discussion 4
discussion 4
Dale Mayman Nursing 220 The nurse on the previous shift reports to you that Mr. Mayman, admitted with tremors, is
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depressed and angry about being in the hospital. Dale is a 51 year old white male divorced twice and just remarried for the third time. He was a truck driver for many years. He would binge drink on weekends so extensive that he was diagnosed with chronic liver disease secondary to alcoholic cirrhosis. He cannot work now and is on disability. He was just recently told he has high blood pressure and is on a salt restriction. He started going to the Methodist church requesting redemption for all his sins. Nursing 215 Mr. Mayman is having a follow-up examination of his blood pressure. The treatment for this blood pressure has been the salt restriction in his diet. When you introduce yourself to Mr. Mayman, his shirt is wrinkled and has coffee stains on the pocket. His hair is combed but appears shaggy. Upon the introductions, he only mumbles hello and has minimal eye contact with you. Mr. Mayman has hypertension. He is being admitted to the psychiatric unit primarily for manifestations of problems with cognition. He is disoriented, mumbling incoherently, volatile temper, threats of violence against his wife, and expression of wanting to end it all. Mrs. Mayman is at his side. The nurse notices bruising on her left upper arm in a pattern indicative of someone squeezing her arm and a healing bruise on her right cheek. The nurse is now admitting Mr. Mayman. Using their pre-class assignments and their reading, use that information to plan care for Mr. Mayman. 1 Interventions focused on Mr. Mayman’s cognitive issues Interventions focused on Mr. Mayman’s substance abuse issues Task Interrelated concepts: Ask students to identify interrelated concepts for both cognition and substance above that may apply to Mr. Mayman. Task Ask students to identify other healthcare providers they will collaborate with when caring for Mr. Mayman. Concept of Interpersonal Violence As the admitting nurse, you are concerned about Mrs. Mayman bruising. Based on the pre-class assignment, ask student to identify the risk factors that put Mrs. Mayman at risk for abuse. Using their pre-class assignment, project the below table and ask students to provide information based on their readings. Assessment Interventions 2 History Questions to ask: Then a cell for physical assessment Task • Ask students to prioritize their nursing interventions and provide their rationales. Day Two of Mr. Mayman’s Admission • Mr. Mayman is in the social area of the unit. He becomes very agitated and picks up a book and throws it. • Based on what is in the reading assignment, walk students through how to de-escalate the situation. Task As you are working through the activities related to Mr. and Mrs. Mayman, engage students in discussion about: • Professional standards of practice • Ethical care — one example of assuming the responsibility for talking with Mrs. Mayman about her bruising. The nurse could have chosen to ignore the signs of abuse. • Health care law — how does this apply to the patient? 3 Nursing 235 Dale Mayman was found unconscious. When he awoke in the emergency room he complains of being itchy, bloated, and nauseated. He states this has been “coming on for months”. His renal function tests reveal 18% functioning capacity of his kidneys. He is put on hemodialysis. Dale Mayman has develop acute renal injury secondary to his hypertension. He is hospitalized. Faculty: Give some orders here. 4
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