Joe LeRoy, age 60, was brought in by his daughter and admitted to your small rural hospital. He has had the stomach flu at home for several days and is suffering from dehydration. He has right-sided hemiplegia due to a cerebral vascular accident (CVA) 3 years ago. Mr. LeRoy has remained in bed during his hospital stay due to extreme weakness and fatigue.You received the report from the previous nurses related to your five patients. From the report, you note that Mr. LeRoy continues to have frequent liquid stools (averaging about three or four times per shift). The doctor has requested a stool sample for culture and sensitivity. When entering your patient's room, you notice his sheets are very dirty and he has a strong body odor.
Prescribed Interventions
- Intravenous fluids: D5 ½ NSS at 125 mL/hr
- Stool sample for culture and sensitivity
- Vital signs every shift
Developing Clinical Reasoning and Clinical Judgment
- Develop your priorities and rationales for the following nursing care for Mr. LeRoy:
- Considerations when collecting the stool sample
- Changing his sheets
- Completing the initial nursing assessment
- Describe how your attitude and nonverbal behavior could affect Mr. LeRoy's hospital experience.
- Are there any assessments that you would want to pay particular attention to during your nursing care?
- Obtaining vital signs
- Collecting the sample
- Giving a bath
Suggested Responses for Integrated Nursing Care
- Prioritizing care is sometimes a difficult, but important skill for all nurses. Determine whether Mr. LeRoy can provide his own personal care, although this is unlikely due to his hemiplegia and weakness. If you need to assist him with his personal care, determine the needs of your other patients before beginning this care (refer to Chapter 7). Before leaving Mr. LeRoy, let him know your plan and the time he can expect to have assistance with his bath. Another alternative is to delegate the bath and changing of bed linens to assistive personnel (AP) (refer to Chapter 7). During your initial assessment of Mr. LeRoy, cover any very obviously dirty areas of his sheets with a blue waterproof pad or a clean sheet. You could also offer him a wet, warm washcloth and a dry towel for initial cleaning while you are completing the nursing assessment. You should also inform Mr. LeRoy of the need for a stool specimen (refer to Chapter 18).
- If an AP is not available, return to his room after completing your other patient assessments. First, obtain the warm stool sample, give the bath, and then change his linens (refer to Chapter 7). This sequence saves time and energy for both the nurse and the patient, because the linens may become soiled when providing a bed bath or assisting a patient on a bedpan.
- While wearing gloves, collect and send the stool specimen promptly to the laboratory. Specimens should be sent while still warm, because the microorganisms present at body temperature may die when the specimen temperature changes, and this would produce a false-negative result (refer to Chapter 18).
- Measurement of Mr. LeRoy's vital signs will provide insight into his fluid and electrolyte status, which may be altered related to complications from the flu, including dehydration and diarrhea. Mr. LeRoy's age and underlying chronic health condition impacts his ability to maintain homeostasis. Measurement of vital signs should be implemented based on the nurse's judgment of this patient's situation (refer to Chapter 2). During your assessment, pay particular attention to Mr. LeRoy's skin. Mr. LeRoy is at risk for alterations in skin integrity and pressure injury due to his age, diarrhea, altered nutrition, and immobility (refer to Chapters 3 and 8). Assist Mr. LeRoy to turn over so that you can inspect his back and bony prominences, the most likely areas for alterations in skin integrity. Institute nursing interventions to prevent pressure injury. If you notice any skin breakdown, institute appropriate nursing interventions, based on facility policy, and notify the health care team (refer to Chapters 7 and 8).
- A nurse's nonverbal behavior can have a dramatic impact on a patient's health care experience. Projecting a positive attitude and providing nonjudgmental care help a patient cope with hospitalization. You may be offended by Mr. LeRoy's body odor and the smell of his stool, but as a nurse, you need to learn strategies to manage strong odors and make sure that your facial expressions or body language do not convey discomfort or disgust.