TASK 44 You are a Registered Nurse preparing Mrs. Jasmine Thompson’s discharge. Mrs. Thompson has had a right total shoulder replacement. She is to be discharged home today with assistance from ‘In home Nursing Service’.
Patient : Mrs. Jasmine Thompson
Address : 73 White Road, Bayview
DOB : 01.07.1942
Age 75
Social Family background: Lives in single-storey house with large garden Utilises cleaning services once a month. Widow. 1 daughter- lives in Bayview, 1 son -married with 2 children, lives in Stillwater.
Daughter will stay with mother for 1 month post-surgery
Medical history R humerus fracture- 1997
Osteoarthritis-R shoulder which has not responded to conservative treatment Chronic R shoulder pain-↓ movement and ability to carry out activities of daily living (ADL)
Current medications Voltaren 50mg daily (ceased 14 days pre-operatively)
Panadeine Forte (codeine/paracetamol) 30/500 mg x 2, 6hrly p.r.n.
Admission diagnosis: R shoulder osteoarthritis
Medical treatment record:
11.07.17 R Total Shoulder replacement (TSR)
Medical progress: Post-op R shoulder X-rays confirm position of TSR Post-op exercise regime – compliant with physiotherapy Post-op bloods – within normal limits Post-op pain management-analgesia, cold compress R shoulder R shoulder wound-clean & dry, drain site-clean & dry
15.07.17 Plan for discharge home with daughter today -home nurse to assist at home
Nursing management Observations – T, P, R, BP (all within normal range)
Neurovascular observations – colour, warmth, movement, sensation Oral analgesia Wound care and observations
Cold compress/shoulder-brace 4 hours per day ADL assistance as required
Physiotherapy management
Exercises as per TSR protocol- Neck range of movement exercises Elbow and hand ROM exercises.
Pendular shoulder exercises
Cryo cuff (cold compress) 4 hours per day Discharge education
Follow-up physiotherapy outpatients appointments Referral to community hydrotherapy
Discharge plan
Patient discharge education – Post TSR:
R arm sling for 4 weeks
Strictly no lifting for 4 weeks
Physiotherapy outpatients x 2 per week, plus hydrotherapy x 1 per week
10 days post-op-staples removal, follow-up appointment in Orthopaedic Joint Replacement Outpatient Department
Orthopaedic Joint Replacement Nurse Specialist contactable by calling hospital, Mon-Fri for any concerns
Referral to ‘In- Home Nursing Service’- assist with showering, administration of LMWH (Clexane) subcutaneous for 4 days as DVT (deep vein thrombosis) prophylaxis
Writing Task: Using the information given in the case notes write a letter of referral to Ms. Roberts, a home nurse, Informing her of the patient’s situation and requesting appropriate care. Address the letter to Ms. Nita Roberts, In-Home Nursing Service, 79 Beachside Street, Bayview.
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