1. Integrated Case Studies: Intermediate Case Study: Jason Brown
Jason Brown is a 21-year-old college football player. It is the second post-op day
following surgical repair of a fracture of his right tibia and fibula. He has sutures over the
anterior knee and lateral malleolus and a posterior splint on the right leg. He continues
to report considerable pain. His vital signs at midnight were as follows: temperature,
98.3°F; pulse, 58 beats/min; respirations, 12 breaths/min; blood pressure 118/70 mm
Hg. He reported his incisional pain as sharp, stabbing, and a 3 on a scale of 1 of 10 (10 =
worst) at about 10 PM. He has a peripheral IV in his left forearm infusing D5 ½ NSS at a
rate of 20 mL/hr. He is using a PCA pump for pain relief. The nursing care for the
morning includes routine AM care, cast care, and a trip to physical therapy (PT). Shortly
after morning report, the unit secretary catches you and says, “Jason says he needs a
nurse. He is in terrible pain.”
You enter the room. Jason is pale and diaphoretic. His sheets are damp with some wet
spots. He says, “My leg hurts. It really hurts.” You ask him to rate his pain, and he
answers, “At least an 8. I’ve been pushing my pain pump but I’m still in pain.” His IV site
looks okay. You say, “I’m going to find out why it is hurting. I need to get your vital signs
first.” His vital signs now are as follows: temperature, 98.9°F; pulse, 72 beats/min;
respirations, 20 breaths/min; blood pressure, 124/78 mm Hg.
Prescribed Interventions
Vital signs q4h
Intravenous fluids: D5 ½ NSS at 20 mL/hr
PCA—Morphine sulfate 1 mg/mL, 1 mg q6min; lockout max 10 mg in 1 hr
Zolpidem 5 mg prn at bedtime for sleep
PT for weight bearing, as tolerated

Suggested Responses for Integrated Nursing Care

a. What is the significance of the changes in Jason’s vital signs
b. How do you assess the following?
c. What interventions for Jason’s pain must occur immediately before
administering nursing care and PT?