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212 UNIT III Nursing Conceptual Models

is completing her degree as an English major. At gas results have always been within normal limits.
the time of her appointment, she told the nurse Most diagnostic study values are within normal
practitioner that she was having the worst pain limits in patients with fibromyalgia, making treat-
possible. ment difficult.
Using Levine’s Conservation Model, the nurse Conservation of structural integrity involves
practitioner completed a comprehensive assess- maintaining the structure of the body to promote
ment in preparation for developing a plan of care healing. Because there is no known cause of fibro-
in consultation with the physician. Nursing care is myalgia, treatment focuses on reducing symptoms.
organized according to the conservation princi- Yolanda’s symptoms could not be traced to any
ples, with consideration of how the individual physical or structural alteration, yet she reports
adapts to the internal and external environments. severe pain and fatigue. The nurse practitioner
Yolanda’s diagnosis of fibromyalgia was based on knows that it is important to acknowledge the reality
the exclusion of other illnesses with a cluster of of the symptoms and work with the client to deter-
symptoms, including pain, fatigue, and sleepless- mine if activities of daily living result in changes in
ness (e.g., systemic lupus erythematosus, multiple the pattern of illness. In addition, Yolanda thinks she
sclerosis). Laboratory and other diagnostic results is going through menopause, and she is having
all were within normal limits. trouble determining if her symptoms are caused by
The external environment includes perceptual, menopause or fibromyalgia.
operational, and conceptual factors. Perceptual With continued questioning, the nurse practitio-
factors are those that are perceived through the ner learns that Yolanda was diagnosed with irritable
senses. Yolanda reported a history of unexplained bowel syndrome several years earlier. She is not
fatigue and pain for years. She recently stopped worried about constipation but is concerned about
her medications “to clean my body out.” However, sudden diarrhea. She is afraid to go to school; she
she reported that the pain became unbearable and fears embarrassment because she might have an
was making it difficult for her to sleep. She noted “accident.” Yolanda was taking several medications
that when she sleeps at least 6 hours a night, her for her discomfort. One of them made her feel so
pain is less intense. With the current insomnia, “hung over” that she stopped taking it after 2 weeks.
her pain is very intense. She was given amitriptyline (Elavil) for sleep. It was
Operational factors are threats to the environment the only medicine that helped her get 6 hours of
that the client cannot perceive through the senses. continuous sleep.
Yolanda reported severe pain in response to both the Personal integrity involves the maintenance of
cold weather and changes in barometric pressure. one’s sense of personal worth and self-esteem.
The conceptual environment includes cultural Yolanda reported that she lost control when she
and personal values about health care, the meaning was diagnosed with breast cancer. A dear friend
of health and illness, knowledge about health care, convinced her to go to church and encouraged her
education, language use, and spiritual beliefs. In to use prayer. When feeling sorry for herself, she
response to breast cancer, Yolanda developed her would go into her bedroom and read her Bible, cry
spirituality through prayer and reading the Bible. by herself, and pray. She believes that prayer and
She believes that this is how she gets through the Bible reading helped her heal. She continues to
painful moments of her current illness. pray and read her Bible to gain the strength she
Conservation of energy focuses on the balance needs to live with her illness. She also believes that
of energy input and output to prevent excessive she needs to be able to laugh at herself; humor
fatigue. Yolanda complains of a fatigue that just helps her to feel better. She actively seeks health
“comes over me.” She has difficulty doing house- information, as indicated by her quest to learn
work. One day of work usually means one day in about her new diagnosis of fibromyalgia. She is
bed because of extreme fatigue. Her hemoglobin most upset about not being able to walk like
level and hematocrit are normal; her arterial blood she used to walk. One of her favorite pastimes