The nursing process is used as a problem-solving framework toplan and provide
safe, patient-centered care to patients and their families. Theincorporation of
growth and development and cultural concepts in the planning andprovision of
care promotes patient safety and ensures quality
care.
Scenario:
Jane Vuong is a Vietnamese 24 year-old
single woman who is living in the United States on an academicvisa. She has
been attending the local university for two years, studyingcellular biology as
an undergraduate. She comes from an affluent Vietnamese family. Herparents are
paying for her education and want her to come back to Vietnam withher doctorate
and take over the research lab owned by her uncle. Jane is astraight “A”
student and spends much of her time studying. She makes extra moneyby working
part-time in the molecular biology laboratory in the universitycampus research
center. She takes the subway or rides her bicycle to getaround.
Jane
enjoys working out doing Quan Khi Dao at the local martial artsschool. One day
while working out, she feels a severe tightness in her chest andsays she is
having difficulty breathing. Susan, a regular attendee in theclass, brings Jane
to the emergency department where you work. You note that Jane ishaving trouble
speaking, appears anxious, and her lips are dusky. You are able tohear a
wheezing sound when she breathes. She denies a history of asthmabut says that
she has some allergies which she generally treats with herbs. Susantakes you
aside and tells you that she has noticed over the past month thatJane has
seemed out of breath after taking the stairs up to the martial artsstudio and
that she no longer rides her bike to the studio.
Because of the severity
of her symptoms, the doctor decides to admit her for evaluation andobservation.
The physician orders supplemental oxygen, a chest X-ray, bloodtests, and a
regular diet. Her anticipated stay is two days.
Once on supplemental
oxygen, she is better able to communicate, and you begin to do ageneral
assessment and take a history. Here are some of your
findings:
Diet: Jane states that she is proud that she onlyeats a
traditional Vietnamese diet of fresh vegetables, chicken, rice andnoodles. Much
of the food she eats is prepared with Nuoc mam (fish sauce), soysauce, sour
lemons, bean sprouts and scallions. She prefers to eat Banh Khuc(rice ball),
Banh Cuon (rolled rice pancake), and Pho-bo (beef and noodle soup).You note
that she is very slender, verging on being underweight.
Religion:
Jane states she is a Mahayana Buddhist. She goes to the Buddhisttemple early
each morning for meditation and communion with her dead ancestors.She says her
meditation brings blessings from her ancestors, and they watch overher and help
her succeed and stay healthy.
Health history: Jane admits she has
had a dry cough for several months which she attributes toallergies. She says
her allergies have kept her from riding her bike to work. Shecontinues to smoke
1 pack of cigarettes daily and says smoking doesn’t bother her. Shelaughs and
says she could never quit because her roommate smokes too.
Six months
earlier she tested positive for Hepatitis B. The diagnosissurprised her since
she didn’t have any symptoms. She denies drug use but admits tobeing sexually
active. She reports having 5 sexual partners in the past sixmonths. She states:
“I meet guys at the college bar and we have weekend flings. I likeit this way,
so I don’t have to be involved in any type of long-termrelationship, which can
make life really complicated.” When asked if she uses protection,she shrugs and
says, “Sometimes.” She claims that no one told her that Hepatitis Bwas sexually
transmitted, but she isn’t worried because she says she is overit
now.
Exam: During her examination, red circular burnsare found on
Jane’s chest. On Jane’s back, there are reddened abrasions. Whenasked about
these strange marks, Jane explains that she was having difficultybreathing
earlier in the week, and went to a Vietnamese medicine man whotreated her with
“coining” on her back and “cupping” on her chest to remove the badair. He also
gave her an herbal mixture and told her to boil it and breathe thesteam from
the mixture three times daily. She says it really helped her.
Jane’s
primary nursing diagnosis is “impaired gas
exchange.”
Task:
ScholarMatic: Explanation & Answer
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