Unfolding Case Study
Option 1: Left knee injury, preop; Option 2: Pain
Rationale: Patient has an old knee injury from playing sports in high school and college. The patient has been off of her medication, ibuprofen, and is likely in pain.
A panic attack may cause irritability, irrational thinking, lightheadedness, or dizziness; however, it is not the primary reason the patient presented to the hospital, or cause of the patient’s presenting problem. Depression may be present with a hopeless outlook and possible crying; however, it is not the primary reason she presented to the hospital. This certainly needs to be addressed by the nurse but is not the primary cause of the patient’s priority problem. Medication side effects are unlikely as she only takes ibuprofen and has not taken in 1 week. The patient has a normal WBC and is afebrile, thus is not likely to have an infection, nor a cause of her knee injury. Although patient education is a priority, that is not the cause of a fever, possible infection, respiratory rate of 30, or irritability. Patient education is a high priority for the patient and begins preoperatively. The nurse will assess any knowledge gaps and provide these for the patient.
| Assessment Finding | Left knee injury repair | Depression | Anxiety |
| Pain in the left knee | X | ||
| Lack of education for surgery | X | ||
| Grieving loss of prior activity and exercise tolerance | X | ||
| Emotional support from her husband | X | ||
| Withdrawn | X |
Rationale: The pain in the patient’s left knee is a direct result of overuse and damage from her athletic career. The patient’s anxiety can be a significant result of the unknown of the surgery scheduled for that day. Without explanation and expressed understanding by the patient, the anxiety will most likely manifest. The patient had admitted to depression from the loss of the active lifestyle and endurance in performing prior activities using her left knee. It is very likely this has been a contribution to her depression. Support from her husband most likely provides comfort and working towards acceptance. This may assist her depression from escalation and being more manageable. The patient admitted withdrawal and lack of pleasure from the regression of prior left knee injuries and damage. The mutual goals created with the nurse and the patient and husband need to be reasonable for the patient to assure the ability to comply. They may include the external support resources that have been provided to the patient and her husband along with the patient’s agreement and confirmation of understanding of how to accomplish her goals. All of the nurse’s assessment findings relate to the diagnoses listed; however, the correlations of the preceding assessments are the most likely reasons for the nurse’s findings on patient presentation and obtained history.