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In week 5, you initiated care for  Julia Morales and Lucy Grey who were partners for more than 25 years.  Julia died 2 months after that initial visit.  Lucy has called 911 “about once a month since Julia died” and was transported by ambulance to the emergency department today.  You arrive in the Emergency department to assess Lucy’s status.   

Review the SBAR and the medical record. 

Lucy’s SBAR and Medical Record Download Lucy’s SBAR and Medical Record

As you walk toward Lucy’s room, the charge nurse stops you and says, “I am glad you are here to see Lucy Grey. She was just here 3 weeks ago, nothing is seriously wrong. She is lonely. Maybe she can’t live alone any more. You’ve got to talk to her and help her understand that calling 911 is not how to manage her grief. We are too busy.” 

You enter the room and ask Lucy how she is feeling.   Listen to Lucy’s monologue.   

After you have reviewed Lucy’s chart and listened to her monologue, use the clinical judgment model described in Module 2 to review Lucy’s current clinical condition. 

Complete an initial assessment of Lucy’s situation, using all sources of information. Recognize and analyze the important cues. Your response should include (but is not limited to)

What are Lucy’s strengths?

What are your concerns for Lucy?

What is the cause of your concern?

What additional information do you need

What are the priority concerns for Lucy?

Prioritize hypothesis (i.e. urgent, likelihood, risk, difficulty, time, etc.) 

Generate solutions:

Consider multiple interventions that can impact goals

Consider what are your options as the RN who is planning Lucy’s care? 

What  referrals would you recommend to Lucy and the health care provider?

 

Take action. (Implement solutions to address highest priority) 

*****The RN caring for Lucy, are sharing with the charge nurse. You will also record an SBAR (situation – background – assessment – recommendations) with recommendations  to the RN, who will be taking over of Lucy on the oncoming shift.

 

Lucy Grey Monologue Script

This monologue takes place a few months after Julia’s death. Lucy is in the emergency

room.

Well, here I am again, waiting to be seen by the emergency room doctor. This must be

the third time this has happened since Julia died. I miss her so much. I never knew it

would be so lonely in that house by myself. Nora comes to visit every once and awhile.

In fact she’s on her way here now, with my neighbor Adele. I don’t want to scare them

though I know Adele saw the ambulance and must be worried. This has happened about

once a month I think.

I feel okay, then for no reason at all I just get anxious and dizzy. My heart kind of

pounds and I just feel like I can’t walk or do anything. One time I fell, but I didn’t get hurt

too bad. This time I almost fell, landed on my couch and scraped my arm. I think I

tripped over my shoe that I was going to put on. I was able to reach for the phone and

call 911. I felt a little better by the time the paramedics got there, but they thought I

should come in and be checked out anyway. I need someone to look at this scrape on

my arm. They should probably check my knees too. They’re a little weak. I had surgery

on one of them. Most days I’m fine, it’s just once in a while…….

I don’t think we ever had to call 911 when Julia was alive. I don’t remember ever having

these dizzy spells then. My knees were weak, but I took it easy and never fell that I can

recall. I was feeling pretty bad these past few years that I couldn’t walk as far or as fast

as we used to. We loved to travel, and hike around new places. We traveled all over. I

think my favorite place was Ireland. Julia wanted to go there, she picked that trip. It was

wonderful. We rented a car and just drove all everywhere. We went out to pubs for

music every night, and we went to the Waterford crystal factory. It was lovely. It’s so sad

to know we’ll never have those experiences again. Oh, we loved our adventures! They

are all over now. It’s just me in that old house.

Nora visits when she can, every few weeks or so. Neil came once for my birthday. That

was nice. My neighbor Adele stops by, but not very often because she has her

grandkids to take care of. Sometimes days go by and I never talk to another soul. That

never happened when Julia was alive. She always had something to say! I felt safer

then. I never had these dizzy spells. Maybe the doctors will figure it out this time.

SCIENCE
HEALTH SCIENCE
NURSING
NUR 261

 

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