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SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE
STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC
ARREST

Post-op Pain Management: Day of Surgery
(1/2)

Sheila Dalton, 52 years old

Primary Concept
Pain
Interrelated Concepts (In order of emphasis)
1
...

3
...

5
...

7
...


Gas Exchange
Glucose Regulation
Perfusion
Inflammation
Clinical Judgment
Patient Education
Communication
Collaboration

SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE
STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC
ARREST
© 2016 Keith Rischer/www
...
com

SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE
STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC
ARREST
UNFOLDING Reasoning Case Study: STUDENT

Post-op Pain Management: Day of Surgery (1/2)
History of Present Problem:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD
...
She had an estimated blood loss (EBL) of 675 mL during surgery and received 2500 mL of
Lactated Ringers (LR)
...
She was started on a
hydromorphone patient-controlled analgesia (PCA) with IV bolus dose of 0
...
2 mg
...
You are the nurse receiving the patient directly from the PACU
...
She has two grown children from whom she is
estranged
...
This combined with 2500 mL Lactated Ringers will
significantly lower Ms
...

Posterior spinal fusion of L4-S1 0
...
1 mg of IV bolus
post-op
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Dalton should be monitored for mild signs and symptoms of
of oxygen
oversedation, which include altered mental status and altered
consciousness
...

• I would want to continue monitoring her oxygen saturation so that
it stays above 90% as well
...
The patient could be at increased risk for falls
due to living alone, chronic pain, and need for oxygen
...
)
PMH:
Home Meds:
Pharm
...
Citalopram 40 mg daily
Antidepressant
Alleviate depression
• Low back pain with
2
...
Oxycodone 10 mg every 4 Narcotic
hours
prn
Alleviate SOB
Bronchodilator
• Depression
4
...
Sildenafil 20 mg tid
One disease process often influences the development of other illnesses
...

• Underline what PMH problem(s) FOLLOWED as domino(s)
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2 F/37
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2 Pulse
• Temperature is elevated and could signify a possible infection
...
I would continue to monitor for a change in temperature
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of 24 and 88% oxygen sat
• High respiratory rate and low oxygen sat could signify respiratory distress or pain
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98/50 Blood pressure Pain
• Low oxygen saturation could indicate shallow breathing
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Dalton’s pain level is significant and should be treated and monitored
...

movement
...
I could also offer
essential oils to aid in relaxation
...
This is due to increased secretions and bronchial
spasms obstructing the airway
...
The patient may need a bronchodilator to open up
her bronchi and aid in breathing
...
It
is imperative that I get her up and moving as soon as possible in order
to improve GI function
...
If ordered, I
could offer her Zofran or possibly some sprite and saltines in order to
calm her stomach
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5–11
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8
10
...
2
15
...
5–5
...
6–1
...

Worsening
A low hemoglobin level indicates a significant loss in Worsening
red blood cells and blood volume
...

A percentage of band forms indicates a low number of
immature neutrophils
...

Current:
134
3
...
9

High/Low/WNL?

Prior:
136
3
...
1

What lab results are RELEVANT and must be recognized as clinically significant by the nurse?
TREND:
RELEVANT Lab(s):
Clinical Significance:
Sodium
Glucose

Ms
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An intervention would be to give her a
solution of saline
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Dalton’s blood glucose is elevated
...
An elevated blood sugar could delay
healing and increase the chances for surgical-site infection
...
4

12-16
g/dl
Critica
l
Value:
20 g/dl

The patient’s hemoglobin An intervention could be follow up lab draws or a blood
is below the normal level; transfusion to raise her red blood cell count
...
Dalton’s vital signs for significant
monitored closely
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SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE
STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC
ARREST
Clinical Reasoning Begins…
1
...
What is the underlying cause/pathophysiology of this primary problem?

The underlying cause of acute pain is Ms
...
Her low oxygen saturation is likely due to a build-up of secretions and bronchial spasms which can be
attributed to her history of COPD along with shallow respirations and the use of accessory breathing muscles due to
pain
...
1–0
...
1–0
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9% NS 100 mL/hour IV

Clear liquids/advance diet as
tolerated

Apply lumbar orthotic brace
when up in chair or ambulating

•
•

Will decrease pain level/keep pain under control
...

The patient will have no pain
Will keep the patient comfortable
...

The patient will lab values will
Will expand patient’s lungs, decreasing pain
become normal
level and need for high levels of oxygen
Will keep the patient hydrated and balance
electrolytes
Will keep patient from being nauseated by
advancing too quickly after surgery and increase
fluid intake
Will decrease patient pain level and increase
mobility
Will allow for a trend and continued monitoring
of patient’s laboratory values
Will allow for a trend and continued monitoring
of the patient’s abnormal CBC levels

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