Question

Client: African-American female, 35 yo Diagnosis: Infection secondary to appendectomy History: Hypertension, diabetes mellitus type 2, right toe ulcer Ms. Nina Jackson is a 35-year-old African-American female who was admitted to the medical/surgical unit with a diagnosis of infection secondary to appendectomy. The client had an appendectomy 1 week ago. The admitting nurse noted that the area around the abdominal incision is warm to touch and slightly red. Pt rated pain at 5 on a scale of O to 10. Pt has a history of HTN and DM, type 2. She takes insulin to keep her BG level stable and adheres to a diabetic diet. She has an@ toe ulcer that has not healed for 6 weeks. The admitting nurse noted that hertoe is swollen and contains purulent exudates /L Pt stated upon admission, "I feel weak in my knees and this toe ulcer is driving me crazy. I can barely feel my foot now and sometimes the pain is unbearable!" Pt rated toe pain at 10 on a scale of 0 to 10. She is Full Code. She is allergic to sulfa and eggs. She is scheduled for a chest x-ray because of a recent positive (+) Mantoux. The clinician ordered these medications for her: 0.9% NS, IV running at 125 mL/hr to maintain hydration and fluid balance, enalapril 5 mg PO BID t stabilize high blood pressure, Extra Strength Tylenol 500 mg PRN q4-6 hr to relieve pain, 1 multivitamin tablet PO daily to supplement vitamin and mineral intake, NPH insulin subcut per insulin protocol to regulate blood sugar, and cefazolin 2 g in Ds W 50 mL IVPB q8h to fight the infection. She needs to be scheduled for CBCLab. She also needs to have a blood glucose capillary saple TID AC. Her VS and 02 sats should be checked q 4h and she should be weighed daily. The abdominal incision site and toe ulcer, along with pain level should be assessed. Contact precautions should be taken. She has bathroom privileges with assist of 1. A wound consult has been ordered for both the incision site and the toe ulcer. She also needs a focused respiratory assessment because of the (+) Mantoux. Mrs. Jackson is married and has two sons, and 11 years old. She is a pleasant woman. She works as a account and loves playing video games with her sons. She is a Baptist and active in her church.

Answer 1

1. From a psychological perspective Mrs. Jackson is most concerned with her bonding with the children as there is a necessary for the contact isolation which would make her think, she will be stressed with all the diseases and its complications, the emotional disturbances would be more as the diseases which she is diagnosed to have. Thus there is a risk that she may go for depression, social isolation and self ignorance and fear of complete dependence. The other is interruption of family process due to the care giving of her children.

2.The action the nurse can take to respond Mrs. Jackson psychological needs are:

* to arrange the pastoral care

* demonstrate the relaxation techniques

* arrange the social worker for the assistance at home

* counselling

* family conference to check out the support

* social support group to improve and prevent the social isolation.