Case Study, Chapter 10, Principles and Practices of Rehabilitation
Mrs. Adams 72 years of age is admitted to the rehab unit with the diagnosis of stroke. The stroke affected the limbic area in the brain which has caused the patient to have emotional labiality (her mood changes rapidly because she misinterprets situations). As a result of the emotional labiality she sometimes refuses to be repositioned or to participate in physical or occupational therapy. She sometimes also refuses to eat and drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that do not go away with repositioning. She is incontinent of urine and stool. She has problems with communication called global aphasia (difficulties understanding speech and the written word and difficulties with speaking and writing). She is 5 feet tall and weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin and she has several bandages on her arms. The family states they are concerned because the staff on the previous medical-surgical unit would drag their mother up in bed when she slid down. The staff would chart when their mother refused to be repositioned and then would not reposition her for hours. (Learning Objectives 2 and 4) Principles and Practices of Rehabilitation
Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers?
What nursing measures need to be instituted for Mrs. Adams based on the information presented in the case study?
You are assigned to care for David Ramsey a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility. Principles and Practices of Rehabilitation
(Learning Objective 4)
What assessments are indicated based on this nursing diagnosis?
List other major nursing diagnoses based on David’s clinical presentation.
Answer Hint:
Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers?
Pressure ulcers involves the breakdown of the skin due to prolonged pressure, friction and shear force and insufficient blood supply usually at bony prominences. Weight bearing …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Susceptible areas includes the sacrum, coccyx, heels, knees, greater trochanter and elbow
What nursing measures need to be instituted for Mrs. Adams based on the information presented in the case study?
Decreased tissue perfusion, especially with diabetes, obesity and edema…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Decreased nutritional status (anemia, hypoalbuminemia, vitamin deficiency)