solved

You are conducting a home visit with your patient, Mrs. S, whom you have been visiting for nearly 2 months. Mrs. S is amotivated, active 79 year-old woman who lives alone in her own home. She is a healthy woman with a medical history ofosteoarthritis, which led to a hip replacement 3 months ago, and chronic constipation. You began visiting Mrs. S at home following discharge from the hospital. Her recovery has been slow, so visits have continued to ensure safety and monitor mobility.
When you arrive at Mrs. S’s home, it takes her longer than usual to answer the doorbell. When she does, you are startled to find that she seems flustered and says she forgot you were coming today. She has never forgotten a visit before. You notice that her clothing looks wrinkled and mismatched, there are dishes piled in the sink, and you detect a strong odour of urine when you stand close to her.
The patient repeats to you, several times, that she forgot you were coming today. She begins to put the dirty dishes from the sink back into the kitchen cupboard. When she opens the fridge, you notice that it looks empty. When you ask, Mrs. S tells you she has not left the house since your last visit, 2 weeks ago.
1. Which of the 3Ds is Mrs. S experiencing?
How do you know? Provide 3 pieces of evidence from the case to support your claim.
2. What are some risks you should consider for this patient?
3. What potential causes should you consider related to Mrs.S. smelling of urine? Provide rationale for your claims.
4. What physical examination(s) would be important to include during the home visit? *all 4 answers cannot be confined to a single body system*
5. Based on this client’s presentation, how might you promote elimination for constipation? Provide evidence from the literature to support your interventions. (Include pertinent resources in your submission).
case study #2
You are caring for Mr. P, a 55 year old male, who was admitted to the medicine unit one day ago with a Right lower lobe pneumonia. Mr. P’s past medical history includes diagnoses of dyslipidemia (high cholesterol), hypertension (high blood pressure), and COPD, all diagnosed 10 years ago. He has refused to take medications to help control any of his chronic diagnoses, however is currently on IV antibiotics to treat his pneumonia. He frequently eats fast food, drinks 24 beers on the weekend, and has been smoking 1 pack of cigarettes a day for the past 45 years. He lives alone, and works as a long-distance truck driver. He does not exercise.
When you enter the room in the morning to introduce yourself, you find Mr. P lying flat on his back in his bed. He is alert, looks pale with no cyanosis, and tired. You notice large rises and falls of his chest and abdomen with breathing. Speaking in short sentences Mr. P states that he forgot to mention that he has had a wound on his leg for the past 4-5 months that is not healing, he’s wondering if he should let someone know about it. He also asks when he can go out for a cigarette as he has not had one yet this morning.
Your vital sign assessment finds: BP 156/92, Pulse 110 and regular, Respiratory rate 22, Oxygen Saturation 90% Temperature 38.2 orally.
1. How would you interpret the above vital signs? How do they make sense in light of what you know of the patient? Explain your answers.
2. Based on what you notice in the image provided, document your objective findings.
3. What questions would you ask in the history to help you decipher between a chronic arterial versus venous cause for his wound?4. How would you approach the concept of smoking cessation with this client? What evidence-based resources could you use as a nurse, and provide to your patient? (Include pertinent resources in your submission).
5. How could you promote adequate oxygenation in this client?

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