Assessment of Cardiac Status (graded)
Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient’s room for report.
Approximately 1 hour later, you return to Ms. Jackson’s room with her morning pills and find her slumped over the bedside stand in tears. The patient states, “I don’t know what is wrong, I don’t feel right. My back hurts and I’m just so tired. What is wrong with me?” The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach.
Just then the nursing assistant comes into the patient’s room to record Ms. Jackson’s vital signs, you take this opportunity to quickly research the patient’s medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn’t get the patient’s pulse because “it is all over the place.”
Please address the following questions related to the scenario.
- What do you suspect is the cause of the patient’s symptoms?
- Describe the course of action that you will take to confirm this suspicion and prevent further decline.
- What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so.
- While you are caring for this patient, how will you ensure that the needs of your other patients are being met?
Expert Solution Preview
Introduction:
In this scenario, a 56-year-old female patient is experiencing increased back pain and other symptoms after a surgery. As a medical professional, it is our responsibility to assess the situation and take appropriate measures to prevent further complications.
1) What do you suspect is the cause of the patient’s symptoms?
Based on the information provided, the patient’s symptoms could indicate multiple potential causes such as postoperative pain, side effects of medication, or even a more serious underlying medical condition such as a hernia or gallbladder issue. It is important to gather more information about the patient’s medical history, as well as conduct a thorough physical examination.
2) Describe the course of action that you will take to confirm this suspicion and prevent further decline.
The first step would be to conduct a physical exam and gather more information regarding the patient’s medical history. Vital signs, such as heart rate and blood pressure, should be monitored closely. Additionally, a pain assessment should be performed to determine the cause and severity of the patient’s back pain. Further diagnostic tests such as imaging (e.g. X-ray, CT scan, etc.) or bloodwork may also be ordered to determine the underlying cause. Based on the findings, appropriate treatment options will be discussed with the patient and her medical team.
3) What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so.
Additional assessments, lab values, and diagnostic tests that may be ordered for this patient include a complete blood count (CBC), comprehensive metabolic panel (CMP), and abdominal ultrasound or CT scan. The frequency of testing will depend on the patient’s medical condition and response to treatment. Moreover, if the initial tests are inconclusive, additional testing may be required.
4) While you are caring for this patient, how will you ensure that the needs of your other patients are being met?
It is essential to prioritize patient needs based on their level of acuity. If the patient’s symptoms indicate an emergency situation, immediate action should be taken. The patient should be closely monitored, and any necessary interventions should be promptly initiated. Additionally, the other patient’s care should not be compromised, and their needs should be met as per routine. Adequate staffing, delegation, and effective communication among the healthcare team can help ensure all patients’ needs are met.
