Nursing Question

Instructions:

In this assignment, you will work through one patient scenario listed under the case study below

and create a total of 6 SMART goals:

2 Affective domain goals (1 for patient education, 1 for direct patient care)

2 Cognitive domain goals (1 for patient education, 1 for direct patient care)

2 Psychomotor domain goals (1 for patient education, 1 for direct patient care)

For each goal, you will develop 1 evidence-based nursing interventions with rationales and

citations from reputable sources (e.g., ATI, textbooks, peer-reviewed articles, .edu, .org, .gov

websites).

Use the template/grid provided below.

Add Title and Reference page per APA.

Case Study: Mrs. Maria Lopez Post-Surgical Recovery and Education

Patient Overview:

Name: Mrs. Maria Lopez

Age: 58

Diagnosis: Mrs. Lopez underwent a Total Hip Replacement (THR) surgery due to severe

osteoarthritis of the hip. Her osteoarthritis had caused chronic pain and significantly impaired her

mobility, leading to difficulty performing daily tasks. After exploring conservative treatments,

including physical therapy and anti-inflammatory medications, she opted for a hip replacement

as a more effective long-term solution. The surgery was performed successfully, and Mrs. Lopez

is recovering well, though she is still experiencing moderate pain and some anxiety related to her

mobility restrictions.

Current Condition:

Mrs. Lopez is currently hospitalized, recovering after her Total Hip Replacement surgery. She

is stable but continues to experience mild pain at the surgical site, especially during movement or

when changing positions. Her mobility is still quite limited, and she requires assistance with

most Activities of Daily Living (ADLs), including bathing, dressing, and getting in and out of

bed. She has also expressed concerns regarding how to manage these activities once she is

discharged and returns home, mainly due to the fear of re-injury or overexerting her new hip

joint. Mrs. Lopez is also anxious about adjusting to the limitations of her new physical condition,

particularly regarding household tasks and her overall independence.

Vitals:

Temperature: 98.6F (37C)

Heart Rate: 78 beats per minute, regular

Blood Pressure: 126/80 mmHg

Respiratory Rate: 16 breaths/min

Oxygen Saturation: 97% on room air

Pain Level (on a scale of 010): 4/10 (reported to be more significant during movement

and physical therapy exercises)

Weight: 155 lbs (70 kg)

Height: 5’5″ (165 cm)

Medications:

Pain management:

o Acetaminophen 500 mg every 4-6 hours as needed for pain

o Oxycodone 5 mg every 6 hours as needed (post-surgical)

o Ibuprofen 200 mg three times a day for inflammation and pain

Antibiotics:

o Cefazolin 1g IV every 8 hours (prophylactic for post-surgical infection

prevention)

Anticoagulation:

o Enoxaparin 40 mg subcutaneously once daily to prevent deep vein thrombosis

(DVT)

Antiemetic:

o Ondansetron 4 mg IV every 8 hours as needed for nausea

Laxative:

o Docusate sodium 100 mg daily to prevent constipation due to opioid use

Supplements:

o Vitamin D 1000 IU daily to support bone health

Labs:

Complete Blood Count (CBC):

o White Blood Cells (WBC): 6.2 x 10/L

o Hemoglobin (Hgb): 13.0 g/dL

o Hematocrit (Hct): 39%

o Platelets: 225 x 10/L

Basic Metabolic Panel (BMP):

o Sodium: 137 mEq/L

o Potassium: 4.2 mEq/L

o Chloride: 104 mEq/L

o Bicarbonate: 25 mEq/L

o Blood Urea Nitrogen (BUN): 12 mg/dL

o Creatinine: 0.9 mg/dL

o Glucose: 95 mg/dL

Coagulation Panel:

o Prothrombin Time (PT): 12.5 seconds

o International Normalized Ratio (INR): 1.0 (on enoxaparin)

o Activated Partial Thromboplastin Time (aPTT): 29.7 seconds

Urinalysis:

o Clear, yellow; no signs of infection

X-ray (Hip Post-Op):

o Post-operative hip replacement appears stable, with proper alignment and no signs

of infection or complications.

Prior Health and Social History:

Medical History:

o Osteoarthritis of the hip (diagnosed 8 years ago), progressively worsening over

the years.

o Hypertension (diagnosed 5 years ago) well-controlled with medication.

o Type 2 Diabetes (diagnosed 3 years ago), well-managed with oral medications

(metformin 500 mg twice daily).

o Hyperlipidemia (diagnosed 4 years ago), currently treated with atorvastatin 20 mg

daily.

o No prior history of major surgeries other than minor arthroscopic knee surgery

several years ago for meniscal tear.

o No known allergies to medications or food.

Surgical History:

o Total Hip Replacement (THR) Right hip (recent surgery)

o Knee Arthroscopy for meniscus tear (5 years ago)

o Appendectomy (25 years ago)

Family History:

o Father: Hypertension, heart disease, and stroke (died at age 72).

o Mother: Osteoporosis, diabetes, and breast cancer (currently living at age 80).

o Siblings: One brother (age 55) with hypertension and one sister (age 60)

with arthritis.

o No known family history of hip fractures, cancer, or chronic respiratory diseases.

Social History:

o Occupation: Mrs. Lopez works as an administrative assistant in a local medical

office and has been on medical leave for several weeks due to her hip condition.

o Tobacco Use: Non-smoker

o Alcohol Use: Social drinker, consumes 1-2 drinks per week

o Exercise: Prior to surgery, Mrs. Lopez was active with daily

walking and stretching exercises for her hip, although she was limited due to pain.

o Living Situation: Mrs. Lopez lives with her husband in a single-story home. They

have two adult children who live in the area but are not present on a daily basis.

Mrs. Lopez’s husband provides assistance with household tasks but is aging and

suffers from mild arthritis in his knees.

o Support System: She has a strong support system from family and close friends,

though her anxiety about future dependence is causing emotional distress.

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