NURS 234 PATIENT DILEMA _Josphine peters 62yrs

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 Covered in
Each Case Study
Category/Subcategory
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 12-18%
Therapies
● 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 Clinical Significance:
Problem:
1. Post Op day one for anterior-lateral 1. Anxiety, fear, pain and feeling unwell is common
lumbar spinal fusion. after a surgery and the patient may need some
2. Has no visitors today emotional support.
3. Chest tube pulled out three hours ago. 2. Patient has no support group
4. Hard plastic back brace 3. Removal of the chest tube may increase the patient
5. Patient is on oxycodone 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 Clinical Significance:
History:
1. Divorced 1. Does not have a significant other as a support person
2. Has three grown children one living after surgery, can increase stress, anxiety and increase
locally with teenage children metabolism of pain meds
3. Chronic back pain 2. Children are busy with their own lives
4. Uses recreational marijuana 3. Pain can also increase anxiety and stress, causing the
(Illegally) while at home patient to become more emotionally distressed and
5. Works as nurse’s assistant 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.

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II. The Dilemma Begins…Current Concern:
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