Running head: LIFE AFTER WAR
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Case Study
Title: Life After War
History
A 75 years old white male veteran has been a patient at Sunnyside V.A Medical Center since
1961. Since the war, the patient has been admitted to the hospital over 10 times. The patient has
a medical history of uncontrolled diabetes, PTSD, anxiety, COPD and past drug abuse. The
patient has two sisters and 1 brother that he has not spoken to in over 10 years and a daughter
that lives in the same state. The patient was living in an assisted living home which allowed him
to be fully independent with minimal help but moved in with his daughter after his 2017 hospital
stay.
In 2017, the patient came in with a blood glucose of 1,000 mg/dL. The patient was admitted to
the hospital for 14 days to control his blood glucose. Upon the stay, the patient displayed
unstable behaviors, such as accusing the nurses and medical staff of abuse and neglect when
caring for him. The patient continued to have hyperglycemia due to bad eating habits, which led
to further complications.
Chief Complaint
The patient came in agitated due to pain from his recent right leg amputation surgery. The patient
was upset about being admitted and felt his physician was lying about a possible infection at his
wound site. He just wanted pain medication as the one he was prescribed, finished before he
could receive a new bottle. The nurses on the floor have dealt with the patient many times and do
not enjoy when he comes in. Since he arrived, the patient has repeatedly called the nurse for pain
medications, after 10 minutes, the nurse that would be taking over his care, arrived and informed
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him that she would administer his medication only after receiving report during shift change.
Therefore, the patient got very upset and belligerent and began to shout out racial slurs and stated
that she needed to do what he asked immediately. The nurse turned around and left the room.
After reading the patient’s history, the nurse felt the patient was lying about his pain and just
wanted the medication to get high. The nurse failed to follow the Routine Clinical Approach to
Pain Assessment and Management. As a result, the nurse waited a few hours before starting her
assessment on the patient.
During the assessment, the nurse checked the patient’s blood glucose levels with the results
being at 650 mg/dL. When the patient was informed about his elevated blood sugar, he began to
accuse the nurse of injecting glucose into his body. The nurse laughed at him and stated, “I
wouldn’t mind doing that to you if that means, I do not have to take care of you for the
remainder of my shift.” It is evident here, that the nurse failed once again to practice therapeutic
communication with the patient by being sensitive to his concern and reassuring him that there
was no malpractice done while checking his blood glucose. Furthermore, according to WebMD,
one of the many behaviors that can be shown by someone with PTSD, is feeling of danger and
being attacked (WebMD, 2017). Also, this proves that the nurse did not do a thorough job in
reviewing the patient’s chart, which is beneficial in the success of the nurse to patient
relationship. Therefore, as a nurse, she should have immediately used her critical thinking skills
to realize that his statement was not normal and reassessed him.
Continuously, during lunchtime the patient called for his nurse, he was visibly upset because of
the food he was given. It was a diabetic diet which reduced the amount of sugar and
carbohydrate. He asked the nurse why he couldn’t have pizza. Instead of the nurse educating the
patient about the importance of maintaining a healthy diet she stated, “Listen we are not a
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restaurant, you will eat the food we give you.” According to Potter and Perry, the nurse violated
the Standard of professional performance because her role as a nurse entails not only providing
medical care for the patient but also being the patient’s caregiver and educating the patient about
the importance of maintaining a healthy diet (2017).
Questions:
1)
Give two examples of the Standards of Professional Performance that the nurse violated
during the patients stay?
2)
How has the nurse previous interaction with the patient, interfere with the quality of care?
3)
Which step of the Routine Clinical Approach to Pain Assessment and Management did the
nurse fail to do when the patient complained of pain?