Client Stressors Case Study
According to the Betty Neuman model, intrapersonal stressors are “internal environmental interaction forces occurring within the boundary of the client, between client sub-systems,” (12). This commonly includes physical, psychological and emotional issues that become stressors for each particular case. The clear intra-factors in this case are the presence of a kidney infection, acute lower abdominal pain, the fact that she is not taking any medications. She has been staying hydrated, a previous back muscle injury in the past. The patient has been having heavier menstrual cycles with worse cramping, no breast tenderness, did not pass clogs, she believes she is getting close to experience menopause, no prior abnormal paps or STDs, normal mammogram and pap last year, did have surgery for PPTL in 1977 after her third child was born, does not douche, previous hospitalization for back pain 5 years ago, recently went to the ER for her kidney infection with no prior history of UTIs or kidney infections prior to that incident. She does not drink alcohol or use drugs. She walks around 2 miles in the morning about 3 to 4 times per week. She was drinking coffee, but stopped since the kidney infection has only been drinking cranberry juice and water since. An examination proved that she has pronounced CVA tenderness and lower lumbar tenderness on the right side, with only slight tenderness on the left side. She is currently menstruating and using a tampon.
Interpersonal stressors are described as “external environment interaction forces occurring outside the boundary of the client but at a proximal range,” (12). This ultimately means the immediate surroundings of the client that may contribute to his or her condition, like relationships with others, cultural changes, and changes to living environments. Some of the intrapersonal factors are the fact that her sister has had kidney stones before, there is no familial history of renal disease, her older sister had started menopause around the age of 51 and had started having heavier cycles and cramps just prior to starting the change. She has enjoyed a satisfying sexual relationship with her spouse of 18 years, has only had two sexual partners in her whole life, does not experience pain during intercourse, yet back pain is causing her to have less sexual intercourse. Her mother and father are still alive and married, although the both have HTN and her father has rheumatoid arthritis. Two of her sisters have had TAH’s for female problems, but the patient is not sure what exactly those problems were. She takes care of her three grandchildren and is looking forward for her husband to retire so they can take vacations together and travel.
According to research, extrapersonal stressors are “external environmental interaction forces occurring outside the boundary of the client at a distal range,” (13). This could mean environmental pollution, weather climate, or other environmental factors that are completely out of the client’s control. The client has never worked outside of her home, limiting exposure to work-related stressors. The client uses well water, not city water to drink and bathe.
Client System Variables
It is clear that she is concerned because of the fact that she is a care taker, yet cannot truly take care of her grandchildren because of her symptoms. The patient has always been a home maker, and may be stressed because she can no longer perform her duties with her pain. She is also attributing her symptoms potentially because her sister had similar symptoms during the onset of menopause.
Due to her back and abdominal pain, she has stopped her average exercise routines. It has also caused her to stop picking up her grand kids and playing with them as much as she usually does. The past female health problems of her sisters may also be having an impact on her as well, for she is not exactly sure of what they were diagnosed with. Moreover, she has been having less intercourse because of her pain which may also be psychologically stressing.
She uses a tampon during menstruation because it is a socially accepted thing to do, and allows her greater freedom when compared to a pad. She does not use alcohol or drugs, which is a positive element in this case.
Her menstrual cramps have been getting worse, as has the amount of her monthly flow. She believes she is beginning menopause.
Reed, Karen S. (1993). Betty Neuman: The Neuman System’s Model. Sage.
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