Help me out if you can! I'm at disagreement with my teacher over what the nursing diagnosis is for the patient below. Now I don't want to give the answer away for fear of revealing to much, but I promise that I've already faced the repercussions for the Nursing Diagnosis that I made. Thank you for your input and I look forward to your response.
Thanks, E
Mrs. S. is a 28 y.o. African American female admitted to your floor with c/o RUQ (Right upper quadrant) abdominal pain, fever, and Rt. Shoulder pain. Mrs. S. states this started gradually 2 days ago but got worst last night. She rates the pain 9/10 and describes it as an aching pain that is constant. She denies any activity that could of brought it on. It is worst when she rides in a car and goes over bumps in the road. Mrs. S. tried taking Ibuprofen 200mg every 4 hours for the pain with slight relief. Her PMH includes Hypertension. Her current medications include Norvasc 5mg everyday & Lotensin 20mg everyday. Her LMP (last menstrual period) was 1/1/08. Her husband is away in Iraqand she has not been sexually active for 4 months since he was last home. Mrs. S. denies smoking cigarettes or using drugs. She admits to an occasional glass of wine. She was given Demerol 75mg and Phenergan 25mg IM in the ER about 2 hours ago. Her pain has decreased to a 6/10. The ER physician has her scheduled for an ultrasound of the abdomen. Her recent blood work in the ER showed to be normal except for an elevated WBC (white blood cell count) of 15. Her VS are 100.1, 85, 12, & 140/70. Wt. 205# & Ht. 5'5†Lungs are clear to auscultation & percussion. Heart is regular rate with normal S1 & S2. Abdomen is tender over the RUQ with guarding. Bowel sounds are present x 4 quadrants
Someone who has RUQ pain with shoulder pain can be liver related. So what were her liver enzymes? So perhaps she is drinking more than she is admitting with her husband in Iraq increased stress etc. Also 200 mg of ibuprofen with "some" pain relief---400 mg (or 600/800) might be a better choice.
With all this being said, this is a nursing diagnosis question, and not a medical diagnosis question, so what is the nurse's immediate goal? Pain relief and pain control going forward. And 6/10 with the medications given is not adequate.....
Eating the young , before they are hatched. I have no problem guiding a student . It's called mentoring.
right because I came to nursing forums to get my assignments "clarified". Not eating any young, just seems odd, account created and first post is this. Maybe I'm a different type of learner and I don't mind helping a person out but this to me seems like they barely tried!
Pain scale is subjective, the patient may be comfortable with a 6/10.
also she just got pain meds two hours ago, should we dose her again? No.
I also don't believe that pain is a First Level priority.
Uh... real world advice going forward. If she is uncomfortable -- and her subjective rating of 6/10 would indicate a fair amount of pain -- yes she absolutely does need more pain meds. Not the same pain meds if contraindicated after two hours (e.g. acetaminophen), but you would contact the provider for new orders. She could have more narcotics because they don't have a strict upper limit.
Something to consider: you disagreed with your instructor. Now you come here and are given advice by experienced nurses, and you disputed that as well. Perhaps your line of thinking is incorrect?
100.1° is not hyperthermic, btw. Where I work, we don't even give Tylenol until a temp hits 101.5. (Unless it's a TBI pt on a normo- or hypothermia cooling protocol.)
right because I came to nursing forums to get my assignments "clarified". Not eating any young, just seems odd, account created and first post is this. Maybe I'm a different type of learner and I don't mind helping a person out but this to me seems like they barely tried!
Pardon me if I go back 34 years. I was dazed and confused with the minimal guidance I received from both classroom lecturers and clinical instructors. OP is trying.. needs assistance from us, as she is NOT getting it in the real world.
Specializes in Psych, Addictions, SOL (Student of Life).
Alteration in comfort R/T RUQ pain with elevated temperature and statement that pain is 6/10 two hours after medication administration. Remember you are doing a nursing diagnosis here - not a medical one. If there are no emergent life threatening signs always make the patients comfort your first priority.
Emotional support and a support system is needed b/c her husband is in Iraq.
Because of the extremely high incidence of Takosubo's cardiomyopathy in military wives there should be a support system already set up for crisis situations.
I'm not worried about that drug, it's erroneous data meant to throw you off the patients complaints and concerns
Well, you should be worried about that drug.Any data included in the case scenario must be evaluated and considered in your nursing diagnosis. NO guessing allowed, WHY did the patient receive phenergan? Your #1 diagnosis of hyperthermia is not correct.
What would you do first as her nurse, address the pain or the fever?
I have to write a paper about this and before moving forward I wanted to be sure I was correct.
Apparently so far so good. I haven't seen an official Nursing Diagnosis from a book so I don't think anyone can beat my proper answer.
If you think you are so correct and know it all, go ahead and move forward with your paper. I passed nursing school and the boards- I don't have a NANDA book anymore, nor do I feel the need to provide one. We are telling you in our experience acute pain would be the priority, so that means you go look it up in YOUR book. Take your attitude elsewhere. I didn't come on here when tired from working and preparing to head back to work for another shift to get so much snark. Good luck with your assignment, I'm out of here.
Emantsch
9 Posts
I'm not worried about that drug, it's erroneous data meant to throw you off the patients complaints and concerns