First day of NS, confused about homework... I need a little help

[jcolli01]

Hey Everyone,

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 know what the diagnosis would be? 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.

Thanks!

[Fig77]

I am sorry, but I am bit confused about this homework. What's the question? Finding out what the Medical/Nursing Diagnosis or something?

[gfcfnina]

I'm not sure about what you are looking for either, it sounds like you are looking for a nursing diagnosis? Does your instructor want only one (highest priority) or as many that apply (ranked priorities)?

...but either way, a fluid/electrolyte balance (dehydration) will ALWAYS outrank nutritional deficit in terms of priorities. Pain is also a biggie diagnosis you want to address... when in doubt go to Maslow's hierarchy of needs.

hope that helps and good luck! :)

[jcolli01]

I'm looking for a nursing diagnosis... The instructor did not really talk at all about the assignment because she handed it out last minute...

[SRK77]

Well, I am impressed that you can write a nursing diagnosis in correct form on the first day of NS.

[caliotter3]

Well, I am impressed that you can write a nursing diagnosis in correct form on the first day of NS.

Me too. Consult your nursing diagnosis handbook or text if you got a text on nursing diagnosis.

[MERRYWIDOW46]

Writing nursing diagnosis is a skill that takes time to learn. Do you have a reference book of diagnosis and correct nomenclature? I agree with the others, fluid/electrolyte imbalance, pain, metabolic need deficit, weght loss, knowledge deficit related to disease process, etc.

[Charlie0413]

You can have more than one diagnosis. If it does not say any different you can just start listing. If it asks for them to be in order of importance start with the dehydration.

[Daytonite, BSN, RN]

i think your instructions were pretty clear. . .to assess the pain. assessment and description of pain includes the following:

• where the pain is located
  
• how long it lasts
  
• how often it occurs
  
• a description of it (sharp, dull, stabbing, aching, burning, throbbing)
  
  • have the patient rank the pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain
    

  [*]what triggers the pain

  [*]what relieves the pain

  [*]observe their physical responses

  • behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
    
  • sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
    
  • parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness
    

as you can see, your scenario has provided a lot of pain descriptors for you to make a nursing diagnosis. there are two nursing diagnoses for pain and your choice will be based on the definition of pain.

• chronic pain - definition: unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of more than 6 months. (page 355, nanda international nursing diagnoses: definitions and classifications 2009-2011)
  
• acute pain - definition: unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months. (page 354, nanda international nursing diagnoses: definitions and classifications 2009-2011)
  

this is clearly a case of chronic pain. the related factor, or etiology, must be stated as actual or potential tissue damage,. the definition of this diagnosis tells you that. your scenario tells you it is caused by a degenerative disc. a lot of the other information in the scenario is evidence of the pain. i would write the diagnostic statement as follows:

• chronic pain related to degenerative disc as evidenced by uncontrolled radiating back pain in the lower lumbar region of 8 of a scale of 0 to 10 that often reaches a 10 especially with movement, pain is described by patient as constant, throbbing, and radiates with "sharp shooting" pains into the thoracic region, is reluctant to move in bed, has been unable to eat or drink much in the past few weeks, states she all she wants to do is sleep because it "takes my mind off the pain" and is occasionally weepy and anxious.
  

taking darvocet, extra strength tylenol, attempting music therapy and guided imagery and taking hot baths are the interventions that the patient has done (what does or doesn't relieve the pain).

other problems mentioned in the scenario were:

• gait was unsteady and required a one person assist (impaired physical mobility)
  
• depressed
  
• worried about her children
  

however, since pain assessment seems to be the primary focus, that is what i would stick with.

[jcolli01]

Thank You all very much! The assignment was for my FIRST day of Nursing School in the only class I had on that day, and we did not go over anything about the assignment or anything having to do with the assignment, that is why I was confused. I came up with some diagnosis on my own, but I wasn't sure if it was okay to list more then one.

I appreciate all the input everyone gave!

[jcolli01]

Daytonite,

Thank you for all your help! The instructions for the assignment were not very clear because my instructor did not give any instructions and did not talk about anything during class that related to the assignment. None of the other nursing students in my class understood the assignment either, that was our first class of nursing school.

I appreciate all the input you gave me!