Basic Nursing 1st Edition by Judith Wilkinson, Leslie Treas

Exercise 23

Recall Jeannette Wu, a very thin 80-year-old woman who has just been admitted to a skilled nursing facility after fracturing her hip. Review the Meet Your Patients scenario at the beginning of this chapter to answer the following questions about Mrs. Wu.
Doing
Practical Knowledge: What do you know about positioning patients? How would you explain to the NAP about how to position Mrs. Wu "to prevent further pressure on her sacrum"?
Meet Your Patients
Patient 1
Jeannette Wu is a very thin 80-year-old woman who is in the hospital after fracturing her hip. Her hip was surgically repaired 4 days ago, but because of her overall fragile health and some postsurgery confusion, her recovery is slower than usual. One of her nursing diagnoses is Self-Care Deficit (Bathing, Dressing, and Toileting) related to weakness, pain, confusion, and decreased mobility. Her nursing orders (NIC) include Bathing and Self-Care: Activities of Daily Living (ADLs). As the nurse is helping a newly hired nursing assistive personnel (NAP) with Mrs. Wu's bath, she notices a reddened area on Mrs. Wu's sacrum. Realizing that this may be the beginning of a pressure ulcer, the nurse observes carefully and notes a small skin excoriation (abrasion) in the area. She repositions Mrs. Wu to prevent further pressure on her sacrum. After finishing the bath, the nurse records her findings and enters on Mrs. Wu's care plan a nursing diagnosis of Impaired Skin Integrity related to impaired bed mobility and minimal subcutaneous tissue. She writes appropriate nursing orders, including an order to observe skin over bony prominences every 4 hours, and then delegates to the NAP the task of turning and repositioning Mrs. Wu every 2 hours. The nurse also sends a consultation request to a wound care nurse specialist.
Patient 2
Patsy Jimenez is a healthy 25-year-old woman with no medical problems. She eats a balanced diet but says she does not exercise much. She and the nurse have created a plan to help her increase her physical activity. Ms. Jimenez will try to walk for 30 minutes at least 5 days a week. Each week she is successful, she plans to reward herself with a movie or a milkshake, which she usually avoids because of the fat content. The nurse would prefer that Ms. Jimenez not reward herself with food, but respects the patient's decision and realizes that if it is to serve as motivation, the reward must be something that Ms. Jimenez values.