Management of Care. Case study# 3

Case study# 3: Long-Term Care

The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replacement surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation.
Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours.
Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L is an 81-year-old woman with a diagnosis of hypertension and Alzheimer's disease. She is confused, wanders off the unit when not watched, and needs reminders for ADLs.
Mr. W is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently reporting shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. He is lying in bed with his head elevated. He needs help with ADLs.
Ms.Q is a 95-year-old woman with a diagnosis of osteoporosis. She needs help getting out of bed, bathing, and dressing.

Using information from the handover report, the nurse applies principles of delegation and assignment to ensure that patients receive care from staff members who are functioning within the scope of practice.
Which patients could receive most of their necessary care from the APs under the supervision of the RN or LPN? Select all that apply

Case study# 3: Long-Term Care

The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replacement surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation.
Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours.
Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L is an 81-year-old woman with a diagnosis of hypertension and Alzheimer's disease. She is confused, wanders off the unit when not watched, and needs reminders for ADLs.
Mr. W is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently reporting shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. He is lying in bed with his head elevated. He needs help with ADLs.
Ms.Q is a 95-year-old woman with a diagnosis of osteoporosis. She needs help getting out of bed, bathing, and dressing.

Using information from the handover report, the nurse applies principles of delegation and assignment to ensure that patients receive care from staff members who are functioning within the scope of practice.
Which patients could receive most of their necessary care from the APs under the supervision of the RN or LPN? 
Which patient will the RN assess first?

Case study# 3: Long-Term Care

The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replacement surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation.
Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours.
Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L is an 81-year-old woman with a diagnosis of hypertension and Alzheimer's disease. She is confused, wanders off the unit when not watched, and needs reminders for ADLs.
Mr. W is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently reporting shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. He is lying in bed with his head elevated. He needs help with ADLs.
Ms.Q is a 95-year-old woman with a diagnosis of osteoporosis. She needs help getting out of bed, bathing, and dressing.
Mr. W’s arterial oxygen saturation (SaO2) by pulse oximetry is now 89%. Which action would the nurse perform?

Case study# 3: Long-Term Care

The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replacement surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation.
Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours.
Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L is an 81-year-old woman with a diagnosis of hypertension and Alzheimer's disease. She is confused, wanders off the unit when not watched, and needs reminders for ADLs.
Mr. W is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently reporting shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. He is lying in bed with his head elevated. He needs help with ADLs.
Ms.Q is a 95-year-old woman with a diagnosis of osteoporosis. She needs help getting out of bed, bathing, and dressing.
The AP informs the nurse that Mr. K has developed redness on his buttocks and that his incontinence pad has been changed very frequently. Which condition is most likely?

Case study# 3: Long-Term Care

The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replacement surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation.
Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours.
Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L is an 81-year-old woman with a diagnosis of hypertension and Alzheimer's disease. She is confused, wanders off the unit when not watched, and needs reminders for ADLs.
Mr. W is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently reporting shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. He is lying in bed with his head elevated. He needs help with ADLs.
Ms.Q is a 95-year-old woman with a diagnosis of osteoarthritis. She needs help getting out of bed, bathing, and dressing.
At 5:30 PM, the AP reports that Mr. B, who had hip replacement surgery 3 days ago, refuses to get out of bed to walk in the hall as prescribed. What is the RN’s first action?

Case study# 3: Long-Term Care
The RN is the nursing supervisor for the evening shift at a 30-bed long-term care facility (nursing home). The staff for the evening includes an LPN/LVN and three assistive personnel (APs). During the change-of-shift report, the following information is given on these six patients:
Mr. B is a 79-year-old man who underwent hip replace- ment surgery 3 days ago. He needs help getting out of bed, getting dressed, and ambulating. He was admitted yesterday from the hospital for rehabilitation. Ms. R is an 86-year-old woman who has heart failure and type 2 diabetes and is recovering from a recent myocardial infarction. She has an indwelling urinary catheter. She is usually alert and oriented, but she has become confused over the past 12 hours. Mr. K is a 53-year-old man with a diagnosis of amyotrophic lateral sclerosis. He is totally dependent when it comes to activities of daily living (ADLs) and has a percutaneous endoscopic gastrostomy tube through which he receives intermittent feedings every 4 hours. He is incontinent of urine and stool. He has a living will requesting that no heroic measures be used to prolong his life.
Ms. L, who has Alzheimer's disease, wanders into Mr. K’s room. The LPN/LVN finds her disconnecting Mr. K’s tube feeding. Ms. L says, “Hello, dearie, I was just cleaning this up for you.” What is the best action for the LPN/LVN to take at this time?