Emily Grace is a 45 year old woman, 5 ft. 8 in.,180 lbs., of Hispanic descent, who was admitted to a medical surgical unit with a small bowel obstruction. She has had a 4 day history of abdominal pain and vomiting, with up to 12 vomiting episodes per day. The vomitus is blood streaked at times. Her medical history includes an 8 year history of hypertension and type 2 diabetes for 12 years. Recent surgeries include an appendectomy 3 years ago. She is married and has gone to community college and is of the Episcopal religion. She is an administrative assistant. She is allergic to Penicillin and Compazine.She had had an uncomfortable night with pain from 5-8/10 with minimal relief from the morphine pain medication. Her husband spent the night with her and he is quite worried and frustrated. Mrs. Grace says her pain is in the upper abdomen with right side worse than left. The pain is intermittent and feels like bad labor pains. Her abdomen is distended and diffusely tender to palpation. Her abdomen seems more distended this am. There are minimal, hypoactive bowel sounds. The NG drained 600 mL dark brown green drainage this shift. Her urine output was 75 mL with dark yellow, thick urine. Her medication orders include Morphine Sulfate 2 mg, IVP, q2h, prn pain; Ciprofloxacin 400 mg q12hr IVPB; Metronidazole 1200 mg IV x1 dose then 500 mg q6hr prn pain, Promethazine HCL 10 IV q4-6hr prn; Regular insulin per sliding scale.Assess this data utilizing the Roy Model in the handouts given throughout class and the Roy Holistic Manual. Look at all modes and components and cover only the ineffective behaviors and negative stimuli.Case clearly stated 1st level assessment behaviors clearly identified2nd level assessment F C R
All 4 modes..Pathophysiology Radiographic examinations and lab test associated with stimuli Pharmacological intervention NSG DX one in each modeEducational component Transfer/Discharge plans Dilemmas identified Grand Rounds
1. Use your Roy Holistic Workbook, Lecture Notes and past case studies to help you with your final Roy Care Plan
2. There are 8 case studies. I would like to have all eight done for Grand Rounds. This means we need 8 groups. That means that there will be 8 groups of 2 or 3. 4 in a group is not acceptable. 1 in a group is not acceptable. If you are in a group of two you may need another group to come and help you out with your skit or video presentation. You will be responsible for all the work, they will come be actors and participate with you for the skit portion only. Your presentation and paper will be your groups responsibility.
3. Next class session we will pick out of the hat, the topics that each group will choose. This will give each group the same chance at all topics.The Group is to present the following for your case:
Assess the data using the Roy Adaptation Model.
o Look at all modes (4) and components and cover only the ineffective behaviors and negative stimuli.
o (1st and 2nd level assessment of mode behaviors and stimuli)
o For example: if the topic of your case study is physiological, then your top priority nursing diagnosis should be from that group, then go on to look at the role mode, self-concept mode, and the interdendence mode.
o Top priority Nursing diagnosis and appropriate plan of care
o Explanation of Pathophysiology
o Not to be focus of the presentation-cover adequately not in depth
o Analysis of relevant of diagnostic/ lab data
o Analysis of impact of pharmacological intervention
o Teaching/ counseling needs of patient/family
o Transfer or discharge planning and or referral to community agencies, if any
o Ethical dilemmas/concerns with caseFor satisfactory grand rounds:
Present material in a professional manner
Provide audience with supportive material and handouts or use power point or audiovisual. Provide Instructor with copy.
Stimulate group participation
Each group member is to participate by taking a portion of the presentation.
Case study may be presented by skit, video, or??? Please do not exceed 5 10 minutes with this portion of the case study. Be creative, have fun, be professional.Your Power Point presentation will be the rest of your time frame10 minutes. Be complete, be concise.If you go over your allotted 20 minutesyou will be deducted 10 points. With the 8 case studies, the total time is 160 minutes. This gives a 5 minute or less turn around time of 4 min. adding another 40 minutes to the class time.Good luck, contact me questions.The case study will be written up and presented to the instructor with a Face sheet and a reference page. Please use citations within your presentation for material that needs to be referenced.Physiological Areas that are covered by the case studies:
1. Urinary Elimination
2. Bowel Elimination
3. Activity
4. Rest
5. Protection
6. Neurosensory
7. Fluid and Electrolytes
8. OxygenationRubric for Grand Round PresentationPoints AvailablePoints
AwardedCommentsClarity and detail of content20 pointsAll areas of criteria covered and/ or addressed20 pointsCreativity of presentation20 pointsProfessionalism of presentation20 pointsWritten Paper20 PointsTotal
100 pointsPoints deduction for overtime
-10Individual Point awarded for rubric and critique
+5