Question

JP is a 67 yr-old male patient who fell off his bicycle and fractured his right hip. He underwent total right hip repair. JP lives alone. The incision site is dry/intact/approximated edges/no signs of infection. JP is A/O x 3. It has been difficult to manage JP’s pain since the surgery and he has not been wanting to get up, has been refusing physical therapy. Currently his pain is a 9/10. JP is very angry that he is in the hospital and won’t be able to ride his bicycle again for a while (he bought an expensive bike and has been riding with a group for the last 3 months). After he has been admitted for 24 hours you note reddened areas on his heels (bilaterally) and his sacrum. JP is sweating a lot, but insists on heavy covers claiming his is cold in the hospital. JPs’ BMI is 32. He tells you he started bicycling to try and lose weight. At home JP typically eats banana and coffee for breakfast, fast food for lunch and canned soup for dinner. JP tells you he has been skipping meals for the past 2-3 months to try and lose weight.

Scoring for JP

Sensory Perception

Moisture-

Activity-

Mobility-

Nutrition-

Friction & Shear-

Total =

What interventions can we do for JP?

Answer 1

Sensory Perception No completely I limited rely limited Blightly ited limited simpaiement impar (3) Moisture Alonstantly moist 19 Very moist Occasionally NO momist Timpanome Activity Bed Fast Chais East walks walks Occasionally frequently Mobility Completely immobile Very I limited slightly limited No limitation/ Nutrition very pool Peobablyf Adequate Excellent inadequate No Friction le shead problem potential Problem apparent | Peoblem
  
JANUARY 2017 MTWTFSSMTWTFSS W 53 (001 JANUARY SUNDAY 01 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Braden Scale - Is an evidence-based tool developed by Nancy •Braden and Barbara Bergstoom that predicts the risk for developing a hospital or facility "acquired pressure cilces linjury. The Braden Scale use's a scores from less than or equal to a to as "high as 23. 19-23 - no risk 15-18 mild risk. 13-14 - moderate risk less than 9 - severe risk . - There are six categones within the Braden scale sensory perception, moisture activity, mobility, sensory pengl friction I shear. Braden scale sconug for sensory perception. scored on a scale of 1-4 1 completely hrnited 2: Very limited 3: slightly limited 4: No inipaiment. IN IP's case JP is Alox3. His pain sore Is 9/10. So he is verponding to pressure related Scarredaron foot. So his score a 4 CamScanner cs To be child of God means to display his qualities

JANUARY 2017 02 1002-360) W JANUARY MONDAY MTWTFSSMTWTFSS 1 2 3 4 5 9 10 11 12 13 14 15 16 17 18 19 20 21 >> 23 24 25 26 27 28 29 30 31 Braden JP is scoring scale: focus on Moisture sweating a lot , so he I ie, Constantly moist is 10 Broden scale å focus on Activity JP is underwent total right hip repar. He has hd been wanting to get up, has been refusing physical therapy. And has reddened areas on his heels and his sacrum So his scored is ie, Bedfast. Braden scale: focus on Mobility As we can seen for Activity scoring He is completely immobile and Scored 1 Baden scale : focus on Nutution IPS BMI is 32 (obese). He typically eats banane and coffee for breakfast, fast food for lunch and canned soup for dinner and skipping meals for the part 2-3 mont to lose weight Three things to love - Honesty Purity and Truth Scanned with CamScanner

FEBRUARY 2017 MTWTFSSMTWTFSS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 W 002) JANUARY TUESDAY JANUARY 03 is Gobably hadequate So his scoring nutritive intake again a Braden score & focus on friction & shear JP fell off his bicycle and fractured " his right hip. So he has problem and scoring t - 4 Scoring for JP. - Sensory perception - Moisture - Achvity - Mobility - Nuhition -frickon a sheare Total = 10 - a Three things to Admire - Intellect Beauty and Music Scanned Car scanner

Interventions for JP. Refer to a wound clinicion to dekmine 10 the need for ache support surface. " Regardless of support surface, reposition eveg 1-2hlin corporale hegreent small 12 shifts in position between tums. & Elevat HOB 30 or less for short periods only & Protect sacral wounds from feces a infectoluon- keep skin folds dean a day. e Use moisture baries cream. e Mobilice client to support independent mobility & function. Maximise neutritional status through adequate protein & calorie intake. 3 set up & assist with meals as required. Do lateral transless (bed repositioning with a transler sheet lift a position sling. Your specialty influences others, so use it the best way you can Scanned with CamScanner VONO കോടതിസിപി