Present Problem Tim Platt is an 84-year-old male with a past medical history of

Present Problem
Tim Platt is an 84-year-old male with a past medical history of hypertension and type 2 diabetes mellitus. He is a former smoker with a 25 pack-year history, and he reportedly quit 10 years ago. He reports drinking one beer per night and denies illicit drug use. He lives alone in his 2nd story walk-up apartment with his cat Sprinkles. He is widowed, has one supportive daughter who lives 30 minutes away, and has no grandchildren. His daughter is his healthcare proxy. He reports an active lifestyle and enjoys walking around his neighborhood, including attending church every Sunday and the local Veterans’ Group every Wednesday night. He drives independently and is independent in his activities of daily living.
6 days ago, Tim’s daughter arrived at his apartment and found him laying on the bathroom floor. He was confused and unable to remember what happened. He was rushed to the emergency room at your facility and found to have an ischemic stroke. During his hospital stay he was diagnosed with atrial fibrillation and started on coumadin 5mg PO daily. He continues to have left-sided weakness and is using a walker for safe ambulation. He is currently receiving physical therapy (PT), occupational therapy (OT), and speech therapy services (SLP). He is awaiting discharge planning.
His morning vital signs are:
T: 98.7 F Oral
P: 88, regular
BP: 135/76
RR: 16
O2: 97% on room air
Pain: 0/10
1.
Choose three of the following items from the present problem related to Tim’s social history. Discuss how the nurse will incorporate these items into discharge planning.
Clicking on your choices will provide a text box for response
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He is currently receiving physical therapy, occupational therapy, and speech therapy services
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Lives alone in second story walk-up apartment with his cat Sprinkles
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Widowed, one supportive daughter lives 30 minutes away
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Active lifestyle, drives independently and independent in activities of daily living
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Daughter found him laying down on bathroom floor
2.
Throughout his hospitalization, you have built a good rapport with Tim. He has been cheerful, engaging, and motivated during PT/OT/SLP sessions.
This morning, you enter his room and notice that he has not eaten any of his breakfast. He is looking out the window with minimal eye contact and is only responsing with one-word answers.
The nurse knows therapeutic communication is important to provide emotional support by being present and available to listen and discuss concerns. How would you initiate conversation with Tim?
Minimum 3 sentences
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3.
As you discuss Tim’s discharge planning in multidisciplinary rounds you identify the following as potential barriers to Tim’s discharge. Select all that apply and provide rationale for your choice.
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Residual left sided weakness
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Former smoker
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Had a recent fall
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BP 135/76
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New medications to be managed at home
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Lives on 2nd floor
4.
After rounds, you are administering Tim’s morning medications. As you are talking, he tells you, “They said I can’t go home. Mary and I lived in that house for 50 years, I walk the same path to church every day, how can they say I can’t go back?”
Provide your response to Tim:
Minimum of three sentences
5.
Following your conversation with Tim you decide to inititate the following consult:
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Cardiology
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Psychiatrics
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Social Work
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Patient Advocacy
6.
Later this afternoon, the physical therapist informs you that Tim has refused to walk outside of his room today, stating, “If I can’t go home, what’s the point?”
List three complications of decreased mobilization in the hospital. Provide rationale
7.
List three nursing interventions to increase Tim’s mobility during your shift. Provide rationale
8.
The decision is made for Tim to be discharged to his daughter’s home with home services. Select one of the following topics for patient education and list specific instructions you would give to Tim and his daughter.
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Medication
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Nutrition
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Physical Therapy
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Occupational Therapy
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Follow-up Appointments
Reflection
9.
As you worked through this case study, how did it make you feel?
10.
What information did you already know about these case studies?
11.
What areas would you like to develop/improve?
12.
How will you apply what was learned to improve patient care?
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