Question

VN 100 Fundamentals of Nursing

Case Study: Self-Care Ability: Hygiene

Addie Johnson is a 52-year-old morbidly obese female with diabetes mellitus. She has had a stroke and has right-sided paralysis (hemiplegia). She tends to slow, cautious behavior and needs frequent instruction and feedback to complete tasks. She has retinopathy (affects her eyesight) and peripheral neuropathy (affects sensation in legs) from her diabetes mellitus. Her Katz Index of Independence in Activities of Daily Living indicates that she is very dependent in the areas of bathing, dressing, transferring, and toileting.

1. Discuss how this resident’s health status has affected her self-care ability.

2. During assessment of self-care, the students consult with the resident to assess her willingness and ability to perform ADLs. Why is this step vital to the plan of care and how will it affect the completion of hygiene care for this resident?

The initial interview with Ms. Johnson elicits the following information from the resident:

• “I can’t do anything for myself without a lot of help since my right side doesn’t work.”

• “My sugars have really made me sick over the years; it has affected my eyes and my feet.”

• “I want to help take care of myself, but I am just too slow at it and I will admit my size makes it hard.”

• “I’ve always taken my bath before I went to bed but here, I am on the Thursday morning bath list, with ‘spot washes’ in between. They use the shower chair and have me scrubbed up in no time. It’s just easier for the girls here.”

For each of the responses given by Ms. Johnson, write an open-ended question to elicit more detail to her responses. Why is this important to the development of an individualized plan of care for this resident?

Patient Response

Example of an Open Ended Question

“I can’t do anything for myself without a lot of help since my right side doesn’t work.”

“My sugars have really made me sick over the years; it has affected my eyes and my feet.”

“I want to help take care of myself, but I am just too slow at it and I will admit my size makes it hard.”

“I’ve always taken my bath before I went to bed but here, I am on the Thursday morning bath list, with ‘spot washes’ in between. They use the shower chair and have me scrubbed up in no time. It’s just easier for the girls here.”

You identify a nursing diagnosis of Bathing/Hygiene Self-Care Deficit for Ms. Johnson. Based on the initial interview data as well as potential responses to the follow-up questions write a three-part nursing diagnostic statement to reflect this individual need of this resident.

Using the Assessment Guidelines, hygiene, the following data are documented regarding Ms. Johnson’s physical status as it relates to hygiene needs:

3. Based on Ms. Johnson’s capabilities, which type of bath would best fit this situation and why?

4. Ms. Johnson tells you during the bath, “In the hospital they had prepackaged bath kits. I wish they had them here. I could do parts myself using them.” These products are not available in this facility. How could you provide a similar experience for this resident?

5. During the partial baths done in her room, how would you ensure privacy, safety, and comfort for this resident? Think: What would you desire if you were in this same situation? In addition to the medication ordered by the primary care provider to address Ms. Johnson’s fungal infections of the skin, what other interventions can be done to decrease the skin problems associated with being morbidly obese that are individualized to this resident?

6. What kind of positioning, skin care, and procedural steps would you need to implement to provide adequate/individualized perineal care for Ms. Johnson?

Answer 1

1)How the heath status affected the patient self care ability?

_The patient,she already have left side weakness due to strock,and retinopathy and it affect the sight, peripheral neuropathy,it make the patient law sensation.Also she have less ability to follow the instructions.Because of weakness she can't able to wake up and go for a bath with out help,and there is no proper sight it all will affect her activities.

_2)It is important to assess the self care ability of the patient,becaus through this assessment we will come to know about which all the activities she can do alone,For which activity she need support,and for which activity she cannot do.By this assessment we can take a decision and make a plan of care for this patient.

_By taking assessment we can complete the plan of care,and can save the time for care.We can make her to do which all are the activities she can do alone,and during the time of help we can help her to do,this will save the time,and by this she will get some confidence to her activities.

3) According to her condition and limitations,we can provide bed bath or can provide bath in chair after assisting her to sit in chair,but it will make more difficult for patient and also for care giver.So it easy to provide bed bath according her condition,because she is very slow to follow instructions.

4)We can make all articles needed for bath, near to her to take individual bath.We can provide easy bath packets ,soap and water,dress,sheets,water,dress all near to her and assist her to do bath.

5)We can provide privacy and safety by closing the door or by curtain.During the bath expose the body part where we are cleaning and cover other parts with dress or sheets.While giving mouth make her to sit.While turning the patient keep side rails to avoid fall.Always keep the bed in lower position.

_She can develop skin problems due to her weight and disease condition.So after bath we can provide back massages to improve circulation.And help her to change the position frequently.To avoid fungal infections try to make skin always clean,avoid bed wrinkles,provide proper nutrition.

6)Perinial care:During the perineal care we can provide side laying or lateral position and provide the care.Always keep the area clean and avoid friction.have to clean the area between the thighs and private parts and can put some absorbent power to keep dry.Always make sure the parts is clean.Frequently help her to change the position and provide support by pillows.provide water bed or autologic bed mattress to prevent from pressure ulcers.