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%

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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.

II.The Dilemma Begins…Current Concern: This study source was downloaded by 100000829971918 from qwivy.com on 08-06-2021 02:26:14 GMT -05:00

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