Case Study

Presentation Overview
Brief Patient History Hendersons Need Theory and Maslows Hierarchy of Needs Theory 2 Priority patient needs and diagnoses Details of first Priority and need (key assessment findings, nursing interventions, goals and evaluations of these) Details of second Priority and need (Key assessment findings, nursing interventions, goals and evaluations of these)

Conclusion

Patient History
Male, age 59 History of hypertension, pneumonia, osteoarthritis and newly diagnosed with prediabetes Chief complaint of pain in left knee Current diagnosis of left total knee replacement Osteoarthritis can be confirmed through a few ways......

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Osteoarthritis for this patient was confirmed through an x-ray of his left knee
http://www.cleburneorthopedics.com/arthritis.html

Was on the medication testosterone to increase bone mass (Adams et al., 2010)

Hendersons Need Theory are based My nursing priority patient needs

on (Virginia) Hendersons Needs Theory. Hendersons definition of nursing was: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery, (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible (George, 2011, p 90)

Hendersons Need Theory Cont

14 Components
1. Breathe normally. 2. Eat and drink adequately 3. Eliminate body wastes 4. Move and maintain desirable postures 5. Sleep and rest. 6. Select suitable clothes-dress and undress 7. Maintain body temperature within normal range by adjusting clothing and modifying environment 8. Keep the body clean and well groomed and protect the integument 9. Avoid dangers in the environment and avoid injuring others 10. Communicate with others in expressing emotions, needs, fears, or opinions 11. Worship according to ones faith 12. Work in such a way that there is a sense of accomplishment 13. Play or participate in various forms of recreation 14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
(George, 2011, p 90)

Maslows Hierarchy of Needs

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Comparison
Maslows Hendersons
Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture Sleep and rest Select suitable clothing to maintain body temperature Keep body clean and well groomed and protect the integument

Physiological needs

Safety Needs

Avoid environmental dangers and avoid injuring other

Belongingness and love needs

Esteem Needs
(George, 2011)

Communicate with others worship according to ones faith

work at something providing a sense of accomplishment Play or participate in various forms of recreation Learn, discover or satisfy curiosity

Hendersons concepts are borrowed but it is how they are used that makes them unique to nursing (George, 2011)

Such as the biophysical concept

Priority Patient Needs

Ability to ambulate Maintain skin integrity Maintain adequate nutrition and fluid intake

Education on the progression of pre-diabetes to Type II Diabetes Mellitus

2 Priority patient needs

Ability to ambulate (physical)

Education on the progression of pre-diabetes to Type II Diabetes Mellitus (psychological)

The Ability to Ambulate

Relates to Hendersons definition of nursing Maslows physiological need- ambulation relates to skin integrity which is part of the first tier of pyramid (basic) need therefore needs to be meet before any other need (George, 2011)

8th component - Keep the body clean and well groomed and protect the integument (George, 2011)

Key assessment findings

One day post op One person assist Pain in left knee (8 out 10 with activity, 7 out of 10 at rest) Afraid to put weight onto affected limb

Nursing Diagnosis:
Impaired

physical mobility related to pain and prescribed activity restrictions as manifested by limited range of motion and by a pain score of 8 out of 10 with physical activity and 7 out of 10 pain score with rest (CarpenitoMoyet, 2009) Goals:

Patient will be able to ambulate with walker by 3 days post op

Patient will be at a reduced rate of pain, 5 out of 10 with activity and 3 out of 10 when at rest 4 days post op Patient will put weight on affected leg without encouragement 3 days post op

Interventions
The nurse will enquire of pain rate and inform buddy nurse when it is above 3 out of 10 or when there will be PT activity
The nurse will support the exercise program tailored to the patients ability in consult with the PT. The nurse will reinforce use of ambulatory aids as taught by PT and supervise client ambulation as necessary which will include the intervention of instruct and assist in position changes and transfers

Evaluation of Goals and interventions

Patient was able to successfully ambulate with his walker on the 3rd day post op
Patient did reduce pain and was only at a rating of 3 out of 10 at rest but was still at a rate of 6 out of 10 with activity 4 days post op Patient was able to put weight on affected knee by day 3 post op with education and reassurance from nurse With this in mind all but 1 of the goals were meet which means that the interventions were affective and that I need to be more careful when assigning goals in regards to subjective classifications

Education on the progression of prediabetes to Type II Diabetes Mellitus

Related to Hendersons 14 competent: Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities (George, 2011) Fits with Hendersons definition of nursing Maslows need of safety, security of the bodysecond tier of pyramid and therefore must be meet before other needs can be (George, 2011)

Key assessment findings

Discovered through conversations with patient

Nursing Diagnosis:
Knowledge

deficit of how pre-diabetes develops into Type II Diabetes Mellitus related to information misinterpretation as manifested by verbalizing inaccurate information and denial of the need to learn (Carpenito-Moyet, 2009) Goals: Patient will be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes 4 days post op Patient will be able to verbalize the changes needed to stop pre-diabetes from progressing 5 days post op

Interventions
Learning Facilitation The nurse will observe the patients ability and readiness to learn Teaching: individual The nurse will assess the patients barriers to learning The nurse will present material that is the most significant to the patient first and then build on that

Learning Facilitation: promoting the ability to process and comprehend information Educated on making easy lifestyle changes Different health care workers, have different ways to motivate their clients such as...

http://cdn.hivehealthmedia.com/wordpress/wp-content/uploads/2010/12/exercise-humor.jpg

With my first intervention concluding with that he was not ready to learn I needed to switch to an alternate intervention for my patient to reach the goals I had set out for him Teaching: Individual, is defined as a planning, implementation, and evaluation of a teaching program designed to address a particular patients needs.
On the day the patient was suppose to be discharged I had a conversation alone with him at his bedside

My buddy nurse then came in and did the discharge teaching

Patient asked wife if she could get the car and if I could bring him down in his wheelchair to his car In the elevator he looked at me and said so really, if I don't change what I eat and go exercise this will get to the point that it cant be reversed. I said yeah. He then stated guess I better change things then.

Evaluation of Interventions
Learning Facilitation The nurse promoted the ability to process and comprehend information by observing the patients ability and willingness to learn Teaching: Individual intervention was implemented by the nurse assessing the patients barriers to learning and presenting material that was most relevant to the patient

Goal Evaluation
The patient was be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes 5 days post op so it did not meet my original goal of 4 days post op The patient was be able to verbalize the changes needed to stop prediabetes from progressing 5 days post op Both goals were achieved as evidenced by When he stated so really, if I don't change what I eat and go exercise this will progress to the point that it cant be reversed, guess I better change things then.

Conclusion
Osteoarthritis is a degenerative joint disease characterized by destruction of the articular cartilage and overgrowth of bone Hendersons Need theory has 14 components and is very similar to Maslows Hierarchy of Needs. Hendersons Theory does borrow content from other theories but is unique to nursing in how they are used. 2 priority needs were ability to ambulate and education on the progression of pre-diabetes to Type II Diabetes Mellitus 2 priority diagnosis were Impaired physical mobility related to pain and prescribed activity restrictions as manifested by limited range of motion and by a pain score of 8 out of 10 with physical activity and 7 out of 10 pain score with rest Knowledge deficit of how pre-diabetes develops into Type II Diabetes Mellitus related to information misinterpretation as manifested by verbalizing inaccurate information and denial of the need to learn Goals for first priority need and diagnosis, which was the ability to ambulate, included ambulating with walker (3 days post op), having a reduced rate of pain (4 days post op) and being able to independently put weight on affected limb (3 days post op). The interventions included such things as reduction of pain, supporting the exercise program, assisting the client with proper use of ambulatory aides and helping with transfers when needed. All goals were achieved accept for the timeline of reduction of pain, which implies that goals that are subjective need to be made after getting to know the patient

Goals for the second priority need and nursing diagnosis, which was education on the progression of pre-diabetes to Type II Diabetes Mellitus included that the patient will be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes (4 days post op) and the changes needed to stop pre-diabetes from progressing (5 days post op). The Interventions included learning Facilitation which included that the nurse will observe the patients ability and readiness to learn and then the intervention of Teaching: individual which include The nurse assessing the patients barriers to learning and the nurse presenting material that is the most significant to the patient first and then building on that. All goals were achieved but were both achieved in 5 days so the first goal was not achieved in the specified time.

Cleburne Orthopedic and Sports Medicine Center. (2010). Understanding Artritis. Retreived from http://www.cleburneorthopedics.com/arthritis.html

Day, R. A.., Paul, P., Williams, B., Smeltzer, S. C. & Bare, B.. (2010) Brunner & Suddarths Textbook of Canadian medical-surgical nursing. Second Canadian edition. Philadelphia: Lippincott Williams & Wilkins.

George, J. B. (2011). Nursing Theories - The base for professional Nursing Practice. (6th ed.) New Jersey: Prentice Hall.

Hannon, R. A., Pooler, C., & Porth, C. (2009). Porth Pathophysiology: Concepts of altered health states (First Canadian Edition). Lippincott, Williams and Wilkins.

Hive Health Media. (2011). Top 15 Benefits of Exercise. Retrieved from http://cdn.hivehealthmedia.com/wordpress/wpcontent/uploads/2010/12/exercvise-humor.jpg

Potter, P., Perry. A, A., Ross-Kerr, J. C., & Wood, M. J. (2009). Canadian Fundamentals of Nursing (4th ed.). Toronto: Elsevier.

Rosenbek, L. K., Wagner, L., Lonvig, E. M., Hjelmborg, J., & Henriksen J. E. (2011). The