Case study - Self-care deficit: Nursing

Nurse Yoko works in a long-term care facility and is caring for Penny, a 79-year-old female, who was recently admitted with a history of a stroke with left-sided peripheral neuropathy and weakness. After introducing herself to Penny, Nurse Yoko goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Penny's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Yoko recognizes important cues, including findings from her assessment of Penny’s skin, oral mucous membranes, and nails, as well as her functional ability. Nurse Yoko notes Penny has dry, cracked lips and a yellow-brown film on her teeth. On her lower extremities, Nurse Yoko notes dry, flaky skin, and after removing her socks, she sees that Penny has thick, discolored toenails and a pressure injury on her left heel.

Nurse Yoko asks Penny about her activities of daily living, or ADLs.  

Nurse Yoko: Penny, can you tell me a little bit about how you’ve been doing with your daily routine? 

Penny: I’m used to being able to care for myself, but after the stroke, it’s been hard for me to do things I used to do. 

Nurse Yoko: I understand. Can you tell me what sort of things you used to do that you aren’t doing now?  

Penny: Well, I’m left-handed but now that my left arm is weak, it's hard for me brush my teeth and clean myself up. I can’t even cook a meal for myself anymore. 

Nurse Yoko: That must be difficult. I also noticed you have a pressure injury on your left heel. How long has it been there?

Penny: I have numbness and weakness in my left leg and it’s hard for me to move around. One day I bumped the back of my foot, and the sore hasn’t healed since. I didn’t even notice it was there until days later.

Next, Nurse Yoko analyzes these cues. She reviews Penny’s electronic health record, or EHR, and notes that although she can walk short distances, she’s been using a wheelchair to move around the facility. In the progress note from the occupational therapist, Nurse Yoko reads that Penny requires moderate assistance with ADLs and that she has moderate muscle strength and tone in her right hand and poor strength and tone in her left hand.