Critical Thinking: Reflective Case Study
Mr. Jones is a 42-year-old male patient with a past medical
history of hypertension, diabetes mellitus, chronic pain,
alcoholism, and clinical depression. He was admitted to the
medical-surgical nursing unit for complications of
uncontrolled diabetes. Mr. Jones has an open wound on the
left lower extremity and is on intravenous antibiotics for a
diagnosis of cellulitis. Mr. Jones requires daily wound
debridement. Tara is the registered nurse assigned to the
dayshift care of Mr. Jones and five other patients on the
unit. During a shift change, Tara received a morning report
that Mr. Jones was "non-compliant" with his medications
throughout the night, refusing to take any medicines and
ordering the nursing staff to leave the room. When Tara
attempted to bring Mr. Jones his morning medications,
including antihyperglycemics and antibiotics, Mr. Jones
became acutely agitated and ordered Tara to leave the
room. Tara tried to reason with Mr. Jones, explaining the
risks of refusing his diabetes medications and antibiotics,
including worsening infection and severe illness. Mr. Jones
continued to refuse the medications and ordered Tara to
leave. At that point, Tara decided to give Mr. Jones some
time to rest and opted to administer medications and
provide care to her other patients, with plans to return to
Mr. Jones later. Tara returned to Mr. Jones's room about 2
hours later, and Mr. Jones again yelled for Tara to leave the
room immediately. Frustrated, Tara called Mr. Jones's
attending physician to alert them of the difficulties with
administering medications. In the interim, another patient
became acutely ill, and Tara's attention was diverted from
Mr. Jones for the next few hours. Tara connected with the
physician later in the day, who seemed unphased by the
information. Concerned, Tara reached out to the nurse
manager for assistance.
