Reference no: EM133928575

Roberts Case Study

You are an RN, the charge nurse hands you the following report on a new patient, Maria Roberts, that should be arriving momentarily: History of Present Illness: Maria Roberts, an 80-year-old female, who underwent exploratory laparotomy with colon resection and colostomy earlier today (Thursday). She has an epidural for pain management in place. The PACU nurse reports that Maria's blood pressure has been "lower than usual". Maria's history also indicates she has Type 2 diabetes mellitus, which is generally well-controlled, osteoarthritis, and that she is hard of hearing but doesn't wear hearing aids.

Personal/Social History: Mrs. Roberts is a widow who lives in her own home. She resides with her only child, Simon, who is 60 years old. Simon has Down's syndrome and is developmentally delayed; however, he tries very hard to be helpful to his mother. They live in a small farming community about an hour from the hospital. Mrs. Roberts arrives on the nursing unit and is transferred to a patient bed.

Part 2

At the end of the shift, Maria asks Samantha, the nurse, for a heating pad as her shoulder and back hurt due to her osteoarthritis. Despite already giving report to Nancy, the oncoming nurse, Samantha checks the chart and notes that there is no order for a heating pad. As Nancy is admitting another patient, she decides to make a heat pack using washcloths and water from the coffee pot. While unknown at the time, later assessment revealed the temperature of the water from the coffee pot was 174°F. The washcloths are placed in two plastic bags and a pillowcase and placed between Maria's shoulder and her lower back. As she leaves the unit, Samantha reports the heat pack to Nancy, who was a traveling RN. However, she is in a rush to pick up her children, so she doesn't chart the heat pack in the Electronic Health Record (EHR). Nancy performs a skin assessment but does not see a heat pack as she was looking for an aqua K-pad, which is the only sort of heat pack she even knew existed. She saw no machine; therefore, she didn't give this another thought. Because Maria can turn herself, no request was made, or effort initiated to reposition her every 2 hours. In addition, no further skin assessments were done beyond the one at the beginning of the shift.

The following day (Friday), the nurse, Sean, performed a skin assessment as part of his head-to-toe assessment. Sean stated the patient sat up so the epidural site could be assessed. "Part of a blister" was noticed on the patient's lower back; there were no blisters in the shoulder area, but no further assessment of the area (lower back) was performed. The Wound Care Nurse arrived on the unit later in the day to perform an admission skin assessment and ostomy referral. The Wound Care Nurse rolled Maria to assess the skin on the back and noted an area on the patient's buttocks had blisters present. Sean was notified by the Wound Care Nurse of the blisters and told to call the physician. When the Wound Care Nurse returned on Monday, she observed that the physician was never called, so she called the physician Monday morning and obtained orders to treat the burn.

Part 3

Maria had planned to be discharged home on Wednesday. Because of the burns, she will need dressing changes. As Maria doesn't have any family other than Simon, she is transferred to a skilled nursing floor on Wednesday. After several days on the unit, the staff noted that Maria is not eating much and that she had stopped socializing with her roommate and with the staff. During an assessment, Maria indicates all she wants to do is go home and resume her life. She is also concerned about her son and how he is coping with her extended stay. After the nurse consults with the physician regarding Maria's condition and concerns, a decision is made to discharge her with home health support. Simon will serve as Maria's primary caregiver, with the home health nurse checking in periodically.

1. After reviewing the Coleman and Roman (2015) describe the caregiver's experience as it relates to the patient and son presented in this case. How could the identified themes be applied? What assessments would we want to include? Be sure to address all five themes. do you think that the themes are still relevant? Why or why not? Incorporate sources to support this discussion.

2. Prior to surgery, Maria anticipated being able to return home and live independently while caring for her son. Describe 4 community resources, other than home health, that could help Maria achieve this healthcare outcome. Incorporate relevant sources into the discussion of each one.

3. Describe three workarounds and their potential negative outcomes.

4. Discuss at least two outcomes that could have been avoided for Maria if the nurse had not used a workaround, providing a rationale for your discussion.

5. Describe the process for communicating, clarifying, and revising workflow processes in your facility. Who would you contact? How would you initiate contact? What if they were not responsive?