PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Tabitha Wilson is a 24-month-old infant with AIDS
who is hospitalized with infectious diarrhea. She is
well-known to the pediatric staff, and there is real
concern that she might not pull through this admis-
sion. She has suffered many of the complications of
AIDS and is no stranger to pain. At the present time,
the skin on her buttocks is raw and excoriated, and
tears stream down her face whenever she is moved.
Her blood pressure also shoots up when she is
touched. The severity of her illness has left her
extremely weak and listless,and her foster mother
reports that she no longer recognizes her child.
When alone in her crib, she seldom moves, and she
moans softly. Several nurses have expressed great
frustration caring for Tabitha because they find it
hard to perform even simple nursing measures like
turning, diapering, and weighing her when they see
how much pain these procedures cause.
2.Nursing Process Worksheet
Health Problem:Pain
Etiology:Excoriated skin on buttocks and debilitat-
ing effects of illness
Signs and Symptoms:Tears stream down face when
moved and blood pressure shoots up; moans; skin
on buttocks is raw and excoriated.
Expected Outcome:By 2/15/11, patient’s behaviors
will indicate that pain is sufficiently relieved for
patient to rest comfortably—even during clinical
procedures.
Nursing Interventions:
a.Report pain assessment to MD and collaborate on
designing effective pain management program.
b.Ensure that the analgesia administration sched-
ule produces consistent comfort.
c. Collaborate with wound care specialist in imple-
menting program for healing of lesions on but-
tocks.
Evaluative Statement:2/15/11: Expected outcome
partially met—patient’s behavior (absence of tears,
decreased moaning, decreased BP) indicates some
pain relief, but procedures that involve moving the
patient still result in great discomfort. Revision:
consult with physician again.—E. Daniel, RN
3.Patient strengths: Patient and her foster parents are
greatly liked by the staff; parents show great
willingness to be involved in care.
Personal strengths: Knowledge of pain experience;
experience in designing and monitoring pain
management regimens; experience with pain man-
agement in infants and children; good rapport
with wound and skin care specialist; strong inter-
personal skills
4.Tabitha’s response to procedures is markedly
improved since the new analgesic regimen was
implemented. However, although she no longer
“tears up” when touched, and her blood pressure ismore stable during procedures, she continues to cry
during her bath and during procedures that involve
more movement. Will speak with MD about modi-
fying analgesic regimen.—E. Daniel, RNCHAPTER 36
PRACTICING FOR NCLEX
MULTIPLE CHOICE QUESTIONS
1.d 2.a 3.b 4.c 5.a
6.d 7.a 8.b 9.d 10.c
11.b 12.a 13.c 14.b 15.d
16.a
ALTERNATE-FORMAT QUESTIONS
Multiple Response Questions
1.c, d, f
2.a, d, e
3.b, c, d
4.a, b, d, f
5.b, e, f
6.a, c, d
7.d, e, f
8.c, d, e
9.a, c, d
Fill-in-the-Blank Questions
1.27.5
2.2,178
3.50 to 100 grams
4.10% to 20%
5.50% to 60%
6.115 lb
7.154 lbDEVELOPING YOUR KNOWLEDGE BASE
MATCHING EXERCISES
1.a 2.c 3.b 4.a 5.b
6.c 7.a 8.c 9.b 10.b
11.d 12.a 13.j 14.m 15.n
16.b 17.e 18.g 19.h 20.l
21.o 22.i 23.k 24.c
25.d, milk, eggs, nuts
26.a, dairy products
27.g, salt
28.i, seafood
29.e, salt and processed foods
30.k, liver
31.m, fish and tea
32.f, wheat
33.o, liver and whole grains
34.b, milk products and soft drinks
35.h, liver
36.j, oysters
37.l, beans and fruit
38.n, whole grains
39.e 40.a 41.g 42.b 43.i
44.c 45.f 46.dCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:394 ANSWER KEY
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