Reference no: EM132924611

Yolanda is a 55-year-old married African American mother of two adult children who has a history of breast cancer. She was diagnosed with fibromyalgia 2 years ago, after years of unexplained muscle aches and what she thought was arthritis. The diagnosis was a relief for her; she was able to read about it and learn how to care for herself. Over the past 2 months, Yolanda stopped taking all of her medicine, because she was seeing a new primary care provider and wanted to start her care at "ground zero." In addition to her family responsibilities, she is completing her degree as an English major. At the time of her clinic appointment, she told the nurse practitioner that she was having the worst pain possible.

• Using Levine's conservation model, the nurse practitioner completes a comprehensive assessment in preparation for developing a plan of care. A thorough assessment of characteristics of the internal and external environments is performed, with assessment of the adequacy of the adaptive fit that Yolanda has achieved in response to the changing environmental conditions produced by this health challenge. Nursing care is planned using the conservation principles. Yolanda's diagnosis of fibromyalgia was based on the cluster of presenting symptoms (pain, fatigue, and sleeplessness) and the exclusion of other illnesses.
• The assessment of the internal environment (physiological and pathophysiological processes) was performed by a thorough physical examination and various laboratory and diagnostic tests. Yolanda's tests results were within normal limits.
• The external environment includes perceptual, operational, and conceptual factors. Perceptual factors are perceived through sensory input. Yolanda reported a history of unexplained fatigue and sensations of pain for years. She recently stopped her medications "to clean my body out." However, she reported that the pain became unbearable and was making it difficult for her to sleep. She noted that when she sleeps at least 6 hours a night, her pain is less intense. With the current insomnia, her pain is very intense.
• Operational factors are threats within the environment that the patient cannot perceive through the senses. Yolanda reported severe pain in response to both the cold weather and changes in barometric pressure.
• The conceptual environment includes cultural and personal values about health care, the meaning of health and illness, knowledge about health care, education, language use, and spiritual beliefs. In response to breast cancer, Yolanda developed her spirituality through prayer and reading the Bible. She believes this is how she is getting through the painful moments of her current illness.
• Conservation of energy focuses on the balance of energy input and output to prevent excessive fatigue. Yolanda complains of a fatigue that just "comes over me." She has difficulty doing housework. A day of work usually means 1 day in bed because of extreme fatigue. Her hemoglobin level and hematocrit are normal; her oxygen saturation is also within normal limits. These normal physiological assessments are typical in patients with fibromyalgia.
• Conservation of structural integrity involves maintaining the structure of the body to promote normal functioning. Fibromyalgia treatment focuses on reducing symptoms. Yolanda's symptoms could not be traced to any physical or structural alteration, yet she reports severe pain and fatigue. It is important to acknowledge the reality of the symptoms and work with the patient to determine whether activities of daily living result in changes in the pattern of illness. In addition, Yolanda thinks she is going through menopause (a normal physiological change in body structure), and she is having trouble determining whether her symptoms are menopause or fibromyalgia.
• With continued questioning, Yolanda revealed that she was diagnosed with irritable bowel syndrome several years earlier. This condition presents further risks to structural integrity. She is not worried about constipation but is concerned about sudden diarrhea. She is afraid to go to school, fearing embarrassment because she might have an "accident." Interventions to conserve structural integrity include interventions to promote normal bowel function and optimize Yolanda's nutritional status.
• Personal integrity involves the maintenance of one's sense of personal worth and self-esteem. Yolanda reported that she "lost control" when she was diagnosed with breast cancer. A dear friend convinced her to go to church and encouraged her to use prayer. When feeling sorry for herself, she would go into her bedroom and read her Bible, cry by herself, and pray. She believes that prayer and Bible reading helped her heal. She continues to pray and read her Bible to gain the strength she needs to live with her illness. She also believes that she needs to be able to laugh at aspects of her situation; humor helps her feel better. She actively seeks health information, as indicated by her quest to learn about her diagnosis of fibromyalgia. She is most upset about not being able to walk as she used to walk. One of her favorite pastimes was shopping for shoes at the mall, which now is difficult for her.
• Social integrity acknowledges that the patient is a social being. Yolanda is a married mother of two grown children. She conceals many of her feelings from her children but does share with her husband, who is supportive. Among the ways that he cares for her are to take her places she needs to go (such as grocery shopping) and to make sure she gets to her health care appointments on time.

Question 1: Discuss any needed modifications of activities to prevent injury; assess diet to identify whether any foods exacerbate gastrointestinal symptoms; discuss the normal physiological process of menopause, including associated symptoms; and consider additional laboratory work or referrals to evaluate hormone levels and assess whether additional treatment is indicated to relieve menopause symptoms.