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Allison ApseyCase StudyJuly 30, 2018Pain Case Study: Meet Wrenda FisherWrenda Fisher, a 35-year-old mother of two, visits the pain clinic of the regional medical center in her community. Wrenda is interviewed by a certified pain management nurse. Her chief complaint is recent onset back pain, which has limited her ability to care for her children. Her youngest child is an infant who feeds every 3 hours. Initial assessment includes quality of pain, factors that impact pain perception, and client behaviors such as guarding. Anxiety and acute painare identified by the nurse as priority problems. The nurse selects a short term goal and recognizes the need to discuss the plan of care with Ms. Fisher. After receiving prescriptions for the client, the nurse provides teaching about NSAIDs, cold applications, and use of the client’s heating pad at home. A week later, a TENS unit is prescribed, and the nurse provides teaching and demonstrates application of the unit to Ms. Fisher. A schedule IV analgesic is also prescribed. The nurse responds to an inaccuracy in the scheduled medication count. Ms. Fisher is later admitted to acute care with worsening back pain. The nurse administers an intramuscular medication, and later provides assistance with guided imagery and relaxation exercises. Ms. Fisher undergoes back surgery. Postoperatively, the nurse teaches the client about use of the PCApump, calculates the total dosage received by the client, and recognizes when the PCA pump is no longer needed. The nurse provides teaching about the use of stool softeners in conjunction with opioids. The nurse responds to two other nurses who are talking about Mrs. Fisher in the hallway, demonstrating respect for the client’s privacy and veracity in providing accurate information. Mrs. Fisher is soon discharged and is able to manage her pain.During the RN’s initial interview, Wrenda shares information about her home, career, and family. The RN evaluates the information to determine psychosocial factors that may impact pain management.1.Which information obtained by the RN is most likely to influence Wrenda’s perception of her pain?Wrenda’s perception of pain could be impacted by having an infant that needs to feed every 3 hours. Feeding an infant every 3 hours would inevitably interrupt her sleep cycle and being exhausted from the continuous wake-ups could heighten her perception of pain and impair her coping mechanisms to deal with it.2.To assess the quality of Wrenda’s pain, the RN asks which question.“The pain quality refers to the nature or characteristics of the pain.” (Lewis, et al., 2017, pp. 108)The quality of pain is a descriptive term that could include things such as burning, shooting, stabbing, aching, crushing, etc. The question to ask Wrenda would be “What word best describes the pain you are experiencing?”3.Which behavior that Wrenda exhibits supports her subjective report of acute pain?