catheter. Catheters are usually made from silicon and other material made with polyurethane, polyvinyl-chloride, nylon, polyethylene, which are commonly used in the medical field. More than likely, this material caused B.N. to have an allergic reaction.

What are the priority nursing interventions in this situation? What medications might you expect the health care provider to prescribe?

The nurse must first remove the IV from the patient and immediately give B.N. Benadryl.

What were B.N.’s risk factors for this type of reaction?

Because B.N. has a history of asthma, this could cause her to be hypersensitive to latex. Also, her reoccurring symptoms of contact dermatitis would be cause for suspicion.
My son, 10 yrs old now, also had asthma and eczema when he was a baby. He has grown out of it for the most part but is still very sensitive to a lot of things

Based on this reaction, to what foods should B.N. be tested for allergies?

Some food allergies that B.N. should be tested for include:
Avocado
Banana
Chestnut
Kiwi
Apple
Carrot
Celery
Papaya

How can such reactions be prevented from occurring?

This patient should get tested for food allergies, avoid obvious latex signs, carry an EpiPen, and wear an allergy medical alert bracelet, be sure to tell medical providers about the allergy before surgeries, vaccines, etc.

 

 

Case Study 2: Breathing Patterns

The following nursing case study of breathing patterns is of a patient named Josh.

The nurse assesses Josh’s vital signs. His respirations are rapid and shallow. What is the best technique for the nurse to evaluate Josh’s respirations accurately?

Place a hand on Josh’s chest and count the hand motion- technique to observe chest movement even when respirations are shallow

Josh’s respiratory rate is 36. How should the nurse describe Josh’s respiratory

pattern?

Tachypnea-rapid respiratory rate, which is consistent with his rate. school-aged child breaths per minute: 16-30

Because of Josh’s dyspnea, the nurse is concerned he may need to receive O2. To determine the need to apply a nasal cannula, which assessment is most important for the nurse to perform?

Measure O2 saturation-important data about the pt’s overall oxygenation.

In assessing Josh’s breath sounds, the nurse should ask him to perform which action?

Breathe deeply through the mouth with a slightly open mouth for best auscultation of breath sounds

To measure capillary refill, the nurse must perform which action?

Compress Josh’s nailbed-to measure capillary refill (how quickly normal color returns)

The nurse plans to measure Josh’s O2 saturation w/spring-tension finger clip. While the nurse explains the procedure, Josh asks if it will hurt. Which response is best for the nurse to provide?

The clip feels like squeezing your finger with your other hand–give him context he can understand the sensation

Nurse measures O2 sat: 88% and capillary refill at 1sec. Breath sounds are absent in base and coarse bilaterally throughout the rest of the lung fields. The nurse applies a nasal cannula and administers O2 at 2L/min. When using a nasal cannula, it is most important for the nurse to provide what instructions?

Remind client and family that O2 is combustible and must be kept 10ft from open flames-CLIENT SAFETY

Which nursing diagnosis is most relevant to Josh’s current status?

Impaired gas exchange-Normal (95-100%)-bc sat is well below normal it is impaired

Which assessment finding further supports diagnosis?

Restlessness and fatigue-indications of hypoxia (Restlessness is an early sign of hypoxia that’s often missed)

After determining priority nursing diagnoses, what step should the nurse take next in developing a care plan?

Establish goals and expected outcomes. After analyzing data to determine priorities, nurses should establish care goals and expected outcomes.

Which outcome statement should the nurse use for Josh’s plan of care?

The client’s O2 saturation will be >95% on room air–the client-centered outcome statement describes the desired outcome in measurable terms.

The nurse has initiated the prescribed O2 therapy to achieve the desired outcome. After applying the nasal cannula, the nurse plans to attach a disposal sensor pad to measure the O2 sat continuously. What action should the nurse implement before applying the sensor?

Determine if Josh has a latex allergy-disposable pads may be made of latex-if they are nurse should confirm client does not have a latex sensitivity or allergy

After receiving O2 for a short while, Josh is much less dyspneic. The nurse notes that the O2 sat: at 97%. 15 min later, O2 sat alarm indicates reading changed to 80%. What immediate action(s) should nurse implement

-Reposition the finger clip and obtain another reading since he is not in distress (reapply to confirm the sudden drop in O2 sat)
-Assess Josh for S/S resp distress-priority
-Encourage Josh to begin coughing and deep breathing- coughing helps to clear mucous from the airway, which will allow for max lung expansion

After the nurse repositions the finger clip and O2 sat: 97%. Despite normal reading, Josh’s mother appears worried/nervous “He’s never been sick. I am so scared.”
How should the nurse respond to encourage the mother to share more about her feelings?

“It sounds like this has been a very frightening experience for you.” –this open-ended statement acknowledges the difficult situation the mother is experiencing and encourages further discussion.

After further conversation with Josh’s mother, the nurse needs to leave the room to assess another client. Which action by the nurse demonstrates the use of trust in the nurse-client relationship?

Returning to the room time as promised-trust and rapport is important to develop during the orientation stage, so the client has the most optimal outcome.

Upon returning to the room, the nurse assesses Josh’s cough. Which documentation is subjective data?

The client reports that he is coughing a lot

Which documentation best reflects the nurse’s objective assessment?

Frequent deep cough, producing SMALL amounts of PALE YELLOW sputum–objective report-w/documentation of thorough description of the cough and sputum produced)

Upon further observation, the nurse describes Josh’s sputum as “Tenacious.” To what does this refer?

Consistency-sputum w/ thick consistency (sticking together TENACIOUSLY)

Since Josh has a productive cough, HCP requests that sputum specimens be obtained and sent to the lab for culture and sensitivity. In assisting Josh to obtain a sputum specimen, what action should the nurse take?

Instruct Josh to cough deeply from the chest and spit into specimen cup–this technique is the least invasive and will provide sputum rather than mucus. The alert client who can follow instructions and has a productive cough can obtain a specimen without an invasive catheter.

The patient care technician is planning to transport sputum to the lab. What instructions should the nurse provide?

Place specimen cup in a biohazard bag for transport-this protects the person transporting specimen and the lab personnel receiving the specimen.

HCP determines Josh has a respiratory tract infection and prescribes oral abx and oral liquid cough syrup. Josh’s mother obtains meds at the pharmacy and shows them to the nurse. The prescription for abx reads, “Take two pills for 1st dose, followed by one pill every 12 hours.” The mother asks the nurse if this “seems right.”
How should the nurse respond?

“A large 1t dose, called a loading dose, is often used to achieve a therapeutic level more rapidly in the bloodstream.”

The liquid cough syrup is labeled as an antitussive. The nurse explains this medication should have what effect?

Reduce the frequency of the cough-antitussives are used for this purpose–this may be desirable for Josh at night to allow him to sleep.

The med label states, “Take 2 tsp every 4hrs as needed.” The nurse gives Josh some medication cups and teaches him and his mother to pour the medication into the cup. To what level should the medication be poured?

10mL (1tsp=5mL)

Josh and his mother returned to the HCP office one week later, after Josh completed the course of abx therapy. In assessing Josh’s breath sounds, where should the nurse listen first?

Lung apices-top of the chest, moving down systematically, ending at the lung base.

Nurse auscultates vesicular breath sounds in the peripheral lung fields. What action should the nurse take?

Record presence of clear breath sounds- vesicular breath sounds (NORMAL) in peripheral lung fields

Which serum lab value confirms the resolution of Josh’s infection?

WBC 6,000/mm(^3)-normal value for a child, confirming the resolution of the infection.

 

 

Case Study 3

This is a nursing case study of constipation

Which sequence should the nurse perform the abdominal assessment?

Inspection, auscultation, percussion, palpation.

Which assessment is most important to perform in this nursing case study?

Auscultate bowel sounds.

Which is the most important action for the nurse to perform when assessing bowel sounds?

– Listen for up to 5 minutes when auscultating for bowel sounds.
– Begin auscultation in the right lower quadrant.

The nurse auscultates for Janelle’s bowel sounds and hears faint gurgling sounds after 3 minutes. Which assessment finding should the nurse document?

Hypoactive bowel sounds.

How should the nurse respond?

“Tell me what is making you feel so upset.”

Which response by the nurse will encourage continued verbalization by the client?

“It sounds as if you have had another experience that did not go well.”

Janelle responds, “I did everything my HCP told me to do. The surgery must have caused this. They must have made a mistake.” Which explanation by the nurse is accurate?

Explain to the client the multiple factors that can decrease peristalsis postoperatively, even when the desired surgical outcome is achieved.

Which postoperative medication is most likely to contribute to constipation?

Morphine sulfate, an opioid analgesic.

What impact does this fluid intake have on Janelle’s bowel patterns?

This inadequate fluid intake has contributed to her constipation.

What other questions should the nurse ask Janelle?

“How often do you get out of bed and walk?”

Which response by the nurse accurately describes a barium swallow?

A barium liquid is swallowed, and a series of x-rays are taken.

Which nursing diagnosis should the nurse include in Janelle’s plan of care?

Constipation related to surgery and anesthesia.

How will the nurse explain to Janelle the action of the laxative?

“Soften the stool, distend the rectum to expel the stool.”

The nurse administers the first dose of docusate sodium. This medication primarily alters which aspect of a client’s bowel movement?

Consistency.

Before administering the rectal suppository, how should the client be positioned?

Sim’s

When administering the rectal suppository, the nurse asks Janelle to take several slow, deep breaths. What is the rationale for this instruction?

Relax the anal sphincter and reduce discomfort.

After administering the rectal suppository, it is most important for the nurse to document which information?

  1. One bisacodyl suppository was administered per rectum for constipation, as prescribed.

Which statement provides the best documentation describing the outcome from the suppository administration?

  1. The client produced six ¼ inches hard pellets of brown stool following suppository administration.

To determine the presence of fecal impaction, the nurse prepares Janelle for which prescribed procedure?

– Radiographic examination.
– Digital rectal examination.

The UAP obtains sterile gloves and lubricant for the nurse and offers to perform the procedure since the nurse is busy. Which action is the most important for the nurse to implement?

Ask the UAP to assist with client positioning while the nurse performs the procedure while teaching the UAP about the correct supplies needed.

While performing the digital rectal exam, the nurse recognizes that the client may experience vagal nerve stimulation. This can result in which change in vital signs?

Decreased pulse rate.

What action should the nurse implement?

Administer the enema as prescribed and obtain the HCP’s signature the next day.

When receiving the verbal prescription over the telephone, the nurse repeats the prescription back to the HCP, who sounds angry and shouts, “Are you questioning my prescription?” Which approach by the nurse is the best response to the angry HCP?

“I want to ensure that I transcribe this prescription correctly to avoid an error.”

What actions should the nurse take to relieve the abdominal cramping?

Slow the rate of the infusion.
Roll the clamp to stop the enema until cramping subsides.

What task can the nurse delegate to the UAP?

Assist the client with a bed bath and hygiene if required.
Assist the client who vomited with mouth care after the R.N. administers an antiemetic.

How will the nurse accurately explain the amount of fluid to Janelle using household measurements?

3 cups

The nurse encourages Janelle to increase her daily oral fluid intake to 2 liters of fluid for the next few days. In addition, the nurse advises Janelle to drink a minimum of how many 8-ounce cups of fluid daily?

8 – 9

Which type of diet should the nurse recommend in this nursing case study?

High Fiber

The nurse uses the hospital breakfast menu as a teaching tool. Which breakfast selection by Janelle indicates that she understands teaching about dietary measures to promote bowel regularity?

Orange juice and oatmeal with raisins.

 

 

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