Application to Nursing Process

Nursing Process Based on Benner’s  Clinical Wisdom in Nursing Practice Theory:  An Exemplar

Mrs. PV is a 50- year-old Caucasian female who had transsphenoidal surgery for Cushing’s. She was transferred to the surgical floor from the neuroscience unit on the fourth day after surgery. Nurse MG was assigned to Mrs. PV along with three other patients.

1530 Hours.    Nurse MG  saw Mrs. PV  for initial Assessment  

Hello Mrs. PV, My name is MG,  and I am your nurse for tonight, I will be with you until 1130 PM. How are you? I am just fine except for this nagging headache. Which part of your head are you hurting? My forehead and behind my eyes. Give me a number for your pain. 4/10. It was 8/10 earlier but TD, the day nurse gave me two Percocet,  and it took the edge of. That is good, but do let me know if you need your pain medication. You are allowed to have it every four hours. I can also give you ice packs to place on your forehead, sometimes cold applications can help. No, thank you; the pain is tolerable. Now, may I take your vitals? Sure.  Nurse MG went ahead and did a physical assessment and found  everything to be normal.

Your doctor ordered  blood work for 6 PM, What blood work? asked Mrs. PV. Just routine stuff. He just wants  to check your sodium level and electrolytes.  Blood was drawn this morning to check my  cortisol, do you know the result? It was less than  one, that is why I would like you to read this handout about Adrenal Insufficiency. If your cortisol level is extremely low, your body will  show signs and symptoms of Adrenal Insufficiency. The booklet will also tell you what to do if you have those symptoms. There are also illustrations about how to give yourself  hydrocortisone injection. So please read that and I will come back later to review with you the information. Now before I go, is there anything else I can help you with or any concerns that you would like me to know about? No, thank you.

1800 Hours.     Nurse MG heard Mrs. PV bathroom’s emergency alarm going off. She rushed to the  room and found her on the floor. What happened, did you fall?  No, I suddenly had chest pain, and I  cannot  breathe  so I slowly sat on the floor. Nurse MG immediately helped  her patient back to her bed;   pulse ox fluctuating between 84 to 88% BP 150/90, HR 178 RR 34. MY chest pain is getting worse. How would you rate  chest pain? 10.  You are going to be all right Mrs. PV. Help is coming. CALL A CODE. I NEED SOMEBODY TO START A LINE. GIVE ME  2  SST, an EDTA,  and a blue top tube. I need  the Endocrine Fellow  STAT

Code blue team came, blood works, ABG, and EKG were done, Intensivist initial diagnosis was  Pulmonary Embolism, Mrs. PV was immediately transferred to ICU. Spiral CT confirmed the diagnosis. Nurse MG documented the incident in the Occurrence Reporting system for Quality Practice Monitoring.

Mrs. PV was transferred back to the surgical floor three days later. Her conditions improved. It was determined by the Endocrine  Service that surgery was successful. Patient education was continued in preparation for discharge. Mrs. PV was discharged  two days afterward.