Case study: Nursing care plan

Identification: John Grant is a 63-year-old man who was diagnosed with bilateral knee osteoarthritis 12 months ago. John is a widower and co-owns a café with his eldest daughter. He previously worked six days a week, however due to his painful knees he now works two days a week and worries about his daughter’s workload. John lives in his own home, which has six steps at the front, and is able to undertake all his own activities of daily living (ADLs), and housework independently. His family visits regularly, and recently his family has been helping with the housework and cooking. Situation: John has returned to the surgical ward post right total knee replacement (TKR) surgery. He has IV Normal Saline 0.9% running @ 84 mL/hour. He is drowsy but rousable and is complaining of pain (rating 7/10). He has an indwelling urinary catheter in situ with 60mL of urine output in the past hour. He has a dressing on his right knee that is intact, but there is a small amount of blood oozing onto the dressing. He has a Bellovac drain in situ that contains 30 mL of frank blood. John has a patient-controlled analgesia (PCA) device in situ. Observations: His vital signs on arrival to the ward are: BP 145/70, RR 22bpm, HR 105bpm, Temp 35.9ºC, SpO2 99% on 8 litres of oxygen via a Hudson mask. Background: John has a history of angina, hypertension (HTN), hyperlipidaemia, type 2 diabetes (T2DM), and depression. John is a member of the Mormon church and throughout his life has travelled on missions to share his faith. Responsibility: You an Registered Nurse have been allocated the care of John

1) TWO (2) actual or potential priority problems relevant to the patient?

2) For EACH priority problem, identify ONE (1) SMART goal for care (Total 2 goals) (SMART goal is specific, measurable, attainable, realistic and timely)

3)EACH goal, describe TWO (2) evidence-based nursing interventions you would implement to meet the goal (total 4 interventions).

4)For EACH goal, identify the expected outcomes and describe your evaluation approach (e.g., how, and when, would you evaluate that your interventions have been effective or not?).