Nursing Case Study Scenarios

Nursing Case Study Scenarios

Introduction

Nursing case study scenarios help nursing students to test their knowledge of identifying illnesses and prescribing the right medication.  With more and more health cases developing and the need for adequate medical care, nursing students need to use case studies to get critical thinking facilities. The nursing case study scenarios below provides information about various medical tconditions.

Complex Care Facility

Complex care is a facility that provides 24-hour skilled nursing care and supervision for people who can no longer care for themselves. Staff members administer medications and assist residents with their daily needs, such as bathing, dressing, and eating.

Cerebrovascular accident

A cerebrovascular accident, also known as stroke, is when blood flow to the brain is stopped by a blockage which would be ischemic, or by the rupture of a blood vessel which would be hemorrhagic

Hemorrhagic Stroke

Hemorrhagic Stroke is when a blood vessel ruptures, and bleeding into the brain occurs. Due to this, the intracranial pressure in the brain may increase, thus disrupting normal brain function. Hemorrhagic strokes can be classified by location, as intracerebral or subarachnoid.

ischemic stroke

The obstruction of a blood vessel causes ischemic Stroke by an atherosclerotic plaque, a blood clot or a combination of the two, or other debris released into the vessel that stops the blood flow to an area of the brain. In an embolic stroke, the clot is travelling through a blood vessel from outside the brain and lodges into a cerebral artery. A thrombotic stroke develops when an obstruction forms in a blood vessel of the brain.

Diagnosis for CVA

MRI to detect brain tissue damage/bleeding.

Frontal Lobe

Patient JP suffered a minor stroke recently. Although he has recovered most of his function, he still is unable to speak clearly. He sounds stitled and almost “Tarzan-like.”

Occipital Lobe

Patient GN recently was struck in the head with a crowbar. Although her eyes were undamaged, she is now unable to see.

Amygdala

Patient AF is suffering from a brain tumor. As the tumor grows, he is becoming increasingly belligerent and aggressive. However, he also seems to have no fear when confronted with threats or danger.

Parietal Lobe

Patient BB, ironically enough, has been shot in the head with a BB gun. The BB is now lodged in her brain, and she has lost feeling in her left hand

Hippocampus

Patient PD suffers from an extreme seizure disorder. Doctors have located the source of the seizures. To prevent PD’s death, they have surgically removed the affected area. Unfortunately, while PD’s seizures have lessened considerably, he is now unable to form new memories.

Cerebellum

Patient FD has suffered from a minor stroke. Now she is extremely uncoordinated and seems to have completely lost her sense of balance

Plan of care for pt

QPA (increase IV rate), bubbles, blood transfusion, recheck fundus, talk ab PP depression w, instructor

components of QPA

safety, general appearance, LOC/LOO, in’s and out’s, pain, safety

blood transfusion first check

check pt label on dr order to pt label on transfusion record

blood transfusion second check

check pt info on the green tag to transfusion record, then actual information on green tag to blood product

blood transfusion third check (in room)

get pt to say and spell name and state DOB while checking wrist bands, green tag, transfusion record, then double-check J # on blood product and pt bracelet

before blood transfusion

check dr order, ensure consent, explain the procedure, ensure venous access, get ABO group from the computer, then go to the blood bank

what is needed for blood transfusion

Two bloodlines, regular IV line, 50ml NS, 500 ml, NS

What to do if a transfusion reaction is suspected?

Stop transfusion, start 500mL bag of NS, take vitals q5 minutes until stable, do three checks again to ensure mistake on your end wasn’t made, return products and lines to the blood bank.

what causes acute hemolytic reaction

ABO incompatibility

what causes febrile hemolytic reaction

WBC’s or antibodies in donors blood

what causes anaphylaxis reaction

proteins in donors blood that patient is allergic to

what causes circulatory overload

too much blood in a short amount of time

signs of anaphylactic reaction

hives, itching, wheezing

Signs of acute hemolytic reaction

back pain, headache, dyspnea

signs of circulatory overload

cough, distended neck veins while sitting up

Signs of febrile non-hemolytic reaction

fever, chills, flushing

When does PP depression occur?

starts within one-month pp and can last weeks or months

signs of pp depression

hopelessness, guilt, anxiety, inability to eat and function, sleep disturbances, lack of bond with baby, decreased pleasure in once pleasurable activities

APGAR (what does it stand for)

appearance, pulse, grimace (response to stimuli), activity, respiration

how many points are possible in each aspect of APGAR

2

Four components that could lead to pp hemorrhage

trauma, tissue (fragments), thrombosis, tone

aspects of bubbles assessment

B- breast condition and nipples (heat, nodules, tenderness, intactness of nipples, etc.)

U- uterus tone and placement

B-bladder

B-bowels

L- legs and lochia

E-emotional status

S- suture and perineum

right before transfusion begins

take vitals, resp and cardiac assessment, have RN hang blood, and start transfusion at 1/2 speed.

once transfusion begins

stay for 15 mins. Take vitals at the 10-minute mark, get RN to increase the rate at 15 mins before you go. vitals q1hr once it begins

care plan for someone at risk for PP depression

ask about supports, offer resources, assess mental wellbeing post-birth, address concerns and explore them.

why is someone at higher risk for pp depression

past HX, family has Hx of bipolar disorder, less support systems, first baby, young or old age, unplanned pregnancy, loss of partner or relationship recently

aspects of ins for patient

IV tubing, rate(change), solution, site, food, drink

aspects of outs for patient

peri pad (may need to weigh. 1g=1mL), urine output, gas, bm

Pain Assessment

Where is the pain? Inside or outside?

P- does anything make it better or worse?

Q- How would you describe the pain? (throbbing, stabbing, aching)

R- does it radiate anywhere else? or stays in the one area

S- scale of 1-10?

T- when did it start?

mild cerebral palsy pathophysiology

interruption of oxygen supply to the fetus or newborn resulting in mental and physical capacity

mild cerebral palsy manifestations

toe walking, stiff or floppy muscle tone, lack of balance/coordination, uncontrolled tremors or movement

BP for 12-year-old

110-120/ 65-75

RR for 12-year-old

12-20

pulse for 12-year-old

85-105

t3’s use/side effects/ onset/ nurse considerations

moderate to severe pain, constipation/suppressed respiratory rate, take RR and observe LOC/LOO.

why is ringers lactate given

to improve hydration and replace electrolyte loss

plan of care for individual

QPA, assessments, d/c Cath and IV, dressing change, therapeutic convo about missing school, etc.

QPA components

safety, general appearance, ABC, LOC/LOO, In’s/out’s, pain, safety

what do you need to grab for catheter removal

empty syringe, blue pad, clean gloves

what do you need to grab for IV removal

gauze, tape, clean gloves, sanitizer

what do you need to grab for incision cleaning

blue pad, sterile kit, sterile gloves, NS, abdominal dressing, clean gloves, sanitizer

dressing change steps

check dr order, explain the procedure, ensure comfy, clean surface, put materials on the table, put down the blue pad, remove dressing, open kit, add other materials, put on gloves, begin cleaning. And redress/chart.

why do focused assessments

abdominal because post-op and using opioids can cause constipation, respiratory because post-op using anesthesia and want to make sure lungs sound good.

therapeutic conversation

how he’s feeling, how many days he’s missed from school, if he’s been given homework, if we could ask his parents to reach out, reason about friends not visiting.

aspects of the ins and outs

ins- IV, food, drink

outs- catheter, bm’s, gas, and dressing shadowing

med check (prelim)

prelim- pages in mar, pt name, allergies, any unfamiliar meds, which to pour first, discontinued meds

med check (1st)

pt name, drug, dose, time, route, reason, documentation, pt education, pt right to refuse

med check (2nd)

pt name, drug, dose, time, route, reason, documentation, pt education, pt right to refuse (expiry date!)

med check (3rd)

pt name, drug, dose, time, route, reason, documentation, pt education, pt right to refuse

med checks (once in the room)

identify pt with bracelet, and they say name and DOB.

behavior that would indicate post-op pain

holding site, pallor, sweating (diaphoresis), confusion, vomiting, grimacing

RR for four-year-old

20-25

BP for four-year-old

95-100/ 55-75

Pulse for four-year-old

100-120

budesonide (use, side effects)

corticosteroid to reduce inflammation in airways, headache, N+V, drowsiness

salbutamol (uses, side effects)

bronchodilator to open airways, headache, N+V, tremor

interstitial iv signs / nursing interventions

when fluids are going to the area around the vein, redness, inflammation, cool site, pain (D/C + warm compress)

Asthma patho/ causes of attacks

inflammation of airways in the lungs. Characterized by episodes of severe breathing difficulty, coughing, and wheezing. Exacerbations may be due to cold, exercise, allergens, etc.

plan of care for the patient

HELP BREATHING, QPA, focused assessment, admin medications via nebulizer, d/c IV, remove sutures, communication on dx and situation

what is included in QPA

safety, general appearance, ABC, LOC/LOO, In/out, pain, safety

ins for patient

IV, food, water

outs for patient

bm, suture exudate/dressing, urine output

what to bring to discontinue IV

clean gloves, gauze, tape, sanitizer

what to bring to remove sutures

steri strips, suture removal kit.

Prelim check for neb meds

  1. name, allergies, pages in MAR, unfamiliar meds, discontinued meds, what needs to be poured first

1st check for neb meds

patient, drug, dose, route, reason, time, documentation, pt education, pt right to refuse

2nd check for neb meds

patient, drug, dose, route, reason, time, documentation, pt education, pt right to refuse, EXPIRY!

3rd check for neb meds (in room)

patient, drug, dose, route, reason, time, documentation, pt education, pt right to refuse. get pt to say name and DOB, check bracelet, pour salbutamol first, and nebulize

how to give the next nebulizer med

do 3rd check-in room, rinse chamber with water, pour in, and nebulize

salbutamol or budesonide first

salbutamol

removal of sutures quick walkthrough

clean gloves on, remove dressing if present, remove every other suture (forceps in non-Dom, scissors in dom hand), apply sterile strips.

education to provide for asthma

ensure he has an aero chamber, talk about when attacks happen, determine if he’s using meds properly, talk about always carrying it on them, etc.

plan of care for pt

QPA, bubbles assessment, focused assessments, insert a catheter, abdominal dressing change, breastfeeding education

QPA includes

safety, general appearance, ABC’s, LOC/LOO, in’s and out’s, pain, safety

BUBBLES assessment

breast(feel for lumps, tenderness, heat, nipple condition)

uterus (tone and location)

bowels

bladder

legs and lochia

emotional status (supports, how feeling since the birth, concerns about going home, etc.)

sutures and perineum (check for hemorrhoids or inquire)

ins for patient

food, water

outs for patient

urine, bm’s, gas, lochia, abd shadowing

re inserting catheter (before supplies)

check dr order, explain the procedure, allergies to latex or shellfish

prep for inserting a catheter (up draping patient)

position patient, the blue pad under bum, perform peri care, apply anchor, set up drainage bag, clean surface, open kit, add catheter, put on sterile gloves, drape patient

insertion of catheter

clean perineum w antiseptic (farthest labia first), lube catheter, insert on a count of 3 while bearing down, proceed until urine return then proceed another 2-5 cm, inflate the balloon, and pull back until resistance, attach to a drainage bag, attach to anchor. clean up supplies

what to bring in for catheter insertion

kit, blue pad, catheter, anchor, drainage bag, sterile gloves

what to bring in for abdominal dressing change

clean gloves, dressing kit, abdominal pad, NS, blue pad

what assessments and why

resp cause post-anesthesia, abdominal because of pain meds can slow motility

breastfeeding education

positioning, nipple creams, what a good latch will look like (not painful, see jaw moving, not hearing milk sloshing, bb has the whole nipple in mouth, looks like a fish), chin to breast first.

APGAR

appearance, pulse, grimace, activity, respiration

how many points are possible per the Apgar section

2

When is Apgar scoring performed on infants?

1, 5, 10 mins post-birth

why would fungus have deviated from midline

full bladder

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