Eugene Shaw, age 87, is a retired illustrator and former Marine who served in the Korean War. He and Nancy, his wife of 59 years, live in the city. Gene has had cold sensitization and nocturnal pain in his lower limbs and hands since trench foot, acquired in Korea, required amputation of several toes. He has hypertension, osteoarthritis, and Type 2 Diabetes. He is overweight, and he smokes and drinks. Chronic leg pain and ulcerations bring him to the hospital where he is admitted for femoral-popliteal by-pass surgery. The nurses who care for Gene's physical and emotional needs, pre- and post-operatively, consider changes in lifestyle that may affect his recovery and rehabilitation.
Gene is in the triage in a hospital emergency department. He tells the nurse that he has had chronic pain in his right calf for the past several days and feels achiness, fatigue, burning, and discomfort in the muscles of his feet, calves, and thighs. He talks about his family, and his buddy, Jim, who served with him in Korea. He speaks about the climate in Korea and how it affected his feet. Additional statements provide cues that further evaluation is needed of his medication compliance, smoking behaviors, alcohol use, and management of his diabetes.
Simulation Scenario 1
Gene has been admitted to the medical-surgical unit. An angiogram revealed a clot in the popliteal artery, below the right knee. He is scheduled for a femoral-popliteal bypass surgery in the morning. The nurse will do pre-op teaching and manage his pain.
Simulation Scenario 2
Gene is in the pre-operative suite. The nurse will complete the pre-op checklist, administer a pre-op antibiotic, and provide emotional support as Gene expresses his concerns about the surgery and changes in his functional ability.
Simulation Scenario 3
Gene is in his second postoperative day and his vital signs are stable. The incision is healing well and his neurovascular checks are greatly improved. The nurse needs to encourage him to ambulate, and assess how he will be able to manage in his home after discharge.
Finish the Story Assignment
Learners have now seen Eugene at three snapshots in time. What do they think his life will be like three months from now?
C. Anne Ganzer, PhD, RN
Hunter-Bellevue School of Nursing
New York, NY