Musculo-Skeletal Nursing Care, Case Study Example

Question

He has a nursing diagnosis of impaired physical mobility. What data would you collect before you provide care to Mr. Jones when you are assigned to his care 24 hours post op?

Answer

Data collected would be related to:-

1. Post operative instructions
2. The extent of the immobility on a scale of 0-4
3. The presence of pain on a scale of 1-10
4. The condition of the incision site
5. The psychological disposition of the client

Question

Describe 5 nursing interventions you would expect for his care at this time, including      rationales?

Answer – Nursing Interventions

1. Assessactual immobility and note patient’s perception to it

Rationale: Clients’ perception can accelerate or inhibit recovery of mobility due to misconceptions produced by pain and discomfort.

2. Encourage participation in activities that would divert attention away from the impact of surgery

Rationale:Client gets an opportunity to reflect on positive outcomes. Hence, attention is refocused towards rebuilding self esteem which stimulates self worth and enhances recovery (Burckhardt et.al, 2004)

3. Encourage client to conduct deep breathing exercises and assist with movementof body parts which tend to be decompensated due to the surgery

Rationale:-This improves circulation and reduces collapseof respiratory muscleswhich remain inactive during surgery and recovery period.

4. Carefully monitor vital signs four hourly

Rationale: – This would enable the nurse to asses the client’s reaction to surgery and development of any post complications.

5. Ensure that footboard and pillow are placed appropriatelybetween legs and at heels to support the hip joint.

Rationale: When applied properly to the affected areas they enhance healing by maintaining normal positions, especially, preventing foot drop and dislocation of the prosthesis (Gordon, 2009)

Multiple Choice Questions:  

Before Mr. Jones has surgery what primary symptom of osteoarthritis might you have noticed?

1. Superficial sharp pain
2. Stiffness following joint use
3. Edema in the effected limb
4. Crepitus with Movement

When caring for Mr. Jones which of the following requires immediate nursing intervention.

1. Soiled dressing
2. Redness over incision site
3. Increased capillary refill
4. Pain level of 8

Mr. Jones’ post op care in the first 24 hours would not include:

1. Supine position with head of bed slightly elevated
2. Use of an overhead Trapeze

1. PROM to right hip
2. Assisting the physician with the dressing change

When assisting Mr.  Jones to ambulate in the hall on his third day post op you would expect him to be able to ambulate:

1. Using the wall rail
2. With the help of two nurses
3. By himself using a cane
4. Using a walker

When Mr. Jones is ready for discharge, which of the following is the most important discharge instruction?

1. Use of walker and elevated toilet
2. Pain medication use
3. List of calcium enriched food
4. Enrollment in smoking cessation program

References

Burckhardt Judith, Irwin Barbara, Dobish Barbara, Dillion Deborah, Mahoney Ellen. (2004).The Course Book: Preparation for the NCLEX-RN Exam (7th ed). New York: Kaplan, Inc.

Gordon, Marjory (2009) Manual of Nursing Diagnosis (12th Edition).  Boston: Jones & Bartlet Learning