Chapter 20 Scenarios
Scenario # 1
You are caring for a 72 year-old female patient that has been transferred to your floor s/p right total hip
replacement. The patient is arousable but drifts back to sleep quickly without stimulation. VS: 140/80,
HR 79 (irregular), RR 12, O2 Sat 97% on 2L n/c. The right hip dressing is clean, dry, and intact. The
patient has a Foley catheter in place that is patent and is draining pale yellow urine. You position the
patient appropriately and assess her pain level. She reports pain 2/10 and denies medication. You later
come to administer ordered dose of Enoxaparin (Lovenox). You administer the dose without difficulty or
incident.
The patient is accompanied by her daughter. The daughter is supportive but obviously anxious regarding
her mother’s surgery/hospitalization. She asks you many questions. They are as follows:
1. I don’t want to end up like my mother. How do I prevent this from happening to me?
2. Why is that huge pillow thing between my mother’s legs? It looks very uncomfortable.
3. Why do you have to give my mother that shot? She told you she does not need pain medication.
Questions:
1. How do you respond to the questions above?
2. What appropriate nursing diagnoses do you identify? Why? (List at least 3)
Scenario # 2
You encounter a patient in the clinic setting. The patient is a 29 year-old female. The patient is in the
clinic for management of symptoms related to rheumatoid arthritis. The patient presents today with
complaints of increased pain and a low grade fever 99.5. Vital signs are otherwise stable. The patient is
frequently seen in the clinic. She is compliant but appears to have difficulty retaining patient teaching
points and often presents with repeated problems and similar symptoms. The doctor has ordered:
Prednisone 20 mg daily in addition to the Methotrexate that the patient has been taking for 18 months.
The patient tells you that she is looking forward to getting these symptoms back under control because
she and her husband want to start a family. The patient also has a history of fibromyalgia. She expresses
frustration with this condition also. She tells you that she tries to be as active as possible and is not
going to give into these conditions.
1. What teaching does this patient require regarding the medications listed in the scenario?
2. What are your concerns as a nurse?
3. What teaching does this patient require regarding her disease processes?
4. List at least 2 appropriate nursing diagnoses.