I had my first class of Nursing school this morning... It was Fundamentals lab, I'm a little confused on the homework that was assigned and any help would be greatly appreciated! The homework is a pain assessment patient scenario and here is what the scenario is:
"A.R. is a 45 year old mother of 3 children, one whom still lives at home. She is divorced and works as a bank teller Mon-Fri. She was admitted today to your floor with dehydration, progressive weight loss, and uncontrolled back pain. Upon further assessment, you lean she has been living with chronic back pain for 2 years and recently learned she has degenerative disk that will require surgery.
Her pain is primarily in her lower lumbar region but will radiate with "sharp shooting" pains into the thoracic region as well. She describes the pain in her lower back as constant, throbbing, and sharp. She rates it an 8 right now and says it often reaches a 10 especially with movement. She is on complete bed rest today, and is reluctant to move in bed. She tells you the pain has been so bad in the past few weeks that she has been unable to eat or drink much, and that all she wants to do is sleep because it "takes my mind off the pain."
She has a prescription for Darvocet 500mg q6hprn, but says she many times cannot wait 6 hours and will even double up on the medicine because of inadequate pain relief. She also takes extra strength Tylenol that she says does nothing. She says she has tried alternatives to medication, such as music therapy and guided imagery, but has found no relief with either. She does like a hot bath with a quiet room and says she experiences slight relief with that.
She expresses difficulty falling asleep and only sleeps a few hours before being awaken with pain. Prior to bed rest, her gait was unsteady and required a one person assist. She is depressed, worried about her children, occasionally weepy and anxious. She just wants the pain to ease so she can go on with her daily activities"...
That is the homework I got on my FIRST day of Nursing school! What I can't figure out is what the diagnosis would be... At first I thought the diagnosis would be "chronic back pain in lumbar region related to degenerative disk." But then, I reread it and in the beginning it says she was admitted to the floor with dehydration, progressive weight loss, and uncontrolled back pain, so I thought the diagnosis would be something having to do with Imbalanced nutrition... I'm so confused... Does anyone help me? Am I even close?
I'm also having trouble coming up with what provokes whats going on in the scenario... In the scenario it says something about movement, so would movement be what is provoking?
Again, any help would be greatly appreciated.
Jan 9, '10
If you could wave a magic wand and fix one thing for this woman which would improve her quality of life what would it be?
You are correct in thinking that pain should be the focus of your nursing diagnosis. Her pain is the source of her nutritional compromise, of her sleep disturbance, of her impaired well being, and of her activity intolerance.
She has a medical problem which is the cause of her nursing diagnosis, it is exacerbated by activity apparently.
Take your ideas to your instructor and ask for some help in fleshing them out. You are on the right path.