- Case Study:
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.
- Top 3 priorities agreed upon by client and nurse practitioner: This section assumesyou and the client have discussed the stressors each of you identified and have come to a MUTUAL AGREEMENT about which 3 stressors are the highest priority. YOU MAY NOT USE ANY PHYSIOLOGICAL STRESSORS AS A PRIORITY. The following information should be placed in table format (Table 3).
- Inferences for each identified stressor: After reviewing the client’s data/relevant evidence and using critical reasoning, what conclusions have you reached? You must cite references to support your conclusion(s) (dictionary.cambridge.org/dictionary/English/inference).
- Nursing diagnosis for each identified stressor: State-appropriate nursing diagnoses based on accurate interpretation of theory and client data. You must cite references for your selectednursing diagnoses.
- Desired outcome/goal for each identified stressor: Cite a desired change from the nursing diagnosis and write in an objective form with a timeelement; the statement must be measurable and able to be evaluated.
- Hypotheses: Describeantecedent and consequent components (if “x” occurs, then “y” will follow.) A hypothesis statement can be tested and evaluated.
- Nursing actions:Identify specific nursingactions (primary, secondary, and tertiary prevention as intervention modes) for each identified stressor. You must cite references for your nursingactions.
- Evaluation: Measuresprogress toward achievement of client goals.Client outcomes can be made up by the student group.And remember, not everything resolves, some things require reassessment and additional interventions or time to achieve.