Read the case study and answer the questions below

Read the case study and answer the questions below.

 

Case Study:  

Mrs. Green is an alert & oriented 76-year-old client who has been in the hospital for six weeks while recovering from a cerebrovascular accident (CVA).  Prior to admission, Mrs. Green lived with her 78-year-old husband in a bungalow.  They have no children. Mrs. Green is an avid gardener and states that she is concerned about whether she will be able to resume her gardening when she returns home.  She also played bridge once a week with several friends and enjoyed walking in the park with her husband.  Both she and her husband are non-smokers.

 

Mrs. Green is in a 2-bed hospital room which she shares with another woman who is disoriented and who is often noisy at night.  Mrs. Green wears glasses and a hearing aid in her right ear.  Her speech is slightly slurred.  There is a radio in her room, but no television.  She uses her call bell frequently and states “I just wish someone would pay attention to me.”  She often asks the nurses to call her husband to ask him to come and visit her.  Her husband visits only once per week because he suffers from hypertension and has poor vision.  Driving is difficult for him.  She is anxious to return home because she is worried about her husband’s ability to manage without her.

 

Mrs. Green has right-sided weakness.  She requires and asks for the assistance of one nurse to pivot transfer her into her wheelchair.  She can turn herself to her right side by placing her left hand on the side rail and pulling.  However, she tends to roll back into the supine position unless her back is supported with a pillow.  She attends physiotherapy each day and is starting to ambulate with a quad cane. She tires easily and her balance is poor.  She can exercise her right arm, using her left arm, but has limited strength to exercise her right leg.

 

Mrs. Green can feed herself, using her left hand once containers have been opened. She has been experiencing some difficulty swallowing and is now receiving a minced diet with thickened fluids.  She finds the food unappetizing and often leaves most of the meal on the tray uneaten.  She drinks approximately 1500 mL of fluid / day.  She is 150 cm and weighs 50 kg.

 

Mrs. Green’s skin is intact, but yesterday, the nurse noted small areas of redness, about the size of a quarter, over the coccyx and outer aspect of her right heel.  Both ankles are edematous.  Lately, she has been experiencing urinary urge incontinence and is wearing adult briefs.  She states, “I am so embarrassed to wear these diapers.”  She doesn’t complain of burning.  She last had a bowel movement (BM) four days ago.  Her usual BM pattern at home was every other day.  She says she hates to use the bedpan because it is “uncomfortable and embarrassing.”  The doctor ordered laxatives to be administered, if necessary.

 

Today, Mrs. Green’s vital signs are: TPR 37.5°C, P80 beats/min, R20 breaths/min, BP 110/70 lying and 98/60 standing. O₂ sat is 95% on room air. She has a dry, occasional cough which she attributes to the dry hospital air.  She has minimal chest expansion, with decreased breath sounds in the lung bases.

 

QUESTIONS!!

 

1. What is the analysis of data cluster according to the scientific knowledge base (SKB) and nursing knowledge base (NKB)?
Data Cluster:

– Redness, about the size of a quarter, over the coccyx and outer aspect of her right heel.

– Both ankles are edematous.

– She drinks approximately 1500 mL of fluid / day.

– She is 150 cm and weighs 50 kg.

-She last had bowel movement (BM) four days ago.

SKB: Nutritional deficiencies can reduce red blood cells and white blood cells that can affect delay of oxygen and inflammatory res[once for wound healing (Kozier, et, al., 2018). The blood supply to the wound increases, bringing substances and nutrients important to the healing process. As a result the area appears red and edematous (Kozier, et al., 2018). In adequate intake of calories, protein, vitamins, and iron could be a high risk of development of pressure injury, nutritional supplements should be considered for nutritionally compromised patients (Kozier, et, al., 2018). Water acts as a solvent for nutrients and waste products. Muscle contains more water – percentage of total body water is greater in lean people than obese. Water can dissolve wastes and acts as a transport and exchange medium in the body (Marieb, 2017). To digest foods, water molecules are added to the bonds of larger molecules in order to break them down; water acts as a reactant (Marieb, 2017). Poor nutritional conditions affect skin integrity. For example, rough, dry, scaly, pale, pigmented, irritated appearance; bruises; petechiae; subcutaneous fat loss therefore patients will be at high risk of skin infection (Potter, et, al., 2019).

NKB: Hydration is key to all individuals, it aids in preventing many diseases, helps regulate the body, and it helps transport nutrients to cells (Marieb, 2012). For example, research shows that increasing water intake compared to other beverages can lead to body homeostasis. The body needs water to digest nutrients and eliminate waste products (Marieb, 2012). Such as constipation and infection could be prevented. In addition patient should encouraged fluid and fibre intake to ease and regulate bowel movement (Potter, et, al., 2019).

 

2. What is the analysis of data pattern according to the scientific knowledge base (SKB) and nursing knowledge base (NKB)?
Data Pattern:

She finds the food unappetizing and often leaves most of the meal on the tray uneaten.

SKB: Smell plays a crucial role in stimulating appetite. When individuals encounter pleasant aromas from food the brain triggers hunger signals and enhances desire to eat. Temperature and texture of food can also enhance or spoil the taste for individuals.

Many factors affect taste, and what is commonly referred to as our sense of taste depends heavily on stimulation of our olfactory receptors by aromas. (Marieb, Keller, 2021).

NKB: Eating with others encourages good nutrition and promotes socialization with peers (Potter et al., 2019).

Medical conditions such as a stroke can cause difficulty with eating and swallowing. These issues can be a result of muscle weakness and neurological damage leading to potential risk of aspiration. Nurses can assist with feeding, however, nurses require skilled intervention to promote independence, dignity and safety.

 

3. What is the analysis of data norm according to the scientific knowledge base (SKB) and nursing knowledge base (NKB)?
Data Norm:

76 years old

SKB: Older adults need nutrients for energy, however, this need declines over the years. Moreover, there is a decline of physical exercise, and unappetizing frequent uneaten tray, and that could affect increased weakness and decreased healing ulcers (Potter et al., 2019).

NKB: Growth and nutrition needs to be stabilized during adulthood (Jarvis, 2014). Lifestyle factors such as stress, lack of physical activity, fluid intake and diets high in saturated fats, cholesterol, salt and sugar, as well as diets low in fibre, require needs-based nutrition education, which prevent or delay the onset of chronic diseases (Jarvis, 2014). The patient’s poor lifestyle factors at age 76 has shown to be a potential diagnosis of a disease (Jarvis, 2014).

 

4. Provide scientific knowledge base based on the data gap and what is the analysis of data cluster according to the scientific knowledge base (SKB) and nursing knowledge base (NKB)?
Data Gap:

What were the patient’s dietary habits before admission?

SKB: 

 

NKB: Knowing patient dietary habits before admission is essential as it help nurse in understanding patient baseline nutritional needs and preferences. This will help nurse to tailored care plan and align it with the patient’s dietary habits and nutritional requirements*******This will also allow nurse to identify any significant changes in patient’s eating pattern (Potter, et al., 2019).

Changes in health condition may indicate a need to change the nutritional care plan. Interdisciplinary team members should be consulted, and the patient should be an active participant whenever possible.The patient’s ability to incorporate dietary lifestyle changes with the least amount of stress or disruption will ensure success. (Potter, et, al., 2019).

 

5. What is the analysis of data cue and inference according to the scientific knowledge base (SKB) and nursing knowledge base (NKB)?
Data Cue and Inference:

Cue: Loneliness

Inference: Being away from her husband and friends, she won’t be able to eat properly on time based on the Canadian Food Guide which can affect her nutritional condition.

SKB: Older adults should lead a meal plan based on their health (Kozier, et, al., 2018). Physical change such as impaired sense of test, and smell can affect eating habits. Decreased saliva and gastric juice secretion can also cause a patient’s nutrition. Loneliness could affect psychological nutritional problems. As a result patients may adopt poor dietary behaviour, anxiety, depression, dependence on others (Kozier, et, al., 2018).
NKB: Research shows that older adults living alone are at higher risk for malnutrition and cachexia of aging such as, lean muscle wasting, osteoporosis, immune dysfunction, anemia, and poor wound healing (Kozier, et, al., 2018).