Reference no: EM133858665

Patient Research

Carole Jones, a 75-year old female, is admitted to your unit with a severe infection of the left foot and lower leg. Two weeks ago she developed a foot wound that has not healed even after antibiotic therapy and wound care was done at home. Now there is a deep open wound with drainage on the foot with redness, edema, and continuous pain over the entire lower leg and foot.

Ms. Jones has a history of chronic lower back pain from a fall that happened 7 years ago. At home she uses a moist heating pad, rest, and ibuprofen 400mg whenever her back pain causes distress. She gets massage therapy every Friday. Until her current illness, she slept well most nights.

On admission to your unit, her medical diagnosis is cellulitis: left lower extremity. Vital signs are T-101.5, P-97, RR-18, B/P 124/74. She is 5 foot 7 inches and weighs 188 pounds. Diagnostic studies done prior to admission indicate no osteomyelitis of the left foot. Her medical orders include bedrest with left lower extremity elevation; IV antibiotics, Percocet 5/325 1 or 2 tablets every 4 hours as needed for pain, Ambien 5mg hs prn; notify physician for fever over 102; and bedside physical therapy. The orders for wound care include dressing changes twice a day with gentle saline irrigation and application of Bactroban then rewrap as a wet-to-damp dressing using Kerlex.

1. What is happening to the tissue in her leg that can produce her pain experience?

2. How about her chronic pain?

3. What aspect of her history, illness, and admission could affect her rest and sleep? Why?

4. What Nursing Diagnoses do you think would apply in relation to her pain or sleep?

5. Before you go in to assess your patient, what are priority areas would you plan to obtain subjective data early this morning? Why?

Verbal Report

You receive verbal report from the nurse on the unit. He reports that Ms. Jones complained of pain during the night but refused to take any analgesic medication. Ms. Jones said, "Those medications can cause addiction, you know." Her leg dressing is clean; it was changed at 11pm and she complained of severe pain when the dressing was changed. Her vitals were taken 15 minutes ago and are T-100.0, P-88, RR-16, B/P 134/86.

1. What are you going to be on the alert for today with this patient?

2. Based on the report you received, what important assessments do you plan to make?

3. What problems might your patient complain of today?

4. What interventions do you plan to implement should your patient complain of these?

Initial Assessment

Upon entering Ms. Jones's room, you observe that the patient is safely lying in bed with her left leg supported on a pillow. She opens her eye, looks and nods at you but does not smile or speak. The breakfast tray is opened but most of the food is untouched. You observe that Ms. Jones's breathing is eupneic, she is generally in poor body alignment, and the IV antibiotic is infusing without problem. The TV is on but she is not watching it.

1. What assessment data should you collect regarding the patient's need for both rest and comfort?

2. Suggest some specific questions and communication methods to use when obtaining this subjective data.

3. What information should you obtain from Ms. Jones about her use of the ordered analgesic medication?

Patient Care

The patient said that she has not been sleeping well since she has been on your unit. She feels tired but cannot get good sleep. The infected leg causes constant pain; right now she rates the pain as 8 on a scale of 0-10 and that it "feels like the whole leg is on fire from the knee to the toes." Ms. Jones adds that being in bed all the time with her leg elevated has aggravated her chronic back pain. "I just can't get comfortable." She has no appetite and says "I just can't think of anything except how much I hurt."

1. What is your priority action? (be specific)

2. List additional interventions that could be done at this time to increase her level of comfort.

3. What priority information should the student nurse teach Ms. Jones about managing her pain and using analgesic medications to obtain the best effect?

An hour after receiving the analgesic medication, Ms. Jones appears more relaxed. She states the leg pain is now rated at 3 out of 10 and her back feels better. She agrees to have a partial bath and requests that the leg dressing be changed first, "Do it now, please."

1. Describe some actions that the nurse can teach and assist Ms. Jones to use during the dressing change which will lessen the pain of the procedure. Explain why these actions can be effective.

2. Following the dressing change, what actions by the student nurse will promote the patient's comfort and rest?

3. What ongoing assessment data does the student nurse need to obtain during the day related to comfort and rest?