Josephine Peters is a 52-year-old female who is postoperative day one for anterior-lateral lumbar spinal fusion. Her pain has been controlled with oxycodone 5 to 10 mg PO every four hours. She has had no visitors today and has been resting comfortably between doses of pain medication. She had her c...
PATIENT Dilemma Demanding/Disrespectful Family Member Josephine Peters, 62 years old Primary Concept Coping Interrelated Concepts (In order of emphasis) ● Pain ● Stress ● Clinical Judgment ● Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment ● Management of Care 17-23% ✔ ● Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% ✔ Physiological Integrity ● Basic Care and Comfort 6-12% ✔ ● Pharmacological and Parenteral Therapies 12-18% ● Reduction of Risk Potential 9-15% ✔ ● Physiological Adaptation 11-17% Clinical Dilemma Activity: STUDENT I. Scenario History of Present Problem: Josephine Peters is a 52 -year-old female who is postoperative day one for anterior -lateral lumbar spinal fusion. Her pain has been controlled with oxycodone 5 to 10 mg PO every four hours. She has had no visitors today and has been resting comfortably between doses of pain medication. She had her chest tube pulled out three hours ago. Her last dose of oxycodone was 10 mg three hours ago. To support her back when she is out of bed, Josephine has a hard plastic back brace. She is currently sitting in a chair with the hardback brace in place. Personal/Social History: Josephine is divorced and has three children. She has chronic back pain and uses recreational marijuana (in a state where it is NOT legal) to manage this pain at home. She currently works as a nursing assistant in a skilled care facility. Her oldest son lives locally and has two teenage children. What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: 1. Post Op day one for anterior -lateral lumbar spinal fusion. 2. Has no visitors today 3. Chest tube pulled out three hours ago. 4. Hard plastic back brace 5. Patient is on oxycodone 1. Anxiety, fear, pain and feeling unwell is common after a surgery and the patient may need some emotional support. 2. Patient has no support group 3. Removal of the chest tube may increase the patient pain 4. A hard plastic brace might make the post -op recovery more difficult for the patient because she is uncomfortable. 5. This can cause respiratory depression and is a strong opioid RELEVANT Data from Social History: Clinical Significance: 1. Divorced 2. Has three grown children one living locally with teenage children 3. Chronic back pain 4. Uses recreational marijuana (Illegally) while at home 5. Works as nurse’s assistant 1. Does not have a significant other as a support person after surgery, can increase stress, anxiety and increase metabolism of pain meds 2. Children are busy with their own lives 3. Pain can also increase anxiety and stress, causing the patient to become more emotionally distressed and slowing the healing process. 4. Lack of using her personal remedy for pain relief might be causing her additional anxiety and stress. 5. Working as a nurses’ assistant can put more stress on the patients back causing pain levels to increase. Patient will also have a long period off work which can cause stress due to finances. This stud yIsIou.rcTe whasedowDnlioaldeedmbym100a000B824e77g89i7n7 fsro…m CCoursueHrerro.econm tonC05-o06n-20c21e0r4:n39
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