SITUATION: You have been assigned to care for Mr. Rich Tilly, a 32-year old admitted to your short-term rehabilitation unit after a lengthy hospitalization following a bike crash that occu

SITUATION: You have been assigned to care for Mr. Rich Tilly, a 32-year old admitted to your short-term rehabilitation unit after a lengthy hospitalization following a bike crash that occurred during a triathlon competition. He had sustained a closed-head injury resulting in a 14-day coma but is now awake, alert and oriented. He also had fractures to the right femur and tibia and right radius. The leg fracture sites were stabilized with external fixation devices. He has a fiberglass cast on his right arm extending from his hand to his elbow. He can bend the right elbow. He is permitted no weight-bearing on the right leg. Goals of his rehabilitation include reconditioning and independence in mobility and self-care activities.

1. What type of exercise should be initiated with Mr. Tilly to regain muscle strength?
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2. Mr. Tilly wants to be able to help himself reposition in the bed telling you, “I am either stuck in one spot or sliding down in the bed. I want to be able to move myself instead of asking the staff to help me.” Keeping his injuries and treatment method (external fixation and casting) in mind, what kind of positioning devices would be appropriate for him to use?
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After completion of admission protocols the physiatrist writes the following orders:
OOB (out of bed) to chair for all meals, no weight bearing to right leg
May ambulate to bathroom with assistance, instruct in use of walker

3. Mr. Tilly wants to get out of bed as soon as possible. You sit with him on the side the bed but he complains of being’ woozy and nauseated”. What is happening to him and how will you intervene?
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4. How could you have assessed for the potential of this event occurring in this patient?
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5. In consideration of the methods available to transfer patients out of bed, which method would be best to implement for Mr. Tilly at this time? Give the rationale for your decision.
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6. Discuss the proper body mechanics that are imperative to safe patient care and transfers in any situation?
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A week after admission Mr. Tilly is progressing slowly in his rehabilitation. He has verbalized frustration at his inability to ambulate freely. He states, “I just don’t know if I am ever going to get better and some days don’t even feel like trying.” He has difficulty walking the required distances due to his musculoskeletal impairment and fatigue and has resorted to using a BSC (bedside commode) instead of using the bathroom with assistance.

7. Formulate two nursing diagnosis that reflect the present issues being experienced by Mr. Tilly? (two of each: a.) Nutrition, b.) Elimination, c.) Mobility, and d.) PsychoSpiritual)
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8. For each nursing diagnosis, identify the most appropriate NOC outcome for this patient. Develop a Develop an individualized goal for each that reflect the uniqueness of Mr. Tilly’s present situation.
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9. Using NIC Interventions, formulate three appropriate nursing interventions (with rationale) to facilitate the recovery and wellness that are individualized to Mr. Tilly’s present health status.
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10. Considering the Mr. Tilly is feeling concerned of his present condition, how will you support and care for him psychospiritually?
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11. How can the presence of support system affect the recovery of Mr. Tilly?
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12. What are the possible considerations on nutrition that is being addressed to with Mr. Tilly? What type of diet should be prepared for him?
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