Content check — Fundamentals of Nursing, Chapter 6: Promoting Individualized Care

Case Study 6.2.1 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Recognize cues: Based on the information provided in the case study and your knowledge of Maslow’s hierarchy of needs, what is the patient’s priority need at this time?

Answer

The patient is stable and appears to have basic physiological needs met. However, she expresses concern about employment and finances, indicating that her security needs are not currently met. This is the next-highest priority after physiological needs, so the nurse should address these concerns as the priority.

Case Study 6.2.2 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Analyze cues: What other information should the nurse gather from the patient regarding her security concerns and needs?

Answer

The patient reports being worried about affording medications and care for her mother, so the nurse should ask about health insurance coverage and/or access to medication discount programs. Also, the nurse should ask about the patient’s living situation to determine if there are any safety or environmental concerns. Any of these concerns should be escalated to the social worker so that they can be addressed before discharge.

Case Study 6.2.3 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Prioritize hypotheses: Based on the information presented in the case study, what emotional considerations should the nurse address with this patient?

Answer

The nurse should address the patient’s anxious feelings, as mentioned in the previous question. Additionally, the nurse should inquire about any other emotions the patient is experiencing about her own condition, such as fear. When she presented to the hospital, she was experiencing severe dyspnea and decreased oxygen saturation, which was likely scary. The nurse should discuss those feelings with the patient and address any lingering emotions before discharge.

Case Study 6.2.4 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Generate solutions: What actions can the nurse take to address the patient’s concerns before discharge?

Answer

The main concerns the patient has listed currently involve finances and resources for caring for her older mother. The priority action by the nurse is to provide resources and support for the patient. Typically, the best way to do this is to connect the patient with a social worker who is knowledgeable about financial assistance or community support programs that may be able to help ease the financial and emotional burden of caring for her mother. It is important that the nurse connect the patient with the social worker well before discharge to ensure the patient receives the resources they need.

Case Study 6.2.5 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Take action: In addition to addressing the patient’s security and financial concerns, the nurse decides to conduct a spiritual assessment. How would the nurse go about this?

Answer

First, the nurse should ask open-ended questions about the patient’s faith, religion, and spirituality beliefs. This should be done in a nonjudgmental manner, and the nurse should closely assess the patient’s comfort level throughout the conversation. Some patients will be comfortable talking about this subject while others will not, so it is important to be mindful when asking questions. If the patient is comfortable talking about this topic, the nurse should ask about various factors that may influence the patient’s spirituality, including family influence and previous beliefs and life events.

Case Study 6.2.6 §6.2 source ↗

Refer back to Chapter 2 Communication and Chapter 5 Cultural Competence for Unfolding Case Study Parts 1–6 to review the patient data. The medical-surgical nurse is providing care to a 28-year-old patient who arrived to the hospital one hour ago from a walk-in medical clinic. The patient speaks Spanish and is accompanied by her bilingual 10-year-old son. She has been admitted to the medical-surgical unit for observation.

Nursing Notes	2310: Assessment History and assessment is difficult to obtain because patient does not speak English. Son reports patient was seen at the clinic for a cough, was diagnosed with pneumonia, and was started on a medication to treat it. Patient remains on 2 L oxygen via nasal cannula, breathing pattern appears normal without distress.
Flow Chart	2310: Assessment Blood pressure: 135/75 mmHg Heart rate: 97 beats/minute Respiratory rate: 22 breaths/minute Temperature: 100.1°F (37.8°C) Oxygen saturation: 97 percent on 2 L nasal cannula Pain: 9/10 (ear)
Nursing Notes	0100: Patient given one dose of acetaminophen and reports ear pain is now 4/10. Interpreter has arrived and plans to stay on the unit until morning rounds so they can translate when the provider comes in. Patient resting comfortably, son sleeping on couch at the bedside.
Nursing Notes	0700: Assessment Patient is awake and alert and reports feeling “much better.” Patient reports anxiety about finances and is worried about being able to feed her family. She states that she makes enough each month to get by, but her mother is getting older and beginning to require more care and medications.
Flow Chart	0700: Assessment Blood pressure: 128/72 mmHg Heart rate: 87 beats/minute Respiratory rate: 18 breaths/minute Temperature: 99.1°F (37.3°C) Oxygen saturation: 97 percent on room air
Provider’s Orders	0745: New Orders Discharge after meeting with social worker.

Evaluate outcomes: How would you determine that the patient’s social needs have been addressed sufficiently before discharge home?

Answer

Many times, nurses provide patients with resources and referrals while in the hospital, but then have no idea if they followed through and got the assistance they needed. To improve this, the nurse can do a few different things. First, the nurse should work closely with the social worker to ensure that appropriate resources are available, and that the patient’s contact information is provided and all follow-ups are scheduled. This helps ensure that contact with the patient is not lost after discharge. Additionally, the nurse should continuously assess the patient’s social needs while they are in the hospital, initiating appropriate referrals as needed. In many cases, nurses and patients build a rapport during the hospital stay, which allows the patient to confide in the nurse and allows the nurse to assist the patient with resources. The nurse can ask the patient questions to determine whether the patient’s social needs have been completely addressed: Did I address all of your concerns? Is there anything you are worried about that we haven’t talked about yet?