30.3: Chapter 7
Unfolding Case Study
1. The patient’s daughter expressed concern about her father not being asked about going to the bathroom and being left in soiled undergarments. Based on these concerns, the nurse would first want to perform a physical assessment on the patient with special focus on the perineal area. The nurse should assess the skin of the perineal area, noting any areas of redness or breakdown. Additionally, the nurse should assess the patient’s mobility to gather information about whether the patient can safely ambulate to the bathroom alone or if assistance from care staff is required.
2. During the skin assessment, any areas of redness or breakdown in the perineal area would require immediate intervention by the nurse. This area of the body is prone to breakdown and subsequent infection if not kept clean and dry. These infections can quickly become severe and result in significant problems for the patient as they are hard to heal effectively once they occur. During the mobility assessment, if the nurse determines that the patient requires assistance getting to the bathroom, intervention by the nurse would be indicated.
3. There are several factors that could be contributing to the patient’s current condition. First, the patient likely has limited mobility, making it difficult for him to ambulate to the bathroom without help. There may also be a lack of nursing staff, making it challenging to find someone to help him to the bathroom. In some cases, patients are also embarrassed to ask for help, so this may be a contributing factor. Regardless of contributing factors, it is imperative that the nurse begin to think about solutions to improve the patient’s condition and prevent further tissue damage and decrease risk of infection.
4. Asking the nursing assistant to evaluate and document a patient’s response to hygiene care is appropriate if the patient is alert and oriented. If the patient was not alert or oriented, this would be inappropriate. Asking the nursing assistant to provide perineal care for an unstable patient is not appropriate because this task is not in their scope of practice. They can only provide hygiene care for stable patients. The unit secretary should not be asked to help with the care as this is not in their scope of practice. The nursing assistant should not be asked to administer pain medications as this is not in their scope of practice. The nursing assistant can let the nurse know if the patient requested medication, but they cannot be the ones to administer it.
5. It’s important to remember that family members of patients often need nursing support too. The daughter is clearly experiencing guilt for not being there for her father. One of the first things the nurse could do is reassure the daughter that her father is being taken care of. Let her know that her concerns are valid and are being addressed. It would also be helpful for the nurse to give the daughter more information about how her concerns are being addressed. For example, the nurse might let her know that her father will be asked every two hours if he needs to use the bathroom. During this interaction, it is important for the nurse to be kind and respectful of the daughter’s feelings.
6. Outcomes that would indicate these interventions were successful include no perineal skin breakdown, no evidence of urinary tract infection, and maintenance of clean and dry undergarments. Additionally, the nurse would expect to observe patient and family satisfaction with new care plan.