Reference no: EM133635361

From the below diagnoses, Evaluate your plan of care with a focus on patient outcomes. If timelines are unrealistic for your Care Plan, outline how you would evaluate whether your goals and interventions were met.

Ineffective airway clearance related to pneumonia as evidenced by labored breathing and productive cough
Activity intolerance related to pneumonia as evidenced by ability to walk with assistance for short periods of time with shortness of breath
Impaired urinary elimination related to urosepsis as evidenced by urinary incontinence

CASE STUDY

Mrs. Butters is a widowed 99-year-old female who resides in a very small basement bachelor apartment on her own. She grew up on a farm with her parents and seven brothers and sisters. As the oldest of eight children, Mrs. Butters left school in grade ten to help tend to her younger siblings and the farm. At age nineteen, Mrs. Butters married and began a family. She has five children; three boys, two girls, and eight grandchildren, all living in the same city as Mrs. Butters. Mrs. Butters stayed home with the children and her husband, Mr. Butters, who worked as a local butcher. They were not wealthy but made enough money to provide for their children.

Mrs. Butters has been widowed for eighteen years and was forced out of her home twelve years ago as she could no longer afford it. She now lives in a small, cold, damp, and dark basement bachelor apartment. Since moving into this apartment, her family has noticed a decline in her health.

Mrs. Butter's grandchildren have been trying to convince her to move in with one of them or at least into a retirement home or nursing home. She continues to refuse the offer as she does not want to be a bother to her family, and she does not believe she belongs in "an old folks' home." She also refuses money from her children and grandchildren when they offer to pay for a more suitable apartment. Children and grandchildren visit her daily.

Over the last six months, Mrs. Butters has made eight visits to her local emergency department (ED) for various reasons, mostly due to respiratory difficulty. Upon assessment by the triage nurse, it has been noted that she looks unkempt, pale, thin, weak, and has crackles. The nurse also notes that she has a smell of old urine on her clothing. During the last visit, the ED physician wanted to admit Mrs. Butters; however, she refused and stated she would just leave against medical advice if he tried.

After not hearing from their mother for several days, Mrs. Butters' children go to her apartment to check on her. When she does not answer the door, they phone 911. When the police and EMS arrive, they break down the door to find Mrs. Butters sitting in her recliner, watching a blank tv. She becomes upset with everyone around and yells, "You're interrupting my stories!" Her family and emergency service personnel note that her apartment is cold, damp, and filthy. She has soiled briefs heaped over the garbage and barely any food in her fridge and cupboards.

Mrs. Butters is brought into the ED, where she is finally admitted. As suspected, a combination of blood work, urinalysis, and a chest x-ray show that she has urosepsis and pneumonia. Mrs. Butters spends two weeks in the hospital, where she is put on a course of piperacillin-tazobactam and levofloxacin, Tylenol plain 2 tabs q4h PRN. She is also started on Ventolin, Atrovent and several vitamins. "I find it hard to catch my breath." Nurse notes signs of dyspnea, abnormal breath sounds, elevated heart rate of 120 bpm, periods of restlessness, and productive cough. During her discharge planning, Mrs. Butters is withdrawn and starts to cry. She states that she is upset that she can no longer live on her own and will have to rely on others for simple activities of daily living.

Nursing Assessment in ER

BP 160/88, HR 120 beats per minute and irregular, respiratory rate 26 breaths per minute and laboured, temperature 37.8 by tympanic, SPO2 85%
Audible crackles throughout lung fields
Productive cough
Restlessness
Yelling at nurses while being assessed, "leave me alone," "I want to go home," and "there is nothing wrong with me."
Client did not sleep on the first night of admission to the unit
Client states, "I am always tired, and I have trouble sleeping because of my breathing difficulty."
Slept for short periods of time during the day
Able to walk with assistance for short periods of time but experiences SOBOE
Urine output dark amber, foul smelling, clarity not assessed, client incontinent.
Physician Assessment and Diagnosis

Chest x-ray shows consolidation in left lower lobe pneumonia
Sputum sample indicates presence of bacteria
Urinal analysis reports urosepsis
Admitted to hospital
Bedrest
VS q4h
Push fluids
Intake and output record
Medications ordered
Antibiotics - piperacillin-tazobactam, levofloxacin