Case study

[Sirius Black]

Mrs Sally Brown is a 32 year old woman who is second day postappendectomy. Sally is moaning, restless, diaphoretic: T 37.2C, P 112 bpm, R 26 BPM, BP 142/92. She states the pain is 8 on a 0-10 scale. She is refusing to shower and wants to be left alone. She refuses to do deep breathing and coughing exercises. Outline the assessment you would perform to validate your diagnosis of alteration in comformt related to pain secondary to appendectomy.

I have physical assessment: vital signs (sympathetic overactivity) - elevated pulse, respirations and blood pressure, diaphoretic.

(I was not sure what to make of the temperature - is it possible for a person to have an elevated temperature with pain? Otherwise, in addition to assessment I would compare these vital signs with past vital signs, particularly temperature (for trends/changes).

Subjective assessment - behavioural responses restlessness, moaning, such as refusing to shower, perform deep-breathing and coughing exercises, verbalising pain (8/10).

Is there anything else I could add? Or doesn't need to be included? Thanks.

[surreal]

sounds like you have the pertinent info for a diagnosis of alteration in comfort r/t pain. i wouldnt say that 37.2 is a fever, but like you said.. i would check the clients norm to see if maybe this is a bit high for her.

if she had a fever and was 2 days after the appy i would seriously question an infection.

You asked if pain could cause an elevated temp and i would say yes. im sure you have learned about prostaglandins in anatomy... they are chemicals, similar to hormones that stimulate neural receptors in the body for pain.. that, in this case most likely is coming from tissue damage related to the surgery. prostaglandins that are released can trigger physiological changes like increased temp and dilation of blood vessels. drugs like asprin are taken to decrease pain and temp because they block a certain enzyme in the body that is needed to create the postaglandins. but prostaglandins also help the stomach lining resist gastric acid so that is why you may realize that asprin can cause stomach irritation and bleeding in some people, especially with long term use.

Mrs Sally Brown is a 32 year old woman who is second day postappendectomy. Sally is moaning, restless, diaphoretic: T 37.2C, P 112 bpm, R 26 BPM, BP 142/92. She states the pain is 8 on a 0-10 scale. She is refusing to shower and wants to be left alone. She refuses to do deep breathing and coughing exercises. Outline the assessment you would perform to validate your diagnosis of alteration in comformt related to pain secondary to appendectomy.

I have physical assessment: vital signs (sympathetic overactivity) - elevated pulse, respirations and blood pressure, diaphoretic.

(I was not sure what to make of the temperature - is it possible for a person to have an elevated temperature with pain? Otherwise, in addition to assessment I would compare these vital signs with past vital signs, particularly temperature (for trends/changes).

Subjective assessment - behavioural responses restlessness, moaning, such as refusing to shower, perform deep-breathing and coughing exercises, verbalising pain (8/10).

Is there anything else I could add? Or doesn't need to be included? Thanks.

[Nrs_angie, BSN, RN]

Outline the assessment you would perform to validate your diagnosis of alteration in comformt related to pain secondary to appendectomy.

I would cut all the crap outta the question and break it down like this:

Q: How do you assess for pain?

A: Verbal report is the best indicator....

Assess the PAIN itself... there are several methods like the PQRST method

always note location, intesity, quality

also note the last time this patient was given an analgesic

perhaps it has been 8 hours since the last time this patient had any pain medication... and that would help to validate the fact that they have pain

[Sirius Black]

Thanks, very helpful.

I never thought of breaking if down, certainly makes the case study easier to address.