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Clinical Exemplar
Catelyn Suttmiller
Clinical Exemplar
discusses specific content (Winkelman, Kelley, & Savrin, 2012). This is a moral distress clinical
exemplar discussing a young female patient that received a left modified radical mastectomy,
who had a history of intravenous (IV) drug abuse. This clinical experience taught me about poor
Story
A 34 year old female patient had a left modified radical mastectomy performed. Her
surgery was delayed for over a month because she was using her port to inject heroin; which left
her with endocarditis and an infected port. She was then hospitalized for endocarditis and sepsis.
When she was approved for surgery, she had a new port placed and the physician
consulted with pain management prior to her procedure. The pain management team leaves the
hospital at 1700 and she was not admitted onto the floor until 1800. Proper pain medications
were not ordered prior to her admission to the floor because they were expecting the pain team to
take over her analgesic regimen. She was extremely drowsy when she first arrived to the floor.
During her initial assessment, she began to scream for her mommy and tried to run out of bed
only being two hours out of surgery. Once we got some pain medication on board the patient
stayed combative and reported having no pain relief. Security was called once she tried to hit a
nursing assistant who was trying to calm her down. She kept frantically trying to run out of bed
and then would heal over in pain. She threw her bedside table at her 21 year old daughter and
started stating that she wished her surgery did not go well and that she did not wake up. The
patient was screaming so loud the patients in the rooms down the hall claimed they could not
CLINICAL EXEMPLAR 3
sleep nor relax with the disturbance she was causing. On multiple occasions the patient was upset
because she did not realize that she would be in that much pain from the mastectomy.
Conclusion
This patient should have had a psych evaluation prior to being approved for surgery, as
well as had the pain consultation before her surgery. When the surgeon realized that the
interdisciplinary teams she consulted were no longer in the building, the patients surgery should
not have been performed. With this patients history of drug and alcohol abuse there should have
been extra steps taken to set this patient up for a successful recovery. She could have benefitted
from therapy prior to her surgery and education to ensure she understood that she would have
some pain after the surgery. Pain can be controlled, but typically a patient will not get down to a
pain level of zero the day of surgery. Mastectomy patients have a high occurrence of chronic pain
References
Humble, S., Dalton, A., & Li, L. (2014). A systematic review of therapeutic interventions to
Winkelman, C., Kelley, C., & Savrin, C. (2012). Case histories in the education of
advanced practice nurses. Critical Care Nurse, 32(4), e1-e17. doi: 10.4037/ccn20123