Please read and complete the case study in order to complete the requirements of Week 4 clinicals.

Insert a cover page (Subject Name, Student Name/ID, University, Instructor)

No. of pages: not less than 5.

Date: No later than 15th July midnight.

Insert citations wherever necessary

Include a reference list.

Case study:

Part I

Mrs. Smith is an 84 year old female s/p spinal surgery (laminectomy) post op 3rd day. She is AxOx4, morphine 1mg IV for severe pain and oxycodone 5-10mg for mild to moderate pain, breathing fine without any need for oxygen inhalation. Her skin is warm and dry, intact except forthe surgical incision on her back, covered with gauze and tegaderm. She was ordered a mechanical soft diet but her intake has been minimal. Patient voids in bed pan 3-4 times per shift, with no BM since surgery, has been OOB with the physical therapy to the chair. Patient has been reluctant to participate in the care due to her pain and prefers to stay in bed and sleep.

You are her nurse assigned for the day.

1. Explain in detail what is laminectomy (give citation)

2. Assess and provide Priority Nursing Diagnoses (2) for this patient and at risk nursing diagnosis (1)

3. Write nursing interventions (with rationale), for the nursing diagnoses chosen for this patient.

4. What are the post operative complications that this patient may develop. Explain by giving reasons why they may occur.

5.Describe your role in preventing post-operative complications for this patient.

6. What are the collaborative/interdisciplinary team members that are included in your care team? Describe their roles.

Part II.

You had gone on your break during your shift and upon returning you entered patient’s room to check on Mrs. Smith. You found that patient was slouched on the chair, her speech was slurred and she could not follow commands. You noticed her left arm was weaker than her right.Her blood pressure was 160/90mmHg, HR 76/min, O2 saturation 92% on RA, temp of 97.8F oral. A code stroke was called, patient was rushed to the CT scan. The CT showed middle cerebral artery infarct and was diagnosed with ischemic stroke.

• What is an ischemic stroke? Define and provide pathophysiology (give citation).

2.What are the other types of strokes?. Explain each type (with citation).

a. Write two specific nursing diagnoses for your patient considering her present situation.

b. Write specific nursing interventions for your diagnoses, providing rationale for each.

3. Write a discharge/education plan for your patient using the best practices in the management and prevention of stroke. Consider the community resources that are available for stroke patients (give citations).

Recommended references:

cdc.gov/stroke

https://www.stroke.org/

Medical-Surgical Nursing: Assessment and Management of Clinical Problems

Author: Lewis, S., Bucher, L., Heitkemper, M., Harding, M., Kwong, J., & Roberts, D.

Fundamentals of Nursing

Author: Potter, P., Perry, A., Stockert, P., & Hall, A.

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