CHAPTER 12 Women's Health Disorders
CASE STUDY 125
Case Study 125
Name
Class/Group
Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.
Scenario
XX
12 Women's Health
T.C. is a 30-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingooophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intraabdominal hemorrhage, and her hematocrit (Hct) dropped from 40.5% to 21%. She was transfused with
3 units of packed RBCs. After discharge, she continued to have abdominal pain, chills, and fever and
was subsequently readmitted twice: once for treatment of postoperative infection and the second time
for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chills,
fever, and nausea and vomiting.
T.C. has now been admitted to your unit from the post-anesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are 130/70, 94, 16, 99.7° F (37.6° C) (tympanic). She is easily aroused
and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal
dressing that is dry and intact and a Jackson-Pratt (JP) drain that is fully compressed and contains a scant
amount of bright red blood. Her Foley to down drain has clear yellow urine. She has an IV of 1000 mL
D5.45NS infusing at 100 mL/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose
2 mg, lock-out interval 15 minutes, 4-hour maximum dose of 30 mg. When aroused, she states that her
pain is an 8 on a scale of 1 to 10. She also has 2 L oxygen by nasal cannula (O2/NC); her Sao2 by pulse oximeter is 93%.
1. During your assessment you note that T.C.'s respiratory rate is 16 breaths/min and shallow.
Identify factors that are affecting T.C.'s respiratory status.
pain management, and the type surgery
2. Articulate a plan for assisting T.C. in maintaining adequate ventilation.
assess respiratory rate and rhythm, monitor vital signs, initiate coughing, turning and deep breathing,
suction if necessary
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
555
PART 2
PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES
CASE STUDY PROGRESS
The unit is busy, and you are concerned about monitoring T.C. carefully enough. Your present patient load
is six; of these, two patients are newly postop and one is getting ready for discharge. You have one experienced nursing assistive personnel (NAP) to help you. You are most concerned with T.C.'s respiratory status
and the possibility that she might, in her drowsy state, self-administer a dose of opioid medication that
would further reduce her respiratory status (despite the lock-out time).
3. Formulate a plan of care for T.C. related to this issue.
monitor conciousness levels, make sure environment is safe and free of objects that she may hurt
herself with, position patient safely on bed with side rails up, monitor rr and PCA pump frequently
12 Women's Health
4. Which of T.C.'s vital sign values would be most important for the NAP to report to you
immediately?
a. Temperature of 100° F (37.8° C)
b. Blood pressure of 160/80 mm Hg
c. Heart rate of 100 beats/min
>> d. Respiratory rate of 8 breaths/min
5. Pain control using the PCA can be tricky. Throughout the first postoperative day, it has been
difficult to balance T.C.'s need for pain medication and depression of her respiratory status.
Discuss the concept of controlling pain with a PCA using opioids and factors that can be
adjusted to better control her pain.
patient controls adminsteration of their pain medication with safety parameters
556
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
CHAPTER 12 Women's Health Disorders
CASE STUDY 125
6. Identify three outcomes that you expect for T.C. as a result of your interventions.
free of pain, respiratory rate is normal and not supressed, pt educated on effects of treatment
7. T.C. is beginning to withdraw from conversations with you and the other staff. She sleeps
most of the day and is not eating. At times, she is tearful and is irritable with her husband.
You believe that she is showing signs of depression. What actions can you take to help her?
depression can happen after treatment, educate her on support groups, self soothing activities such as
writing or listening to music
12 Women's Health
CASE STUDY PROGRESS
T.C. and her husband are talking one evening, and you overhear that they are very dissatisfied with the
care provided by the physician. They believe that he has mismanaged T.C.'s care. They are discussing
­getting an attorney. They ask you what you think.
8. What do you do?
recognize complaint, assess the complaint, validate, respond and come up with a solution such as given it to the
provider
9. You state, “Tell me what's going on with you right now. Maybe I can help you be more
comfortable.” What would be the benefit of taking this approach?
with open ended questions you can assess more of the situation and find ways to help her
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
557
PART 2
PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES
10. Mr. C. says, “No one is telling us anything. My wife came in here for a simple hysterectomy.
She ends up with four surgeries. She still has pain, and she is worse off than when she
started. Somebody has screwed up big time. Then they have the nerve to send me a bill. This
morning they demanded $185,000. I'm not paying a dime until she gets better.” How are you
going to respond?
12 Women's Health
actively listen and face the patient to give her therapeutic communication
558
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.