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Chapter 22: Activity

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Chapter 22: Activity

6 problems · 0 figures

Case Study 22.2.1 §22.2 source ↗

Refer back to Chapter 19 Oxygenation and Perfusion for Unfolding Case Study Parts 1 to 2 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the hospital and has just arrived in her room on the telemetry unit.

Past Medical History Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis
Family history: No significant family history reported.
Social history: Widowed ten years ago, currently living in an assisted care facility. No children.
Current medications:

• Lisinopril 20 mg PO once daily

• Metformin 500 mg PO twice daily

• Metoprolol 50 mg PO once daily

• Aspirin 81 mg PO once daily

• Furosemide 40 mg PO once daily

• Losartan 25 mg PO once daily

• Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Flow Chart Time: 1300
Blood pressure: 142/80 mm Hg
Heart rate: 98 beats/minute
Respiratory rate: 20 breaths/minute
Temperature: 98.9°F (37.1°C)
Oxygen saturation: 94 percent on 2 L nasal cannula
Pain: 6/10 (joint pain)
Recognize cues: What cues are the priority for the nurse to recognize?

Answer

The nurse would first assess the patient’s respiratory and circulatory systems (based on the ABCs of prioritization). The patient’s vital signs have improved since arriving at the emergency room and she is currently stable. At this point, it is most important for the nurse to recognize the patient is reporting moderate pain in the joints, rated 6/10 on the numerical scale.

Case Study 22.2.2 §22.2 source ↗

Refer back to Chapter 19 Oxygenation and Perfusion for Unfolding Case Study Parts 1 to 2 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the hospital and has just arrived in her room on the telemetry unit.

Past Medical History Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis
Family history: No significant family history reported.
Social history: Widowed ten years ago, currently living in an assisted care facility. No children.
Current medications:

• Lisinopril 20 mg PO once daily

• Metformin 500 mg PO twice daily

• Metoprolol 50 mg PO once daily

• Aspirin 81 mg PO once daily

• Furosemide 40 mg PO once daily

• Losartan 25 mg PO once daily

• Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Flow Chart Time: 1300
Blood pressure: 142/80 mm Hg
Heart rate: 98 beats/minute
Respiratory rate: 20 breaths/minute
Temperature: 98.9°F (37.1°C)
Oxygen saturation: 94 percent on 2 L nasal cannula
Pain: 6/10 (joint pain)
Analyze cues: Based on the priority cues recognized in the first question, what other information would the nurse want to obtain from the patient at this time?

Answer

The nurse would want to gather more information about the patient’s pain. Using a mnemonic, such as OLDCARTES, the nurse will assess onset, location, duration, characteristics, aggravating factors, radiating, treatment, effect, and severity. The nurse may ask questions such as how long she has had the pain, if the pain is constant or intermittent, if anything makes it better, and if anything makes it worse. After obtaining that information, the nurse will be better prepared to initiate interventions for pain control.

Case Study 22.2.3 §22.2 source ↗

Refer back to Chapter 19 Oxygenation and Perfusion for Unfolding Case Study Parts 1 to 2 to review the patient data. Mrs. Jenson, a 72-year-old female, presents to the emergency room with worsening shortness of breath, fatigue, and swelling in her lower extremities over the last week. She reports increasing difficulty performing activities of daily living due to weakness and increased dyspnea. She has been admitted to the hospital and has just arrived in her room on the telemetry unit.

Past Medical History Medical history: Hypertension, type 2 diabetes, heart failure (class III), osteoarthritis
Family history: No significant family history reported.
Social history: Widowed ten years ago, currently living in an assisted care facility. No children.
Current medications:

• Lisinopril 20 mg PO once daily

• Metformin 500 mg PO twice daily

• Metoprolol 50 mg PO once daily

• Aspirin 81 mg PO once daily

• Furosemide 40 mg PO once daily

• Losartan 25 mg PO once daily

• Ibuprofen 400 mg PO Q6 hours PRN mild arthritic pain
Flow Chart Time: 1300
Blood pressure: 142/80 mm Hg
Heart rate: 98 beats/minute
Respiratory rate: 20 breaths/minute
Temperature: 98.9°F (37.1°C)
Oxygen saturation: 94 percent on 2 L nasal cannula
Pain: 6/10 (joint pain)
Prioritize hypotheses: How do you think the patient’s osteoarthritis affects her quality of life and physical activity level?

Answer

The nurse would hypothesize that the patient’s joint pain negatively impacts her quality of life and probably decreases her level of activity. Even though studies have shown improvement in joint pain from arthritis with increased exercise, patients often find that information to be counterintuitive, instead choosing to rest the joints in an effort to improve symptoms.

Case Study 22.3.4 §22.3 source ↗

Refer back to Unfolding Case Study #4: Part 3 for a review on the patient data.

Nursing Notes Time: 1315
Patient reports experiencing persistent joint pain, particularly in the shoulders and wrists, rated at 6/10 on the numerical pain scale. Patient states that pain interferes with daily activities, such as getting dressed and cooking. Patient also reports stiffness in affected joints, especially in the morning or after prolonged periods of rest, which improves with movement throughout the day.
Provider’s Orders Time: 1400

• Occupational therapy referral

• Acetaminophen 1,000 mg PO Q6 hours PRN moderate arthritic pain
Generate solutions: How could the nurse further assess the patient’s functional status and ADL performance?

Answer

The nurse should perform a functional assessment to gain a better understanding of the patient’s ability to perform ADLs. There are several assessments that can be used but it is most likely that the nurse will use the Katz Index of Independence in Activities of Daily Living.

Case Study 22.3.5 §22.3 source ↗

Refer back to Unfolding Case Study #4: Part 3 for a review on the patient data.

Nursing Notes Time: 1315
Patient reports experiencing persistent joint pain, particularly in the shoulders and wrists, rated at 6/10 on the numerical pain scale. Patient states that pain interferes with daily activities, such as getting dressed and cooking. Patient also reports stiffness in affected joints, especially in the morning or after prolonged periods of rest, which improves with movement throughout the day.
Provider’s Orders Time: 1400

• Occupational therapy referral

• Acetaminophen 1,000 mg PO Q6 hours PRN moderate arthritic pain
Take action: After performing a functional assessment and determining that the patient requires assistance with several ADLs, what actions should the nurse take?

Answer

The nurse should first relay these findings to the provider. The provider may order medications to better control her osteoarthritis symptoms or initiate a referral to physical or occupational therapy. Additionally, the nurse should offer support and encouragement to the patient, as losing the ability to perform ADLs can have a significant impact on a patient’s mental health. The nurse should also connect the patient to other resources, such as support groups for individuals with osteoarthritis or access to companies that provide assistive devices.

Case Study 22.3.6 §22.3 source ↗

Refer back to Unfolding Case Study #4: Part 3 for a review on the patient data.

Nursing Notes Time: 1315
Patient reports experiencing persistent joint pain, particularly in the shoulders and wrists, rated at 6/10 on the numerical pain scale. Patient states that pain interferes with daily activities, such as getting dressed and cooking. Patient also reports stiffness in affected joints, especially in the morning or after prolonged periods of rest, which improves with movement throughout the day.
Provider’s Orders Time: 1400

• Occupational therapy referral

• Acetaminophen 1,000 mg PO Q6 hours PRN moderate arthritic pain
Evaluate outcomes: What findings would indicate that interventions were effective and optimal patient outcomes were achieved?

Answer

Findings that would indicate that interventions were effective and optimal outcomes were achieved include improvement in pain level, improved range of motion, and increased ability to perform or assist with ADLs. The patient should also express an understanding of the need for occupational therapy and be an active participant in her plan of care.

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Problems and answers are adapted from Fundamentals of Nursing by Christy Bowen, Lindsay Draper and Heather Moore, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/fundamentals-nursing/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.