Case Study 3 – Yolanda Yost (Total Hip Replacement)
Yolanda Yost is going to be discharged in a few days. She will need physical therapy, and, because she will have limited ability to ambulate, she will not be able to return to her own home without someone to care for her. She has only one child who is 60 years old and lives in a city that is many miles away.
You have given Yolanda Yost excellent physical care that has prevented complications related to her surgery such as problems with elimination, respiratory problems, and risk for infection. Her physical needs that seemed overwhelming on admission appear less important now as you listen to Yolanda Yost state her feelings. What can you do to help her? All of what she says is true. She will need help with her care, at least temporarily. She probably will not be able to go home or live independently until she is able to care for herself.
Yolanda Yost states that she will not be able to care for herself, and nothing can be done about her situation. She frequently cries when you attempt to speak to her about her problems. When you try to involve her in care, she says, “Why should I care for myself? I can’t go home anyway.”
Nursing Assessment
Yolanda Yost is an 80-year-old woman who has fallen and fractured her hip. She has had a total hip replacement and a rapid recovery for someone her age. Her vital signs are stable, and she has minimal pain. Her pain is relieved with oral analgesic medications.
You have made a referral to the social work department and anticipate that Yolanda Yost will have to be discharged to a long-term care facility for rehabilitation. In the meantime, you wonder what you can do to help Yolanda Yost cope with her situation.
As you review her history and her symptoms, you see a pattern emerging. Yolanda Yost believes that no matter what she does, her actions will not affect the outcome. She believes that she has no control over her situation.
Helpful Hints
Assess
Identify significant symptoms by underlining them in the assessment.
List those symptoms that indicate the client has a health problem (those you have underlined).
Group the symptoms that are similar
Diagnose
Select possible nursing diagnoses for this client.
Validate the possible nursing diagnoses.
Compare the signs and symptoms (defining characteristics) that you have identified from your client assessment with the defining characteristics for the nursing diagnosis that you have selected. Also read the definition and determine if this diagnosis fits this client.
Write/select a nursing diagnostic statement for one of the nursing diagnoses by combining the nursing diagnosis label with the related to (r/t) factors.
The label is the title of the nursing diagnosis as defined by NANDA.
A related to (r/t) statement describes factors that may be contributing to or causing the problem that resulted in the nursing diagnosis.
Plan
Write outcomes to help resolve the symptoms (i.e., defining characteristics).
Select appropriate interventions with rationales.
Implement
The next step in the nursing process is to give the nursing care using the nursing interventions.
Evaluate
After putting into effect the nursing interventions, the results of the care should be evaluated by determining if the outcomes were met. If the outcomes are acceptable, the care plan is resolved. If the outcomes are not acceptable, further assessment should be done to answer the following questions:
Was the correct nursing diagnosis chosen?
Was the outcome appropriate?
Were the interventions appropriate in this situation?
What other interventions might have been helpful?
Changes in the nursing diagnosis, outcomes, and interventions should be made as needed. This is continued use of critical thinking to ensure appropriate nursing care.
