Esther Jackson, a 56-year-old black woman, is one day post-op after undergoing a left radical mastectomy. During morning rounds, the on-call nurse informs you that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent assistance with repositioning. She states that the patient was given pain medication about 2 hours ago but is still complaining of discomfort, and she suggests that you mention this to the doctor when he comes in later this morning. You move on to the next patient’s room for a report because the patient appears to be in no apparent distress.

You return to Ms. Jackson’s room about an hour later with her morning pills and find her sobbing over the bedside stand. “I don’t know what’s wrong, but I don’t feel right,” the patient says. My back hurts, and I’m exhausted. “What’s the matter with me?” The patient refuses to take her medications at this time, claiming that she is becoming nauseous.

When the nursing assistant enters the patient’s room to take Ms. Jackson’s vital signs, you take advantage of the opportunity to quickly check the patient’s medication record to see if she has a nausea medication. When you return, the nursing assistant hands you the vital signs listed below: T 37, R 18, and BP 132/54, but she can’t get the patient’s pulse because “it is all over the place.”

Please answer the following scenario-related questions.

What do you think is causing the patient’s symptoms?
Describe your plan of action for confirming this suspicion and preventing further decline.
What additional assessments, lab values, and tests are likely to be ordered for this patient, and how frequently? If testing must be completed more than once, please explain why.
How will you ensure that the needs of your other patients are met while you are caring for this patient?