Case study - Personal hygiene: Nursing

Nurse. Melinda works on a medical surgical floor and is caring for Beatrice an 80 year old with a history of iron deficiency anemia.

In collaboration with the registered nurse or in Elijah nurse, Melinda goes through the steps of the clinical judgment measurement model to make clinical decisions about beat's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse, Melinda recognizes important cues including Beatrice's vital signs which are temperature at 98.6 °F or 37 °C.

Heart rate, 90 BPM, respirations, 19 breaths per minute and BP. 100 and 23/88 millimeters of mercury.

During bedside report, nurse Melinda learns that Beatrice tires easily becomes short of breath with activity and needs assistance to get up to the bathroom.

Nurse, Melinda then gathers information from Beatrice. Hi Beatrice, how are you this morning?

I'm tired. I want to get cleaned up but it takes so much energy I can help you get cleaned up.

How about you do as much as you can and when you feel tired I can take over. Ok.

Nurse Melinda analyzes these cues. She reviews the electronic health record or EHR and notes that prior to admission, Beris lived independently but began having trouble performing activities of daily living or ADLs.

Due to fatigue. Nurse.

Melinda understands that iron is essential to produce hemoglobin in red blood cells or rbcs which deliver oxygen to the tissues.

And that iron deficiency anemia develops when there's not sufficient iron to sustain normal hemoglobin production. As a result, there's not enough hemoglobin to fill a normal sized RBC.

So the bone marrow starts producing microcytic or smaller cells that contain less hemoglobin. She also knows that a lack of hemoglobin can cause decreased oxygenation leading to symptoms like weakness, fatigue and reduced exercise, tolerance, making it difficult to perform.

ADLs. Nurse Melinda recognizes that Berus needs assistance with bathing and oral care to promote comfort, maintain hygiene and prevent infection.

Now, using the information she has gathered along with Beatrice's medical history. Nurse Melinda reports her findings to R and Elijah.

And together they choose a priority hypothesis of altered self care. Then nurse Melinda collaborates with RN Elijah to generate solutions to address Beatrice's altered self care.

And they established the expected outcome that Beatrice will participate in bathing and oral care with assistance. Nurse Melinda and RN Elijah then take action to implement these solutions.

They assist Beatrice to safely transfer from her bed to the shower chair in the bathroom where nurse Elijah closes the curtain to ensure privacy.

Nurse Melinda ensures that the water is at an appropriate temperature before assisting Beatrice to disrobe. Nurse Melinda then gives Beatrice a soap covered washcloth and encourages her to wash her hands and face while nurse Elijah washes her back.

Next. Nurse Melinda assists Beatrice to wash and condition her hair.

Nurse Elijah then helps Beatrice to stand and hold onto the shower, grab bars while nurse Melinda washes her peri area and legs after the shower.

Nurse Melinda gently dries Beatrice skin and applies lotion before assisting her into a clean gown and fresh non slip socks.

Nurse Melinda and A and Elijah then assist Beatrice back to bed and provide her with a warm blanket. I feel much better, but I'd like to take a nap before brushing my teeth if that's ok, of course, will let you rest.

One hour later, nurse Melinda reents Beatrice's room to evaluate the outcomes of her actions. She takes Beatrice's vital signs which are temperature 98 °F or 36.6 °C heart rate, 80 BPM, R 16 breaths per minute and BP.

100 and 15/70 millimeters of mercury. Beatrice reports that she's now ready to brush her teeth.

So nurse Melinda sets up the supplies on the bedside table. Beatrice is able to perform oral care independently following set up.

All right, as a quick recap, nurse Melinda recognized and analyzed cues related to Beatrice's altered self care and in collaboration with RN Elijah prioritized hypotheses and generated solutions to address this problem.

Nurse Melinda and RN Elijah then implemented measures and evaluated Beatrice's outcomes and compared them to the expected outcome.

Since Beatrice participated in bathing and oral care with assistance, they determined the plan of care was successful.