Assignment Task

Mrs. Rose is a 51-year-old female who is admitted to the medical surgical unit following a mastectomy of her left breast plus her lymph nodes due to a cancerous growth.

Mrs. Rose is married and has three children – two daughters, age 29 and 26, who are living on their own approx. 2 hours away and a son, age 20, who is in university and living at home.

Mrs. Rose had been in good health until September of last year when she noticed a small bump on her left breast under her arm that hurt. She had a biopsy of the lump, and it was detected as stage three triple negative cancer. It is an aggressive form of cancer, so Mrs. Rose’s treatment plan was moving quickly. She stopped eating regularly resulting in a loss of weight of 9 lbs over 4 weeks as her mind was constantly preoccupied. Mrs. Rose stated she had not been on a diet and had always struggled with her weight.

Mrs. Rose is on a blood pressure medication and takes vitamin D and Calcium po daily. She has no known allergies.

Doctor’s Orders post-operatively include:

Vital signs q4h

AAT ambulate daily

Diet clear fluids for 12 hours then soft

foods with low sodium IV Normal Saline at 100 cc/hr

Medications:

Norvasc 5mg po OD

Calcium / Vitamin D supplements

as per routine Clean wound site with sterile technique daily Morphine 2.5 mg IV every 2 hours prn Gravol 50 mg po q 4 hr prn

You are assigned total patient care for Mrs. Rose. She is now 19 hours post-operative. When you approach Mrs. Rose and introduce yourself, she nods but does not respond.

The patient has an IV #20 intercath infusing in the left forearm of Normal Saline at 100 cc/hr. She has gauze covering her left breast with a hemovac draining fluid.
During your initial assessment, Mrs. Rose begins to cry and says: “I can’t believe this is happening to me.” While you are providing personal care Mrs. Rose covers her head with the sheet.

You examine the wound site while completing the daily dressing change and, note that it is intact with no drainage at the incision site. You inform Mrs. Rose that the incision site is very clean and looks healthy. Mrs. Rose refuses to look at her chest as you are providing wound care and tells you “I do not want to hear anything about this.”

A liquid diet was initially ordered but now soft foods have been ordered for Mrs. Rose. Mrs. Rose refuses the tray stating, “I’m not hungry.”

Mrs. Rose’s husband and son arrive after breakfast and are very concerned and attentive over her. She smiles and asks them several questions about their work and university. Her daughters will be arriving later in the day.

You explain to Mr. Rose that it is important to ambulate daily (as per Dr Orders) and that he and their son can certainly be there and assist. Mrs. Rose tells you she is in too much pain to get out of bed and perhaps it is better that her husband and son go home and come back later. You ask Mrs. Rose about the intensity of the pain. She says it is 9/10.

The next day when you come on your shift to do vital signs, Mrs. Rose appears flushed and you note the following assessment findings:

Temp 38.1,

HR 87,

BP

153/87,

R 20,

O2 saturation per pulse oximetry -100 % on room air.
The incision site has purulent drainage. Mrs. Rose tells you “I am not feeling that well and I am in so much pain.”