CASE STUDY WEEK 6_2
Amanda Orr
[COMPANY NAME] [Company address]
, Post-op Pain Management:
Cardiac Arrest (2/2)
Sheila Dalton, 52 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Acid-Base Balance
, 3. Fluid and Electrolyte Balance
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
© 2016 Keith Rischer/www.KeithRN.com
UNFOLDING Reasoning Case Study: STUDENT
Post-op Pain Management 2/2: Cardiac Arrest
History of Present Problem:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had
a posterior spinal fusion of L4-S1 earlier today. Her pain is currently controlled at 2/10 and increases
with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus
dose that is 0.2 mg and continuous rate of 0.2 mg/hour.
The nurse reported that her nausea has improved after receiving ondansetron IV four hours ago. She was
having increased pain despite using the PCA every 10 minutes. Her pain has decreased from 6/10 to
2/10 since the PCA bolus was increased from 0.1 mg to 0.2 mg of hydromorphone IV one hour ago.
Patient Care Begins:
Current VS:
T: 99.8 F/37.7 C (oral)
P: 78
RELEVANT Data from History:
Clinical Significance:
R: 12
COPD History of respiratory issues, likely retains CO2, potential alveoli
BCPh:ro9n2/i4c8low back dysfunction
pain Recent spinal fusion Use of pain medication with chronic back pain?
surgery Post-op day 0, need to assess for surgical complications/expected
findings, risk for infection/bleeding
OH2ydsarto:m89o
%rphrooonme uaisre4wliittehrs Narcotic use (decr. RR)
n/c Low oxygenation status on 4L NC
worsened pain Is BP complication of meds, sign of bleeding?
Nausea, relieved with Zofran
Low SpO2 89%
Low BP 92/48
Amanda Orr
[COMPANY NAME] [Company address]
, Post-op Pain Management:
Cardiac Arrest (2/2)
Sheila Dalton, 52 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Gas Exchange
2. Acid-Base Balance
, 3. Fluid and Electrolyte Balance
4. Clinical Judgment
5. Patient Education
6. Communication
7. Collaboration
© 2016 Keith Rischer/www.KeithRN.com
UNFOLDING Reasoning Case Study: STUDENT
Post-op Pain Management 2/2: Cardiac Arrest
History of Present Problem:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had
a posterior spinal fusion of L4-S1 earlier today. Her pain is currently controlled at 2/10 and increases
with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus
dose that is 0.2 mg and continuous rate of 0.2 mg/hour.
The nurse reported that her nausea has improved after receiving ondansetron IV four hours ago. She was
having increased pain despite using the PCA every 10 minutes. Her pain has decreased from 6/10 to
2/10 since the PCA bolus was increased from 0.1 mg to 0.2 mg of hydromorphone IV one hour ago.
Patient Care Begins:
Current VS:
T: 99.8 F/37.7 C (oral)
P: 78
RELEVANT Data from History:
Clinical Significance:
R: 12
COPD History of respiratory issues, likely retains CO2, potential alveoli
BCPh:ro9n2/i4c8low back dysfunction
pain Recent spinal fusion Use of pain medication with chronic back pain?
surgery Post-op day 0, need to assess for surgical complications/expected
findings, risk for infection/bleeding
OH2ydsarto:m89o
%rphrooonme uaisre4wliittehrs Narcotic use (decr. RR)
n/c Low oxygenation status on 4L NC
worsened pain Is BP complication of meds, sign of bleeding?
Nausea, relieved with Zofran
Low SpO2 89%
Low BP 92/48
