Homework

Read the case study on Ted Alexander.

Ted Alexander Case study

Mr. Ted Alexander, a 50 year old white divorced salesman from Las Vegas, was on a business trip to Atlantic City when he developed pain in the right lower abdominal quadrant.  He took Alka –Seltzer with little relief, and the pain persisted for the next two days.  He was busy with appointments during the day and evening and was able to ignore the pain.  He ate very little and took two sleeping pills at night.  On the afternoon of the third day, the pain became much more intense, and when it continued for several hours and he began to vomit repeatedly, he went to the emergency department.

Physical examination and laboratory data at this time revealed an alert, well-groomed male with generalized abdominal tenderness, rigidity of the abdominal wall, presence of a palpable mass in the right inguinal area, absent bowel sounds, and a WBC of 20,000/mm’ (normal = 5000-9000).  The diagnosis of ruptured appendix was made.  He was admitted to the hospital for initial medical management, with surgery anticipated at a later date.

Your examination of the patient reveals the following: B/P = 140/80, P=116, Resp=26 and temp 101.2.  The patient indicates that he is 6 ft. 2 inches tall and weighs 196 lbs.  He is alert and oriented and states, “My gut is killing me.” His skin is warm to the touch and slightly diaphoretic.  The patient states that he had been a heavy drinker for 15 years and was admitted to the hospital with cirrhosis two years ago by his family doctor, Dr. Manland, but has never had surgery.  He denies drinking for the past two years but smokes two packs of cigarettes daily.

Mr. Alexander is tense throughout your conversation and shares a number of concerns with you, including his separation from his two teenage children who live with him.  He is also anxious about being cared for by an unfamiliar physician.  The ED Nurse indicates that he wears contact lenses and is concerned because he has left his case and supplies as well as his glasses in his hotel.  He gives you $750 in cash and traveler’s checks to deposit in the hospital safe.  He has a partial lower plate of dentures and caps on his four front teeth.  Further inquiry reveals that the patient prefers a low-fat diet, occasionally uses laxatives, and has had several occurrences of urinary urgency and nocturia in the last six months.

The physician states that his treatment plan includes gastric suction, antibiotics and IV fluid therapy with electrolytes and vitamins until the patient is stabilized enough for exploratory surgery.  Mr. Alexander agrees to this plan but is concerned about his job demands and wonders how he will deal with “getting back home when all of this is over.”

Using the assessment sheet below, complete an assessment of Mr. Alexander.

Client Assessment Tool – Orem

Basic conditioning factors

Age ______________             health state _______________

Sociocultural orientation __________________       Health system _________________

Patterns of living _______________________________

Environment _________________________            Resources _____________________

Universal Self-care Requisites

Air

Water

Food

Elimination

Activity/rest

Solitude/social interaction

Prevention of hazards

Promotion of normalcy

Developmental self-care requisites

Prevention/mgt of condition threatening

Health deviation self-care requisites

            Seeking medical attention when health status altered

            Awareness/mgt of disease process

            Awareness of potential problems associated with regimen

            Modification of self-image to incorporate changes in health status

Adjustment of lifestyle to accommodate changes in health

Now consider, how time efficient is this model?

Did you assess anything using the model that you wouldn’t have assessed using your usual method?

Are there patients that you don’t think this model would work well for?  Who?