yula

Patient F is a 78 year old widowed female who is being seen at an outpatient pain clinic for a 3-year history of low back pain secondary to osteoporosis and arthritis. Although she lives alone, she had been an active woman, who enjoys bowling, gardening and meeting her friends each week for lunch. During her clinic appointment today, she reports for the last two months, she has not been participating in these activities because the aching pain is sometimes just so bad. I must be getting worse. And my friends don't want to listen to me complain. Some are worse off than me!” She says she is unable to keep up with her household chores and she is having a hard time preparing her meals and sleeping. She says she can only manage a bowl of cereal or soup most days because she's not really hungry and it hurts to move for meal preparation. Patient F says she uses Tylenol or Aspirin at home” and does take them most days but I only take one at a time – maybe just in the morning - I hate pills!” Today her vital signs are T37.3°C, P84, RR18, BP112/66. The Nurse Practitioner has ordered the following: • Codeine 15 mg po q8h prn • Ibuprofen 400 mg q6h prn • Follow-up in clinic in one week

I have trouble finding the priority need in this case. I think rest&sleep, spirituality, activity&exercises are three needs in this scenario. At first, I thought spirituality of ineffective coping was the priority need and nursing diagnosis but getting confused with activity &exercise Patient E is a 66 year old woman who has just been admitted to the rehabilitation unit after undergoing a total left knee replacement 5 days ago. She has a history of osteoarthritis. The transfer report from the acute unit notes that her pain has been controlled with Tylenol #3 and her physiotherapy has been going well but the therapist has recorded that she is slow to complete her exercises. Patient E says she has been feeling really fatigued with little energy. During the admission assessment she repeatedly asks the same questions to the nurse while being orientated to the unit. She says that the pain in her left knee is a 4 or 5 out of 10”. She states she is very tired but says she will not take any medications to help her sleep because she does not want to be hooked on drugs.” In addition she states my partner died suddenly six months ago and it has been very straining both financially and emotionally, I barely sleep at night. I know I'm not coping well, but I don't know what I should do.” She has a brother that comes to visit every other day and two children living away, attending university. Her vital signs are as follows: BP 168/94, RR20, HR 106 T 36.8°C. His medication orders are: Acetaminophen 300 mg + Codeine 30 mg po Q4H prn Ibuprofen 400 mg po Q8H