Is This a Difficult Patient,or is it a Genuine Concern?

Nursing Students Student Assist

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Ms.M is a 26years patient admitted to the medical/surgical ward for overnight observation RE: complaint of shortness breath since the last two weeks..... there is no significant medical history. The nurse she is assigned to measured her vital signs ....the findings are: BP 130/70, Pulse 82, RR 21 and non-labored, Temp. 98, O2 sat 98% on 2liters of oxygen, no complaint of pain, and no visible distress observed.

Every 15 mins. Ms. M rings the call bell and reports that she cannot breathe; the nursing assessment reveals no significant deviation from the vital signs above. What action should we take regarding Ms. M's behavior? And what possible nursing diagnosis can we assign to her?

"I do not have all the answers, but together we can find them."

(M Ecallawh

I was thinking anxiety, as well. But, shouldn't there would be other findings in the assessment r/t anxiety? I experience SOB, increased HR, sweating...

OP - I posted this on your other thread but what unit or chapter is this discussion post assigned along with?

"I've saved some sunlight if you should ever need a place away from darkness where your mind can feed." - Rod McKuen

Specializes in Pediatrics, Emergency, Trauma.
I have a correction of this post .....please see other. This is a case study, thanks for your kind cooperation.

"I do not have all the answers, but together we can find them."

(M Ecallawh

Still constitutes "homework" in this forum-just FYI.

Specializes in Education.

Case studies can be a pain, sometimes, yes?

So, like other people have said, think holistically. I'm also going to say remember your basic assessment skills.

When you first see a patient, what do you look at? The patient, or the monitor?

So, once you've thought about all that, take a dive into your textbook. What are some causes of SOB? Think it through, then start letting your brain go nuts. Come back and talk about your thoughts, and maybe people'll give their thoughts.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

duplicate thread merged as per the TOS

IP....a case study is still school work. It is a long detailed care plan. Is this a real patient? Is there any other information?

You start with an assessment. What do YOU think this patient needs.

I thought this was a forum where students come together to discuss cases,as well as pertinent issues affecting the nursing profession;if it is not please accept my apology.

The scenario is plain.....how do we proceed? Shouldn't we begin by looking at the current situation... physical,and psychological,her chart,labs,chest x-ray,and other pertinent diagnostic testing in order to rule out Anxiety? This is a topic to be discussed as not everyone see eye to eye,but together we can do a better job of constructing our nursing diagnosis,as well as taking care of the patient.

“I do not have all the answers, but together we can find them.”

(M Ecallawh

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

it is...however you need to start the discussion. Tell me what YOU think first. After researching this what do YOU feel this patient needs.

The nurse she is assigned to measured her vital signs ….the findings are: BP 130/70, Pulse 82, RR 21 and non-labored, Temp. 98, O2 sat 98% on 2liters of oxygen, no complaint of pain, and no visible distress observed.

Every 15 mins. Ms. M rings the call bell and reports that she cannot breathe; the nursing assessment reveals no significant deviation from the vital signs above. What action should we take regarding Ms. M’s behavior? And what possible nursing diagnosis can we assign to her?

What do YOU think is going on?

I am trying to get you to use your critical thinking skills. Take away the written word. You are the nurse on the floor with a "healthy" 26 year old female who WANTS to be sick and is driving you nuts with the call bell. What could be going on? What would you think the patient needs?

Giving you what I think doesn't help you learn.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I remember now...you are posting a case study for everyone participate like song in my heart did...are you in school?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Ok I'll bite....I think the patient has anxiety.

Even if this is a stab at generating a participatory care plan, not an attempt to get homework done, I still think it's fishy because the language of the initial post is right out of a textbook and not congruent with the rest of the OP's written work. So I still think it's an assignment.

And, OP, you STILL don't get the idea that nursing diagnosis does not not not NOT come from medical diagnoses or diagnostic workup components, as evidenced by your repeated efforts to steer the conversation back to medical diagnosis and findings. Let's see how you make any nursing diagnosis from your nursing assessment findings, with respect to the NANDA-I 2012-2014 defining characteristics and related factors required for making actual nursing diagnoses.

When in doubt, then answer is chocolate bar.

Specializes in Education.

Try breaking it down.

Patient is a 26-year-old woman. Vital signs are as you mentioned. No significant medical history. Shortness of breath for the past two weeks, and the doctors in the ER couldn't figure out why, so they admitted her for observation. Now she's on the call bell every 15 minutes with continued complaints of shortness of breath. Reassessment shows no clinically significant alterations from the previous assessment.

So what about just sitting down with her and asking if she has any concerns? From what you have said, it sounds like this is budging more into the psych-social side of things, less the physical. Honestly, while her clinical, medical diagnosis is important to me, my first focus would be taking a few minutes to sit down and listen to my patient. She's 26 - has she been in the hospital before? Have there been any significant changes that she's gone through recently?

You mentioned anxiety in one of your posts. Okay, why not run with that. Pulling out my much-loved NANDA-I pocket guide, I see a whole list of things for anxiety. What does your book say? (And if you don't have a book, all this is online, as well.)

So you've done your assessment. You've developed a diagnosis. Continuing in the ADPIE track, what is your plan for this patient? What do you want to see? How will you go about that? How will you know if you've been successful?

This is why it's said to focus on your patient, not the monitor. Form your own judgement of what the patient needs from you as a nurse before sitting down and diving into things like chest x-rays and other testing.

Specializes in Emergency, Telemetry, Transplant.
pertinent diagnostic testing in order to rule out Anxiety?

Just to get you thinking here--what diagnostic test is going to rule out anxiety? Put another way, how are you going to determine that a person is anxious?

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