Name: Lois Gardner Caregiver: Phil Gardner Gender:

Name: Lois Gardner Caregiver: Phil Gardner Gender: Female Age: 75 Weight: 126 lbs. (57.2 kg) Height: 5’4″ Race: Caucasian Religion: Jewish Major Support: husband Phil Gardner Past Medical History: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), myocardial infarction (MI) age 51. Hospitalized for pneumonia several times, the last admission was 4 weeks ago. She requires oxygen at home. She was transferred to a rehabilitation facility for pulmonary rehab for several weeks. Evaluated by neurologist and diagnosed with dementia. History of Present Illness: Mrs. Gardner is admitted to the hospital after being transported from home by EMS. Lois fell at home the second day after she returned with her husband to their retirement community following discharge from a rehabilitation facility. She got up in the middle of the night and could not remember where she was. As she tried to find the bathroom, she was incontinent and slipped on the wet floor. She has multiple fractures including 3 ribs on the right, the right humerus and fracture of the pelvis. Mrs. Gardner has the following services set up at home before her fall: RN, Home health aide for 2 hours three times a week, physical therapy, oxygen therapy services. Medications: Levothyroxine, 88 mcg oral Monday-Wednesday and Friday; 100 mcg oral Sunday, Tuesday, Thursday and Saturday. Metoprolol 50 mg oral daily, Atorvastatin 20 mg oral daily Aspirin 81 mg oral daily Albuterol 2 puffs every 6 hours via inhaler, Pulmicort (Budesonide) 0.5 mg via nebulizer twice a day Nitroglycerin 0.4 mg sublingual as needed for chest pain. Patient Controlled analgesia: Morphine 4 mg/hour basal rate; PCA dose 1 mg. Lockout: 15 minutes (concentration = 5 mg / ml (150 mg in 30 ml) Oxygen via nasal cannula at one to two liter per minute. Physical therapy: evaluate and treat Up to chair in AM Sling and shoulder immobilizer to right arm Social History: Married to Phil Gardner since age 49. They live in an independent home in a retirement community.Lois’s adult daughter Sharon lives about an hour away. She is a real estate agent with a 16-year- old son, a 14- year-old daughter and an 8-year-old daughter. Mr. Gardner is attentive to Lois and Sharon helps whenever possible. Two couples from their synagogue visit several times a week. Phil has two children from a previous marriage, but they have demanding jobs and are limited help for Phil. Mr. Gardner is a 78-year-old retired firefighter. He has been recently diagnosed with severe arthritis in his left knee and has been told that he needs to schedule surgery for a knee replacement. He walks with a limp and uses a cane for walking long distances. His orthopedic doctor has ordered Celecoxib which he takes daily as prescribed. He sometimes adds extra- strength acetaminophen to his regimen. He feels terrible about Lois’s fall and feels he should have stayed awake to watch her. Lois’s daughter from a previous marriage is Sharon. She is a 47-year-old overweight woman who is a real estate agent. She is a single parent of three children: a 16-year-old son, a 14- year- old daughter and an 8-year-old daughter. She has been diagnosed with chronic back pain following a car accident four years ago. Her pain has been managed with hydrocodone 2-3 times per day along with occasional complementary therapies. She says her health care provider has been working with her to develop another pain relief plan without the opioid use. Lois has signs of confusion and memory loss for over a year and was officially diagnosed with dementia by her neurologist after her hospitalization 6 months ago. She is on Medicare and supplemental insurance. Primary Medical Diagnosis: Fractures of ribs 3, 4 and 5 on the right, fracture right humerus, fracture pelvis, degenerative process in spine, COPD, CHF, post MI Surgeries/Procedures & Dates: MI, had cardiac catheterization and stent placed at age 51. Lois’s orders read: Diet as tolerated, no added salt. List 4 specific interventions that the nurse should implement when caring for Mrs. Gardner when she has PCA infusing. Provide a rationale for each intervention. The nurse who cared for Phil at his primary care office has established a nursing diagnosis for Phil “Chronic pain related to degenerative changes in left knee as evidenced by limp and use of NSAID”. State a measurable outcome for this diagnosis statement and develop a teaching plan designed to meet Phil’s needs. Sharon’s health care provider has been working with her to develop another pain relief plan without the opioid use. Review Joint Commission Pain Assessment and Management Standards for Ambulatory CareLinks to an external site. standard PC. 01.02.07 (The organization assesses and manages the patient’s pain and minimizes the risks associated with treatment. See Provision of Care, Treatment and Services section) and determines how you, as the RN, will meet this standard for this patient.

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