NU140 Unit 5 Case Study Analysis Example

A Recliner, a Sling and a Fear of Pills: A Case Study Analysis Answering Each Question About a Composite 61-Year-Old Woman Two Days After Total Shoulder Replacement Who Sleeps Badly and Underreports Pain

[Student Name]

Purdue University Global

NU140: Nursing Fundamentals

Unit 5 Case Study Analysis

[Instructor Name]

[Date]

The patient is composite; pain scores and doses are bracketed where illustrative, and the questions are typical of this unit's case prompts.

The Case

[Mrs. W.], a composite 61-year-old retired teacher, had a right total shoulder replacement two days ago. Her arm is in a sling. She rates her pain [3] out of 10 when asked, yet she grimaces when she moves, holds her breath when she shifts in bed, and declined physical therapy this morning. She slept about three hours last night in short stretches, waking each time she turned onto her right side. Her surgeon has prescribed scheduled acetaminophen, an anti-inflammatory and oxycodone as needed. She has taken no oxycodone, telling the nurse, "My brother got hooked on these. I'd rather tough it out."

Question 1: How Are Her Pain and Sleep Affecting Each Other?

They form a cycle. Pain wakes her whenever she shifts toward the operated shoulder, and lying flat stretches the joint capsule, so she cannot reach deep sleep. Poor sleep, in turn, lowers pain tolerance: people who are sleep-deprived report pain as more intense and cope with it less well. Hospital noise, overnight vital signs, a roommate's television and an unfamiliar bed add to the problem. Each night of poor sleep makes the next day's pain harder to manage and makes her less willing to move, which slows her recovery (Potter et al., 2023). In standard terms she shows both acute pain and disturbed sleep pattern, two diagnoses that share causes and must be planned together (Herdman et al., 2024).

Question 2: Why Might She Underreport Her Pain?

Several reasons fit her case. She fears that admitting pain will lead to opioids. She may believe, as many patients do, that pain after surgery is expected and should be endured, or that a good patient does not complain. As a former teacher she may value appearing composed. Her nonverbal signs, grimacing, breath-holding and refusing therapy, tell a different story than her rating. Pain is what the patient says it is, but when words and behavior disagree, the nurse explores the difference rather than recording only the number (Pasero & McCaffery, 2011).

Her rating of 3 is not false; it is the answer she can give without being offered the pill she fears.

Question 3: How Should the Nurse Address Her Fear of Dependence?

Her fear deserves a respectful, factual answer, not reassurance alone. The nurse can acknowledge her brother's experience, then explain the difference between short-term use for acute pain under supervision and the long-term use in which addiction usually develops. Taking a small dose before physical therapy and at bedtime for a few days, alongside the non-opioid medicines, is a common plan, and stopping as the pain eases is part of it. The nurse can offer to start with the lowest prescribed dose and review it daily, and confirm that she is in control of the decision. If she still declines, her choice is respected and the other measures are strengthened.

Question 4: What Nondrug Measures Fit Her Situation?

1. Positioning: sleeping semi-upright, in a recliner or propped on a wedge, with a pillow supporting the operated arm, which keeps the shoulder in a comfortable position and is common after shoulder surgery.

2. Cold therapy: an ice pack or cooling device over the shoulder for set periods, as the surgeon allows, to reduce swelling and pain.

3. Timing: scheduling her non-opioid medicines so they peak before therapy and bedtime.

4. Sleep protection: clustering overnight checks, dimming lights and offering earplugs or an eye mask.

5. Distraction and relaxation: music or slow breathing during exercises.

Question 5: What Would Show the Plan Is Working?

Better sleep, measured by her own report and by fewer awakenings noted on rounds; a pain rating that matches her behavior; participation in physical therapy; and her ability to move the arm through the exercises prescribed. A reassessment of pain within an hour of any intervention, and documentation of both her rating and her behavior, lets the next nurse see the trend.

Question 6: What Should the Nurse Document?

The record should show both her pain rating and the behaviors observed with it, such as grimacing on turning and declining therapy, her stated reason for refusing oxycodone, the education given about short-term opioid use and her response, and every nondrug measure tried with its effect. Recording her refusal as an informed choice, rather than simply "patient refused," tells the next nurse that the conversation happened and what she understood.

Summary

Mrs. W.'s case shows how pain, sleep and fear can form a loop that slows recovery. Breaking it means listening beyond the pain number, answering her fear honestly, and using position, cold and timing alongside any medicine she chooses to take.

References

Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Pasero, C., & McCaffery, M. (2011). Pain assessment and pharmacologic management. Mosby.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.