CASE EXAMPLE Patty M., the day-shift charge nurse on a busy orthopedic surgery unit, receives a report from the emergency room (ER) that she is to admit Mrs. L., a 40-year-old female patient in a diabetic crisis. The patient’s last blood sugar was 450 mg/dL. She is being admitted with an infected deep decubitus ulcer of her lower sacrum that occurred due to prolonged immobility following surgery last month for a cholecystectomy. The reporting nurse also indicated that the patient is very lethargic and seems depressed. She has received 12 units of regular humulin insulin in the ER and is expecting to get her lunch tray upon arrival to the unit. Patty reports all of the earlier findings to the others at the nurses’ station and adds, sarcastically, “Oh, and by the way, she weighs 600 pounds.” “So,” she adds, “I think I am going to need a little help.” Shortly after, the patient arrives and Kathy, the nurse assigned to care for the patient, and two other nurses approach the stretcher. One nurse whispers, “Well, I guess we’ve got our work cut out for us.” None of the others reply, but exchange glances of affirmation. After assessing the situation, Kathy states, “I am not exactly sure how we’re going to do this, I know we can’t transfer her with the transfer board that we usually use; we’ll have to call for the lift.” Mrs. L.’s stretcher is placed against the wall in the corridor until the lift arrives. While we are waiting Kathy begins, “I’ll check your vital signs and begin your nursing history.” Mrs. L. remarks, “I thought that I was to receive my lunch tray when I arrived on the floor, I am starting to feel a little shaky.” One nurse remarked, “I am sure that delaying your lunch until we get you settled won’t hurt you a bit.” Mrs. L. remained quiet and withdrawn throughout the remainder of the shift. After taking Mrs. L. to her room and providing her lunch, the nurses met in the conference room to do their charting. One nurse expressed concern about how they would manage the care of Mrs. L. Another announced that she would assist in every way she could, but that her bad back prevented her from assisting with lifting or positioning Mrs. L. Another nurse expressed frustration with people who allowed themselves to get that heavy: “Isn’t it sad that all she can seem to focus on is her lunch? She needs to be on a strict diet.” She’s going to have to work on developing some will power while she’s here. I really hope they put her on a strict diet.” “I’ll make sure she doesn’t have any extra food brought in from the outside,” another nurse offered. The charge nurse stated that she believed that everyone should take turns in being assigned to take care of Mrs. L. because with the amount of lifting and moving required, her diabetes, wound care, and need for nutritional management, “it just wouldn’t be fair for anyone to be stuck taking care of her all the time.” 
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