Psychological Wellbeing and Risk Factor of Aboriginal Community

Case Study: Nursing Management in Pathophysiology

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Abstract

To deliver optimum patient care, nurses must be equipped with skills, knowledge and
attitudes towards pain, pain assessment and management. These skills must be guided by best
available evidences to prevent any type of harm to the patients. Pain assessment is an integral
part of pain management (Hall-Lord, 2006). In the above case study, the patient complains of
pain in his chest and neck. The complicacy of non-self-reporting pain, even though absent
and as per patient self-reporting he is experiencing pain, there are certain challenges for a
nurse to assess pain.
The patient condition shows no change from the previous status where he was recorded GCS
13 E3, V3 and M6. The above pain rating on GCS scale implies the patient responds to voice,
uttering of words may be inappropriate and some abnormal flexions can be observed on
painful stimuli. But the motor response rating implies he is fine with the motor response as 6
demonstrates the patient obeys the normal orders (lankova, 2006). On contrary to this, the
patient complains of consistent pain in his right side chest and back. These contradicting
views self-reported and evidence based literature act as a challenge for the nurse to assess the
pain for the patient.
In such cases, it is essential to apply the evidence based strategy than any other pain
measuring scale. The following strategy will be maintained for obtaining data about Mr.
Brown pain
To get a self-report from the patient, which in the contemporary scenario behaves as the
single most reliable factor to start with (Herr K, 2004)

A nursing perspective

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Contents
PART A .................................................................................................................................................. 2
Answer 2. ................................................................................................................................................ 3
Answer 3. ................................................................................................................................................ 4
Answer 4. ................................................................................................................................................ 4
PART 7 ................................................................................................................................................... 5
Answer 1. ................................................................................................................................................ 5
Answer 2 ................................................................................................................................................. 5
REFERENCES........................................................................................................................................ 7

PART A
Answer 1. To deliver optimum patient care, nurses must be equipped with skills, knowledge and
attitudes towards pain, pain assessment and management. These skills must be guided by best
available evidences to prevent any type of harm to the patients. Pain assessment is an integral
part of pain management (Hall-Lord, 2006). In the above case study, the patient complains of

Commented [A1]: The start is appropriate and well referenced

pain in his chest and neck. The complicacy of non-self-reporting pain, even though absent and as
per patient self-reporting he is experiencing pain, there are certain challenges for a nurse to
assess pain.
The patient condition shows no change from the previous status where he was recorded
GCS 13 E3, V3 and M6. The above pain rating on GCS scale implies the patient responds to
voice, uttering of words may be inappropriate and some abnormal flexions can be observed on
painful stimuli. But the motor response rating implies he is fine with the motor response as 6
demonstrates the patient obeys the normal orders (lankova, 2006). On contrary to this, the patient
complains of consistent pain in his right side chest and back. These contradicting views selfreported and evidence based literature act as a challenge for the nurse to assess the pain for the
patient.
In such cases, it is essential to apply the evidence based strategy than any other pain
measuring scale. The following strategy will be maintained for obtaining data about Mr. Brown
pain
-To get a self-report from the patient, which in the contemporary scenario behaves as the single
most reliable factor to start with (Herr K, 2004).

Commented [A2]: Analysis well-constructed and the flow among

sections is smooth.

-Going through patient medical history for pain assessment forms another important part, since
every small change at the physical level may induce pain at certain points (Wilson, 2007).
- Consideration of recently applied medical interventions since any procedures applied might be
causing pain.
- Taking data from her wife, to understand the pathophysiology of pain, pain behavior (if she has
previously seen such pain in his husband during hospital admission or home based treatment).
-At times physiologic conditions are underestimated, but they can be the least indicators for pain
so this need to be evaluated in Mr. Brown case.
-Patient behavior at times provides valuable clues for pain identification such as changing
positions, sitting positions can enumerate where the pain is occurring, frequency of pain and
severity of pain (Pasero C, 2002).
So these strategies will be maintained to assess the pain in Mr. Brown.

Answer 2. There can be different reasons for back and chest pain- The pain can be due to
infection in the pleura, which can result in rubbing of two linings of lungs inside and outside thus
causing pain at different points at chest. The rationale is the pleura inflammation can be caused
by pneumothorax, lungs collapse, and pneumonia, which has been already diagnosed in Mr.
Brown.

Answer 3. Opiates are in general used to treat pain or manage the pain in patients who do not
respond to non-steroidal anti-inflammatory drugs. As evidence suggests in patients with end
stage cardiac or respiratory disorders sustained release low dose morphine can beneficial in
reducing pain as well as shortness of breath (Parshall, et al., 2011). Thus, this therapy is justified
in the above case study.

Answer 4. Going through the patient medical history the following assessments are to be made
for Mr. Brown prior to morphine 2.5-5mg administration intravenously. The patient must be
assessed for head injuries, severe renal issues or problems if he has or not, increased intracranial
pressure, severe liver problems, etc. Even a small dosage of morphine administration may lead to
abnormal cerebral circulation (Naqvi F, 2009).
The patient will be assessed for any type of medical allergies to morphine like drugs or
previously used medications that contains morphine like products. If the patient has COPD,
asthma or serious respiratory disorder the morphine must be administered with proper
consultation. To assess the side effects, the following assessments will be carried out
Breathing pattern observation. (Shallow and slow breathing is generally expected).
Assess the patient for any type of seizure and convulsions
Assessment of cognitive and motor skills in the patient.
Urine input and output as urination abnormality can be seen, a patient must be assessed for
bleeding (nose, mouth, rectum, vagina) etc.

Commented [A3]: Short and crisp

While the above assessments will be carried out for heavy side effects of morphine, the
lesser known side effects are headache, dizziness, nausea and vomiting, weight loss, diarrhea etc.

PART 7
Answer 1. In a case of end of life decision which is taken by hospital authority the nurses role
comes under ethical committee scanner as well as ethical guidelines scanner. Since, the nurse has
spent almost every day from the day of admission knowing that the patient doesnt have much
time with him the nurse must showcase that they are positive about his case and he is responding
well from his condition (D. M. Westphal and S. A. McKee, 2009). His needs must be addressed
in order to fulfill all his wishes. The environment must be kept positive in order to give the
patient enough strength mentally to face the discomfort he is having. Making a patients life
much better (quality wise) at the end stage of life should be the goal of nurse.

Answer 2. In the above case, it is essential to convince Mrs. Brown for DNR order given by the
doctor. Mrs. Brown must be made to understand that the prognosis in case of Mr. Brown was
very poor starting from the day of admission, while all sorts of biochemical and biophysical tests
have been done, he is not able to participate in the disease recovery process. So in order to follow
ethical approach and guidelines, Mrs. Brown must be intimated the decision taken by the doctor
and what are its implications for her and other family members. Being a nurse, trust and empathy
must be shown to Mrs. Brown in order to convince as well as give her emotional support (S. Fry

Commented [A4]: Adding justificatons when answering is

appropriate

and N. A. Warren, 2007). Mrs. Brown could be allowed to take daily care of her husband in
order to have some sort of satisfaction. While the approach in these situations are very debatable,
but with no option left and extreme poor prognosis, this decision seems to be best fitting the
ethical and professional code of conduct benchmark (K. T. Kirchhoff, 2000).

Commented [A5]: Appropriately referenced

REFERENCES
D. M. Westphal and S. A. McKee, 2009. End-of-life decision making in the intensive care unit:
physician and nurse perspectives,. American Journal of Medical Quality, , 24(3), pp. 222-228.
Hall-Lord, M. L. B., 2006. Registered nurses and student nurses assessment of pain and distress
related to specific patient and nurse characteristics.. Nurse Education , 26(5), pp. 377-387.
Herr K, S. K. M. P. e. a., 2004. ain intensity assessment in older. Clin J Pain., Volume 20, pp.
207-219.
K. T. Kirchhoff, V. S. L. W. A. H. B. V. C. a. T. C., 2000. Intensive care nurses' experiences
with end-of-life care. American Journal of Critical Care, , 9(1), pp. 36-42.
lankova, A., 2006. The Glasgow Coma Scale: clinical application in Emergency Departments.
Emergency Nurse, 14(8), pp. 30-35.
Naqvi F, C. F. F. S., 2009. Evidence-based review of interventions to improve palliation of pain,
dyspnea, depression. Geriatrics, 64(8), pp. 8-10.
Parshall, M., Schwartzstein RM, P. O. D. & Dyspnea., A. T. S. C. o., 2011. An official American
Thoracic Society statement: update on the mechanisms, assessment, and management of
dyspnea. American Journal of Respiratory and Critical Care Medicine, 185(4), pp. 435-452.
Pasero C, M. M., 2002. Pain in the critically ill.. Am J Nurs., Volume 102, pp. 59-60.
S. Fry and N. A. Warren, 2007. Perceived needs of critical care family members: a
phenomenological discourse,. Critical Care Nursing Quarterly,, 30(2), pp. 181-188.

Wilson, B., 2007. Nurses knowledge of pain. Journal of Clinical Nursing, 16(6), pp. 1012-1020.

Faculty Comments:
The work has appropriate answers as expected. Short and crisp answers have been framed
with a clear demarcation of the asked questions. The work would have been better with
little more efforts in referenecing.