What Should the Nurse Do?

Mehul works on a medical-surgical unit and is informed by his charge nurse that he is receiving an admission. The patient has diabetes and is being admitted from their nursing home for severe hypertension and hyperglycemia. From report, Mehul also knows that the patient has class 3 obesity (as determined by the BMI index) and has difficulty with mobility and performing his activities of daily living (ADLs) such as showering and going to the bathroom without assistance. Given this information, what kind of specialty equipment should he have available?

A nurse is admitting a patient who has a history of falls and is being admitted for yet another fall at home. The ambulance has picked up the patient from their home in the suburbs and will be at the hospital in an hour. The patient is a 95-year-old female who lives with her adult daughter. She is generally alert and oriented but gets “pleasantly confused” at night. The patient is usually able to get around with a walker without falling, but in the past few months she has been more unsteady on her feet and has fallen twice. This evening the daughter heard a “thump” and found the patient lying on the floor next to her favorite chair. EMS was called and brought the patient in for observation. The nurse must set up the patient’s room. What equipment and supplies should be available? What safety measures should be installed in the patient’s room?

A nurse has gotten report on a patient who is transferring to the acute care general medicine unit from a nursing home. The report seems complete, but when the patient arrives, the nurse finds several discrepancies. What should the nurse do?

A nurse is transferring an 85-year-old patient, Marcia Hartman, to an external nursing facility. She was admitted to the hospital after falling at home and hitting her head. She had extensive bruising on her skin, and lacerations on her arm and leg where she fell. She also fractured her hip and had to have minor orthopedic surgery to fix it. She is mildly confused, but pleasant. She knows her name and her birthday but can be forgetful about where she is and what time it is. She is ambulatory again after her surgery, though fairly deconditioned; Marcia is able to get up with a walker and with two people assisting her. She usually doesn’t try to get up without calling for help, but now and then the nurses have caught her trying to get out of bed or the chair. This most often happens when she needs to go to the bathroom, which after meals can be quite frequent. Her incision site from the surgery is mostly healed, she has a few surgical tape strips that hold her incision together, and she has no complaints of pain. What bothers her more are the lacerations and bruising; she gets very angry when nurses or doctors try to examine them. She denies that she is in pain when she gets angry, saying she’s not a wimp. She responds well to acetaminophen, though, especially before going to bed. Her family is very attentive; they were extremely concerned when she was admitted, and they call frequently for updates. How would a nurse structure an SBAR report for Marcia?

The nurse is discharging an older patient from an acute care facility home under the care of an HHA. The patient has diabetes and a history of not managing their blood sugar very well. What are some questions the nurse would want to ask in order to assess health literacy and learning needs of this patient?

A primarily Spanish-speaking patient is being discharged with home health care. The patient has a surgical dressing that needs changing twice a week, but the home health nurse can only come once a week. The patient does not have reliable transportation to get their medications from the pharmacy because they live in a rural area. What should the nurse do to help ensure the patient receives their medications and necessary wound care? Whom should the nurse talk to? What other considerations should be taken into account to ensure this patient’s safety?