Reference no: EM133249228

Case: Claudia Tran, age 84, has been on your skilled nursing unit following a cerebral vascular accident (CVA). Her neurologic checks and vital signs are unchanged from her baseline admission. Her CVA has impaired her ability to chew and swallow and she is receiving weekly vitamin B12 injections for pernicious anemia. She has left-sided weakness, with flaccidity of her left hand. Ms. Tran is emaciated and her skin is very fragile. She has reddened areas on her coccyx, heels, left hip, and elbows. Over the past week, Ms. Tran has become increasingly confused and incontinent. She has a gastric tube for feedings, which she receives every 8 hours. Ms. Tran constantly pulls at her feeding tube and has had to have it reinserted today after pulling it out. Because of this, a soft wrist restraint has been ordered for the next four hours. You check the gastric residual prior to administering the gastric tube feeding and it is 380 mL.

Integrated Case Studies: Basic Case Study: Claudia Tran

Developing Clinical Reasoning

Question 1: Considering Ms. Tran's condition, what special safety measures should be implemented related to the use of the wrist restraint?

Question 2: What are the risks of falling for this patient?

Question 3: What complications could result from the combination of decreased mobility and incontinence?

Question 4: Identify the risks associated with gastric tube feeding for this patient.

Question 5: Identify risk factors and preventive measures to maintain the integrity of Ms. Tran's skin.

Question 6: Identify appropriate sites and administration considerations related to the vitamin B12 injections prescribed for Ms. Tran.