Question

Linda Evans is a 27-year-old patient who was in a motor vehicle accident 5 days ago. She sustained a mild head injury, a broken right hand, and a traumatic amputation of her right leg just below the knee. She is on the orthopedic floor and is going to be transferred to the rehabilitation unit tomorrow. She is engaged to be married in 6 months to her long-time boyfriend. She works as a waitress at a restaurant and takes classes at the local community college. She shares an apartment with two other women who have all been good friends for several years. Miss Evans has been having pain in her right leg and a headache. She rates her pain as a 4 on a scale of 1 to 10. Her right arm has a cast on the broken hand, which makes things difficult to do since she is right-handed. Jane Stone, a 25-year-old nursing student, has been assigned to care for Miss Evans this morning. Jane has come in to give Miss Evans her morning care and get her ready to go to physical therapy.

• Which of Erikson’s Psychosocial Theory of Development is Miss Evans experiencing?
• How will her accident affect fulfillment of this task?

During Miss Evans morning care, she begins to cry and tells you that she knows that her fiancé will not want to marry a “one legged freak who can’t even wipe her own butt”. She tells you that she is going to break up with him because how could someone love her now?

• Jane should base her plan of care on which nursing diagnoses?
• What should Jane communicate to the patient regarding her statements?
• What Collaborative interventions could be used to support Linda?

Answer 1

· Which of Erikson’s Psychosocial Theory of Development is Miss Evans experiencing?

Intimacy vs. Isolation

Intimacy versus isolation is the sixth stage of psychosocial development theory developed by Erik Erikson. This stage takes place between the ages of approximately 18 to 40 years, during young adulthood. The main dispute at this point is focused on establishing close, romantic relationships with other people. We 're starting to interact more closely with others during this point. We 're reviewing leading toward longer-term commitments with someone other than a family member.

Successful completion of this stage will result in a relationship with healthy relationships and a sense of commitment, stability and care.

Avoiding intimacy, fearing engagement and relationships can lead to isolation , loneliness and depression at times. At this point performance will lead to the virtue of love.

· How will her accident affect fulfillment of this task?

Her accident affects her personally in terms of thinking that is loosing of her long term boyfriend.

Effects her career and earning too because of traumatic amputation of her right leg just below the knee

· During Miss Evans morning care, she begins to cry and tells you that she knows that her fiancé will not want to marry a “one legged freak who can’t even wipe her own butt”. She tells you that she is going to break up with him because how could someone love her now?

She is feeling very bad , lonely and isolated as all of a sudden her life was changed because of motor vehicle accident. All her dreams to live a beautiful life became shattered and she couldnot able to take them anymore.She is feeling depressed.

· Jane should base her plan of care on which nursing diagnoses?

Supporting psychological and physiological change, alleviating discomfort, preventing complications, encouraging independence and practical skills, offering information on procedures / prognosis and medical needs.

· What should Jane communicate to the patient regarding her statements?

Jane has to give the patient the moral strength to be positive and recover from this situation as soon as possible

· What Collaborative interventions could be used to support Linda?

· Encourage him to do recommended exercises.

· Provide routine stump care: inspect the area, thoroughly clean and dry, and rewrap stump with an elastic bandage or air splint, or apply a stump shrinker (heavy stockinette sock), for "delayed" prosthesis.

· Immediately rewrap stump with an elastic bandage, raise if cast is unintentionally dislodged "immediately or early.". Prepare for reapplication of the cast.

· Demonstrate and help with methods of movement and the use of mobility aids such as trapeze, crutches or walkers

· Assist with ambulation.

· Instruct patient in exercises around stump conditioning.

· Refer to the rehabilitation team.

· Provide mattress with foam or flotation.