Case Study: Patient Assessment and Care Planning for Miss Violet Paterson

This case study discusses the patient assessment and care planning for Miss Violet Paterson, a 77-year-old woman with acute myocardial infarction, hypertension, and osteoarthritis. The assessment includes cardiovascular condition, pain, and fall risk. The nursing care plan addresses risk of peripheral neurovascular dysfunction, self-care deficit, risk of depression and anxiety, pain management, and fall prevention. Patient education focuses on osteoarthritis management. The team care involves physicians, nurses, pharmacists, physical therapists, occupational therapists, dieticians, psychologists, and social workers.

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Medical Surgical Nursing
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Consider the patient
In this case study, case of Miss Violet Paterson is being discussed. She is 77 years old and
admitted to hospital due to Acute Myocardial Infarction (AMI). She is also associated with
conditions like hypertension and osteoarthritis. Her hypertensive condition and pain are
impacting her activities of daily living. Her condition is worsening because she is staying
alone and family members are not there to take care of her.
Patient assessment
Medial assessment for Violet need to be carried for three conditions such as cardiovascular
condition, pain and risk of fall. For carrying out holistic assessment for Violet, clinical
reasoning cycle is useful. From the provided case study of Violet, her information was
gathered. Information provided in the case study demonstrated that she was suffering through
multiple conditions such as myocardial infraction (MI) and osteoarthritic pain. Moreover, she
was also having history of hypertension. Collected information need to be processed for the
holistic assessment of clinical condition of Violet (Levett-Jones, 2017). Both osteoarthritic
pain and hypertension remain sustained for the longer duration. Hence, it was interpreted that
both the hypertension and osteoarthritic pain related to cardiovascular condition and pain
respectively need to be monitored on the regular basis. Moreover, in the provided case study
it was also mentioned that it was difficult for her to meet daily living needs. Furthermore, she
was staying alone in her apartment. Her age (77 yrs), staying alone in the apartment and
difficult to meet daily living needs indicates fall of risk in case of Violet. Hence, collection of
information and processing of clinical information in case of Violet indicated that her
condition required to be assessed for cardiovascular condition, pain and fall of risk (Levett-
Jones, 2017). Normal blood pressure in adults should be 120/80 mmHg and pain score
should be 0 on VAS pain scale. However, in the provided case study information, exact
values for the hypertension and pain score were not provided. Information related to blood
pressure values and pain scale would have been useful in assessing extent of deviation from
the normal values. Hence, blood pressure was measured using sphygmomanometer and pain
was measured using visual analogue scale (VAS) (Vischer and Burkard, 2017; Breivik,
2016). Osteoarthritic pain might lead to risk of fall in case Violet. Risk of fall in Violet was
assessed through following falls history, medication review, physical examination and
functional and environmental assessments.
Early assessment of cardiovascular condition, pain and risk of fall would be helpful in
planning suitable intervention for Violet. Recording of exact blood pressure would be helpful
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administering correct medication with the exact dose and duration. Measurement of exact
pain scale also would be helpful in administration of suitable medication and planning for
suitable physical exercise. Assessment of fall risk would be helpful in planning fall
prevention strategies for Violet. It is necessary to perform combined assessment of pain and
risk of fall in Violet because these two conditions are interrelated (Vischer and Burkard,
2017; Breivik, 2016).
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Task 2: Care planning
Nursing Care Plan: Violet
Nursing problem: Risk of peripheral neurovascular dysfunction
Underlying cause or reason: Peripheral neurovascular dysfunction might occur due to cardiovascular conditions like myocardial infraction and
hypertension. Violet was associated with both of these cardiovascular conditions.
Goal of care Nursing interventions/actions Rationale Indicators your plan is working
To monitor and assess
peripheral
neurovascular
dysfunction and to
maintain normal blood
circulation in the
peripheral area of
body.
Assess Violet for individual risk factors
like trauma associated with the extremities
which might lead to internal tissue damage,
immobility and sedentary lifestyle.
Record positioning of the casts in the head.
Carry out neurovascular assessment in
Violet if she is immobilised due to any
other factor.
Enquire to Violet about localised pain,
discomfort and inform to nurse about the
numbness, tingling and pain at rest or
during movement.
It would be helpful in the identification
of the circulation insufficiency and
occlusion (Ladwig, Ackley, and Makic,
2016).
It would be helpful in recognizing
probable pressure on the tissues
(Swearingen, 2015).
It would be helpful in the future
comparisons (Ladwig, Ackley, and
Makic, 2016).
It would be helpful in identifying
abnormalities (Swearingen, 2015).
Maintain normal functioning in terms of
sensation and movement in the routine range
of Violet.
Participate in all the normal activities.
Establishing signs and symptoms; hence
suitable intervention can be planned in
Violet.
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Encourage and ensure Violet to perform
exercise on regular basis. Encourage her to
perform motion exercise.
It would be helpful in improving
circulation in the peripheral region.
Moreover, it would also be useful in
providing muscle strength (Swearingen,
2015).
Nursing problem: Self care deficit
Underlying cause or reason: Pain might lead to inability to perform normal activities for self-care.
Goal of care Nursing interventions/actions Rationale Indicators your plan is working
To encourage Violet to
carry out routine
activities of daily
living.
Assess ability and capacity of Violet to
perform activities of daily living.
Provide walker to Violet, if she is not able
to walk on her own due to pain and
osteoarthritic condition.
Ensure personal assistance to carry out her
activities.
Assessment would be helpful in
providing early intervention to Violet
(Gulanick and Myers, 2016).
It would be helpful for Violet for
becoming self-sufficient for walking
(Seed and Torkelson, 2012).
It would be helpful in reducing risk of
fall in Violet (Seed and Torkelson,
2012).
Violet is performing daily activities with
minimum support.
Violet is performing activities of daily living
bathing, cooking and dressing on regular
basis comfortably.
Nursing problem: Risk of depression and anxiety.
Underlying cause or reason: Depression and anxiety might occur in her due hypertension, pain, inability to perform activities and staying alone.
Goal of care Nursing interventions/actions Rationale Indicators your plan is working
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To encourage Violet to
express her depression
and anxiety.
Assess and monitor severity of depression
and anxiety.
Recognize physical response of Violet to
anxious state. Encourage violet to express
her depression and anxiety.
Educate Violet about the signs and
symptoms of anxiety and depression and
provide counselling to her to manage these
signs and symptoms.
Assessment and monitoring of
depression and anxiety signs and
symptoms would be helpful in
providing early and effective
intervention to Violet (Gulanick and
Myers, 2016)
Patients with anxiety and depression
usually would not be keen to verbalise
their discomfort due to anxiety and
depression. Hence, it would be helpful
in recognising early signs and
symptoms and provide relevant
intervention (Gulanick and Myers,
2016).
Education related to anxiety and
depression would be helpful in reducing
stress due to anxiety and depression
(Gulanick and Myers, 2016).
No signs and symptoms of anxiety and pain
in Violet.
Violet verbalised her feeling about anxiety
and depression.
Nursing problem: Pain
Underlying cause or reason: Osteoarthritis lead to chronic pain.
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Goal of care Nursing interventions/actions Rationale Indicators your plan is working
To reduce pain in
Violet to normal level.
Assess Violet’s description of pain.
Assess Violet’s history about pain and
interventions taken to get pain relief.
Find activities which are responsible for
exaggeration of pain in Violet.
Identify whether Violet is reporting her all
the pain experience.
Violet might verbalise pain in knees
and hip. Pain might exaggerate due to
physical activity and feel relief at rest.
However, Violet might experience joint
pain at rest also (Pickering et al., 2018).
Appropriate intervention might have
implemented to Violet to get relief from
pain. Hence, same pain relief plan can
be implemented to her (deWit, and
Kumagai, 2014).
Pain might be associated with certain
physical activities, like monotonous
movement of certain joints (Pickering
et al., 2018).
Patients with chronic pain like Violet
might tolerate basal level pain and
verbalise discomfort which is beyond
Violet didn’t report any type of pain.
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Ensure Violet is applying hot or cold pack.
Administer either or combination of
medications like acetaminophen, NSAID
corticosteroids.
comfort level (deWit and Kumagai,
2014).
Hot condition is useful in improving
blood circulation and reducing pain
reflux. Cold condition is useful in
reducing pain through decreasing pain
inducing chemicals (deWit and
Kumagai, 2014).
These medications would be useful in
pain relief and treating musculoskeletal
pain disorders (deWit, and Kumagai,
2014).
Nursing problem: Risk of fall
Underlying cause or reason: Pain and osteoarthritic condition might lead to pain in Violet.
Goal of care Nursing interventions/actions Rationale Indicators your plan is working
Violet might experience Assess Violet for history of falls, mental Patients with fall risk might fall again if Fall frequency was reduced in Violet.
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less frequency of fall
and might use safety
measure to prevent fall.
status, age-dependent fall risk, sensory
deficit, balance and gait, disease related
symptoms and medications.
Provide Violet with signs for identification
of fall to remind nurses to provide fall
prevention strategy.
they fall for 3 – 4 times in the previous
six months. Confused state and lessened
judgement might lead to risk of fall.
Weak muscles and reduced flexibility
in the older age might be responsible
for the risk of fall. Vision and hearing
deficit in the older age might be
responsible for the risk of fall. Older
people like Violet might be with poor
balance and walking ability; hence, they
might be at risk of fall. Few
medications might lead to fall
(Gulanick and Myers, 2016).
It would be helpful in improving safety
of Violet and prevent falls (Gulanick
and Myers, 2016).
Items far from Violet might increase
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Provide items like call light, water and
urinal near Violet and respond to call light
at the earliest.
risk of fall (Gulanick and Myers, 2016).
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Patient education
Violet should be provided with education for osteoarthritis condition because improving
awareness of Violet about osteoarthritis would be helpful in managing osteoarthritic
condition. Violet should be provided with the information related to the signs and symptoms
of osteoarthritis because she can identify it and contact healthcare provider immediately.
Violet should be educated about the importance of exercise for the management of
osteoarthritis. Exercise would be helpful in improving flexibility of the joints (Gay, Chabaud,
Guilley, and Coudeyre, 2016). Violet should be made aware that she should consume calcium
and vitamin D on the regular basis because these would be helpful in improving strength of
bones and joints. Education for the osteoarthritis patients like Violet is important because
these patients might feel frustrated, depressed and anxious due to continuous pain and
inability to perform normal activities. Education related to osteoarthritis for Violet might be
useful in self-care and self-management of the osteoarthritis. Violet should be educated about
the medications for osteoarthritis. Education about the medications might be useful in
improving her interest in consumption of medication and improving adherence to the
medication consumption. Improving adherence to the medication consumption is an
important aspect in the management of chronic disease condition in the older people like
Violet. Violet should be educated about the weight management because there is direct
correlation between the increased weight and osteoarthritis (Majid, Lee, and Plummer, 2015).
Violet should be educated about the use of supportive devices like canes, walker, raised toilet
seats, and tub and shower bars which would be helpful in minimizing strain on the joints and
performing daily activities with comfort. Violet should be provided with information related
to the osteoarthritis. She should be informed that when no treatment is workable for
osteoarthritis, surgery is the last option (Lopez-Olivo et al., 2018).
Team care:
Different professional like physician, nurses, pharmacist, physical therapist, occupational
therapist, dietician, psychologist and social worker need to be incorporated in care of Violet
during hospital stay and after discharge from the hospital. Physician along with nurse need to
assess exact health condition of Violet considering past history and current assessment.
Moreover, physician and nurse should plan and provide appropriate intervention to Violet.
Pharmacist should provide education about the medications to Violet and dispense
medications considering adverse effects and drug interaction because Violet need to consume
multiple medications. Physical therapist and occupational therapist need to give her suitable
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exercise plan because osteoarthritis and cardiovascular conditions can be effectively managed
by exercise (Pereira, Ramos, and Branco, 2015). Dietician should give her appropriate plan
because increase in body weight can affect osteoarthritis and cardiovascular condition.
Moreover, dietician should advise her not to consume food containing high level of fat
because this type of food can exaggerate her cardiovascular condition. Dietician should work
along with physical therapist because dietician should plan diet for Violet appropriate to the
type and schedule of exercise. Dietician also should work along with pharmacist because
pharmacist need to evaluate food-drug interaction to avoid further complications in Violet.
Psychologist need to perform psychological assessment in Violet because she might be at risk
of anxiety and depression due to her condition for the longer duration. Moreover, she was
unable to perform her daily activities which would produce stress in her. Social worker needs
to assist her to get place in old age home because she needs to go the old age home after
discharge. She was staying alone at home and it would have been difficult for her to take care
of her condition on alone (Hussain, Neilly, Baliga, Patil, and Meek, 2016; Bloch, Srinivasan,
and Mangwani, 2015).
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