Paper PatientCase Studies3Copyright 2014 by Mosby, an imprint of Elsevier Inc.Copyright 2014 by Mosby, an imprint of Elsevier Inc.Ackley: Nursing Diagnosis Handbook, 10th EditionClinical Reasoning and Critical Thinking: Use of the Nursing ProcessCase Study - Mrs. Templeton (Dignity)Case StudiesCase ScenarioIf she calls me sweetypie again, Im going to scream. Mrs. Templeton turned on her call light to ask for help getting up to the commode, and it was answered by the certified nursing assistant (CNA) who was assigned to care for her again today. Mrs. Templeton hated how she was being treated by this CNA. It was obvious that the CNA had no respect for her, and she was talking about doing a car wash again today to get her bath done quickly. Mrs. Templeton knew that the car wash was two people rapidly washing her while she lay there naked with the CNAs talking about anything but what they were doing. She felt like an inanimate object when they did this and wanted to be anywhere but in the bed.Nursing Assessment Including Client StoryMrs. Templeton, 72 years old, had fallen 1 week earlier, tripping over a rug; she sustained both a fractured hip and a fractured pelvis. Her vital signs were blood pressure: 124/80 mm Hg; temperature: 98.2 F; pulse: 98 beats per minute; and respirations: 20 breaths per minute. The fractured hip was repaired, but Mrs. T. remains on bed rest to heal the pelvic fracture. She is allowed to get up only to use the commode at her bedside. The pain is decreasing at the site of the injuriesit is now a 5 on a scale of 0 to 10and she is taking less pain medication. However, the disability she sustained and the lack of respect she is receiving are devastating. Her facial expression is very anxious and unhappy. She is oriented to time, place, and person and able to move all four extremities.Mrs. T. is a retired registered nurse (RN) who lost her husband 5 years earlier and previously lived alone and managed well by herself until the recent fall. She did not take any medications at home. Now, she has been admitted to this extended care facility for care and rehabilitation to enable her to eventually return home. Her son, who is a lawyer, chose this facility without her input; he has durable power of attorney. She wants to move to another facility where she will be treated with respect. She has talked with her son about being transferred to another facility, but he has not been willing to help her.ASSESSIdentify the significant symptoms by underlining them in the above nursing assessment.List the symptoms (those you have underlined) that indicate the client has a health problem.Group the symptoms that are similar.DIAGNOSESelect possible nursing diagnoses for this client.Review the list of nursing diagnoses in the Ackley and Ladwig text, Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, or by accessing the care plan constructor at the EVOLVE site and viewing the nursing diagnoses listed.(The information can be copied and pasted from the EVOLVE site into the area below.)Possible nursing diagnoses:________________________________________________________________Validate the possible nursing diagnoses.Compare the signs and symptoms (i.e., defining characteristics) that you have identified from your client assessment with the defining characteristics for the nursing diagnosis that you have selected. In addition, read the diagnosis definition and determine whether this diagnosis fits this client.Validated nursing diagnoses include:(The information can be copied and pasted from the EVOLVE site into the area below.)________________________________________________________________________________________________________________________________________________________________________________________________Write or select a nursing diagnostic statement for one of the nursing diagnoses by combining the nursing diagnosis label with the related to (r/t) factors.The label is the title of the nursing diagnosis as defined by the North American Nursing Diagnoses AssociationAn r/t statement describes factors that may be contributing to or causing the problem that resulted in the nursing diagnosis.(The information can be copied and pasted from the EVOLVE site into the areas below.)NANDA-I label: _________________________________________________Related to (r/t) factors: ___________________________________________The complete nursing diagnostic statement is:_______________________________________________________________PLANWrite an outcome to help resolve the symptoms (i.e., defining characteristics). Refer to Section III of the Ackley and Ladwig text for the nursing diagnosis care plan.Outcome: ______________________________________________________Select interventions from the Section III care plan or the care plan constructor that will enable the client to attain acceptable outcomes.Nursing interventions:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IMPLEMENTThe next step in the nursing process is to provide the nursing care using the nursing interventions.EVALUATEAfter the nursing interventions are implemented, the results of the care should be evaluated by determining whether the outcomes were met. If the outcomes are acceptable, then the care plan is resolved. If the outcomes are not acceptable, then further assessment should be made to answer the following questions:Was the correct nursing diagnosis chosen?Were the outcomes appropriate?Were the interventions appropriate in this situation?What other interventions might have been helpful?Changes in the nursing diagnosis, outcomes, and interventions should be made as needed. The continued use of critical thinking will ensure appropriate nursing care.Click here to access the Ackley and Ladwig care plan constructor for assistance in formulating your care plan: EVOLVE