Case Study, Chapter 2, Community-Based Nursing Practice 1. Mr. Jones, who is 74

Question

Case Study, Chapter 2, Community-Based Nursing Practice 1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The dischar orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of O-degrees exten n worn when walking with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing postdischar Jay 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. e orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (do ate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plan ostay with him for several weeks to assist him with meals and household chores, and take him to physical therapy and thec hopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a al church (Learning Objective 4) a. What preparations should the nurse make in advance before attaining necessary community resources ar referrals before the patient is discharged? b What necessary commuhity resources and referrals will the patient need?

Explanation / Answer

Community resources and referrals for patient:
Health education:
-Advice the patient about CPM(continuous passive motion) machine to be used in a regular basis..As per surgeon advice first day patient can use this at 0-degree extension worn when walking with crutches..this is non weight bearing post discharge day 1 procedure , and advice the patient to try increase flexion by 10degree each day..weight bearing can begin..the goal for extension(straightning) os 0 degree until the patient bend his knee to 100 degree CPM is needed..
-Home nurse visiting can be done if needed..
-Regarding physical therapy as per Total knee replacement protocols patient has to come for daily visit..Weight bearing is an tolerated and no restriction for active and passive ROM can be continued..
Medication instruction:
   -Advice the patient about lovenox injection and side effects..Provide insrtuction anout subcutaneous injection 70mg that is to be injected under the skin,not in the muscle when the patient ready that time only we must prepare the injection..If any colour chaged or any particles in the vial it should be discarded immediately..
-store at room temperature away from moisture and heat vial must be completed with in 28days..
   -7days daily once thay have to take the injection..It sholud be given in different places..
-Vicodin injection advice include the action it is acetamenophen and opioid pain medication..
-advice not to take overdose..As per doctor advice 10mg every 4hours PRN(when necessary)
-Advice the patient if he get any skin rashes must see the doctors and advice them about side effects..
-Advice them not to drink alcohol..
-Advice them next medication Colace is stool softner to avoid constipation..
-It must be taken at bet time by mouth with full glasses of water or juice..
-Take only 100mg as per doctor advice every day..
-Advice them to come for folowup(review) in 3weeks..
-advice to the daughter about his diet plans..Add plenty of proteins and iron like beef,fish,poultry,eggs,cheese,milk,yogurt,protein drinks,grains,cereals and red meat..
-Advice them to eat plenty of fresh fruits and vegetables..
-Advice them to eat lilttle by little for fast recovery..
-Advice them to follow the instruction in soft copy therepist..walk only to limit distance..avoid driving or long journey to avoid blood clot..
-advice them to take only shower bath and staples should not be rusted..
- Tell the daughter to pass this messages to other sisters also going to take of the patient..

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