You are an aspiring Advanced Practice Nursing Student in collaborative practice with Dr. Tempa Tour, an Internist. You are engaged in your afternoon clinic appointments where you begin your comprehensive assessment of your new clientusing the framework of the NeumanSystems Model (as you alwaysdo) based on the following client database.
The client, Mr. AJ, is a 56-year-old white male. He is the father of four children – three daughters (ages 14,13, and 9 years) by his first wife and one son (six months old) with his current wife, age 30. Mr. AJ is a delivery truck driver for a local furniture department store. He has been working full-time for about 15 years. He is responsible for child support for the three daughters but sometimes gets behind on monthly payments. His former wife has threatened to turn him into the courts – which he hates to hear because he knows he’d be at risk to serve some jail time…meaning an even smaller paycheck. The constant fear of not having enough money has placed a strain on the relationship with the current Mrs. AJ. Before his recent marriage, he did spend a week in jail for non-payment of child support but since then, he hasn’t gotten more than a couple of months behind. He and his wife share a vehicle and it is on the blitz more time than not. She is employed full-time as a teacher’s aide at a local elementary school but wants to quit to be home with the baby (who stays with his grandmother). Mr. AJ and his family live in a lower socioeconomic neighborhood in an underserved area of New Orleans where there have been several muggings, drive-by shootings, and several in-home invasions in the past few years. Drug and alcohol use is evident in the neighborhood and just recently, there was a drive-by shooting that hit AJ’s family’s home. Mr. AJ has a high school education with two years of college courses. He attends the neighborhood church a few times a year for special programs when his daughters invite him. However, he and his wife do not attend any church on a regular basis. Mr. AJ has no medical insurance and althoughinsurance is available at his wife’sjob, they are unable to afford the premiums for the family, so they just pay for her and their son. Mr. AJ enjoys it when his girls come to visit on holidays, but the dynamics between them and the new wife are not always the best. Although, all three girls dote on their baby stepbrother.
Six months ago, Mr. AJ was seen in your clinic where he was diagnosed as having hypertension, type II diabetes, and hyperlipidemia. The medications prescribed for him were atenolol, hydrochlorothiazide, and pravastatin. Today you find he did not have the prescriptions filledbecause he didn’twant to spend the money onmedicines. In addition, he states, “I was on those blood pressure pills before and they interfere with my sex life”. However, five days ago, while on the job, he started having headaches, blurred vision, nausea, and vomiting. Mr. AJ went to the ER where he was admitted for a hypertensive crisis. This was his first hospitalization. He was restarted on meds and told to see you within the week.
Mr. AJ has a history of smoking cigarettes, although he has been trying to quit for about one month.He admits to drinking 2 – 3 beers/night, denies recent illicit drug use, and has no previous history of serious illness or prior surgeries. His mother is diabetic, and his father died of a heart attack at age 52. Revised 9.10.19 2 | Page Mr. AJ’s B/P was 230/146 on admission to the hospital, but today it is 126/84. He is awake, slightly drowsy, but oriented to person, place, time, and situation. He complains of a mild headache in the frontal region and a “swimming head”. He states he feels weak and listless. He denies diminished visual acuity but states he had “small spots” in front of his eyes when he had his “episode” last week. The physical assessment shows symmetrical strength, no motor deficits, no numbness; all cranial nerves intact; pulses +2 upper and lower; pupils equal, 3 mm and reactiveto light, no papilledema bilaterally; no abnormal heartsounds, gallops, rubs or murmurs,PMI left 5th ICS; lungs clear with unlabored respirations @ 22 bpm on room air; no pretibial edema; soft, non-tender abdomen with BS all quadrants; and no other abnormalities noted. He weighs 251 lbs. with a height of 5′ 11½”. You don’t have his hospital recordsand there is no recent lab found on the chart. Currently, Mr. AJ eats whatever he likes, mainly Southern-inspired comfort food – mostly “meat and potatoes”, enjoys social activities and takes care of the yard when he is at home. Mr. AJ states he wants to be released to return to work and feels he needsto get back to work, as he is afraid his boss is going to fire him for being off work. His wife accompanied Mr. AJ to this office visit.
This above case study must be used with the Module 4 Neuman Project assignment.
- Application of the Case Study: Place the followingin table format:
- Stressors identified by the client (Table 1): identify and classify all potential &/or actual environmental stressors/factors that pose a threat to client stability according to their intra-, inter-, and extrapersonal sources and the five client system variables: physiological, psychological, sociocultural, developmental and spiritual. (Put these in a table format with three columns for intrapersonal, interpersonal, and extrapersonal data and 5 rows for the 5 system variables). Indicate whether the stressors are positive (+) or negative (-) or both (+).
- Stressors identified by a nurse practitioner (Table 2): identify and classify all potential &/or actual environmental stressors/factors that pose a threat to client stability according to their intra-inter-, and extrapersonal sources and the five client system variables: physiological, psychological, sociocultural, developmental, and spiritual. Put these in a table format with three columns for intrapersonal, interpersonal, and extrapersonal data and 5 rows for the 5 system variables). Indicate whether the stressors are positive (+) or negative (-) or both (+).
- Stressors’ effecton flexible linesof defense, normallines of defense& lines of resistance: Discuss how the stressors have affected/impacted the client system. What “lines” are under attack? Have any “lines” been penetrated? Is the client’s basic core intact? Has any reconstitution begun?
- Client’s coping mechanisms and other resources: Identify all coping mechanisms and other resources available to the clientand determine if they are positive (+) or negative(-) or both (+)