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CONCEPT 27: Pain CASE STUDY Case Presentation Jenny Alvers is a 38-year-old

CONCEPT 27: Pain

CASE STUDY

Case Presentation

Jenny Alvers is a 38-year-old otherwise healthy female who has been admitted directly to the intensive care unit (ICU) after an automobile accident and emergency abdominal surgery. In addition to surgery, she has deep face, neck, and chest lacerations and contusions. Jenny is on a ventilator and somewhat disoriented and restless with elevated blood pressure and heart rate. She is unable to provide a report of pain, but based on her pathologic condition, the nurse assumes that Jenny has pain and consults with the surgeon about orders for a continuous IV opioid infusion. Knowing that Jenny will be subjected to painful procedures such as endotracheal suctioning and wound care during her stay in the ICU, the nurse also requests supplemental IV opioid doses to administer prophylactically. Jenny’s sister reported that Jenny has no allergies but experienced severe nausea when she was given IV morphine following an appendectomy 3 years ago. The surgeon prescribes an IV infusion of hydromorphone at a dosage appropriate for an adult with moderate to severe pain and supplemental IV hydromorphone bolus doses every hour as needed. Scheduled doses of IV acetaminophen and IV ibuprofen are also ordered. The nurse suspects that Jenny’s restlessness could be related to unrelieved pain and, therefore, administers an IV hydromorphone loading dose before initiating the infusion. Infusions of IV ibuprofen followed by IV acetaminophen are also administered. An aqua pad circulating cool water is placed over Jenny’s chest to provide additional analgesia. The nurse reduces the external stimuli in the room as much as possible and provides Jenny with calm reassurance and orientation while caring for her. Within 45 minutes of these interventions, Jenny is no longer restless, her vital signs are within normal limits and stable, and she appears to be resting comfortably.

Case Analysis Questions

1. What factors place Jenny at high risk for inadequate pain relief?

2. What methods should be used now, and in the future, to assess Jenny’s pain?

3. What type of pain is Jenny most likely experiencing? How does this information affect treatment decisions?

Concept Mapping Spring 23 edits
Criteria Ratings Pts

This criterion is linked to a Learning OutcomeDisease Process and Pathophysiology Risk Factors
5 pts

Satisfactory

Learner performs a thorough review of the disease process pathophysiology; identifies risk factors.

 3.5 pts

Beginning

There are critical aspects of pathophysiology missing. This entry is incomplete.

 0 pts

Unsatisfactory

The pathophysiology information is missing.

5 pts

This criterion is linked to a Learning OutcomeRecognizing CuesWhat matters most?
5 pts

Satisfactory

Based on available patient data, the learner identifies at least four (4) critical cues that are significant and could impact the patient condition. The learner may consider both subjective and objective patient data.

 3.5 pts

Beginning

Based on available patient data, the learner identifies two (2) or three (3) critical cue(s) that are significant and could impact the patient condition. The learner may consider both subjective and objective patient data.

 0 pts

Unsatisfactory

Based on available patient data, the learner identifies zero (0) or one (1) critical cue(s) that are significant and could impact the patient condition. The learner may consider both subjective and objective patient data.

5 pts

This criterion is linked to a Learning OutcomeAnalyzing CuesWhat could it mean?
5 pts

Satisfactory

Based on the identified cues, the learner is able to create three (3) – four (4) supporting connections between the relevant cues and client conditions/problems.

 3.5 pts

Beginning

Based on the identified cues, the learner is able to create two (2) supporting connections between the cues and patient condition/problems.

 0 pts

Unsatisfactory

Based on the identified cues, the learner is able to create one (1) or zero (0) supporting connection(s) between the cues and patient condition/problems.

5 pts

This criterion is linked to a Learning OutcomePrioritizing HypothesesWhere do I start?
5 pts

Satisfactory

Based on the identified connections between cues and patient conditions/problems, learner is able to identify and rank three (3) client conditions/problems critical to positive patient outcomes. These should be listed with most urgent problems first.

 3.5 pts

Beginning

Based on the identified connections between cues and patient conditions/problems, learner is able to identify and rank two (2) client conditions/problems critical to positive patient outcomes. These should be listed with most urgent problems first. This point value is also chosen if client/problems are not listed with the priority concern(s) first.

 0 pts

Unsatisfactory

Based on the identified connections between cues and patient conditions/problems, learner identifies zero (0) or one (1) client conditions/problems critical to positive patient outcomes.

5 pts

This criterion is linked to a Learning OutcomeGenerating SolutionsWhat can I do?
5 pts

Satisfactory

List five (5) solutions/outcomes with appropriate interventions that will positively impact client outcomes and are appropriate to the care of the client. Outcomes/goals are listed in the SMART format.

 3.5 pts

Beginning

List three (3) to four (4) solutions/outcomes with appropriate interventions that will positively impact client outcomes and are appropriate to the care of the client. Outcomes/goals are listed in the SMART format.

 0 pts

Unsatisfactory

List zero (0) to two (2) solutions/outcomes with appropriate interventions that will positively impact client outcomes and are appropriate to the care of the client. This point value is also chosen if outcomes/goals are not listed in the SMART format.

5 pts

This criterion is linked to a Learning OutcomeTaking ActionsWhat will I do?
5 pts

Satisfactory

Describe how each of the five (5) identified nursing interventions will be performed, implemented, administered, communicated, or taught.

 3.5 pts

Beginning

Describe how three (3) to four (4) of the identified nursing interventions will be performed, implemented, administered, communicated, or taught.

 0 pts

Unsatisfactory

Describe zero (0) to two (2) of the identified nursing interventions will be performed, implemented, administered, communicated, or taught.

5 pts

This criterion is linked to a Learning OutcomeEvaluating OutcomesDid it help?
2.5 pts

Satisfactory

Describe how you will determine the effectiveness of the five (5) priority nursing interventions you implemented. How will you know if your interventions are effective or not?

 1.5 pts

Beginning

Describe how you will determine the effectiveness of three (3) to four (4) priority nursing interventions you implemented. How will you know if your interventions are effective or not?

 0 pts

Unsatisfactory

Describe how you will determine the effectiveness of zero (0) to two (2) priority nursing interventions you implemented.

2.5 pts

This criterion is linked to a Learning OutcomeNursing Process template
2.5 pts

Satisfactory

Recognizing the completion of this template will assist the learner with the concept map assignment, all six (6) boxes are thoroughly completed. The SBAR information is thoroughly identified, and the chosen concept for the assignment is clearly identified.

 1.5 pts

Beginning

Information is missing from one (1) to three (3) box(es). The SBAR information is thoroughly identified, and the chosen concept for the assignment is clearly identified.

 0 pts

Unsatisfactory

Information is missing from four (4) to six (6) boxes. This point value is also chosen if the SBAR information is missing and/or the chosen concept for the assignment is not identified.

2.5 pts

Total Points: 35

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