— Overview
Two nursing cases, and a third beside them, are read for critical thinking. Mr. Park, 84, slipped in the bathroom three days earlier and broke his left arm. He lives alone, five years after his wife’s death, smokes a pack a day and has done so for more than twenty years, and walks with a cane. He is 157 centimetres and 49 kilograms. His history includes a left-leg fracture in 1953, a gastric perforation in 1968, a bowel obstruction in 1973, hypertension in 2017, a femoral fracture and a meningioma in 2018, and diabetes in 2020.
On admission his blood pressure was 140/100 mmHg, his pulse 112, his pain 6 on the NRS. After surgery the first nursing diagnosis is acute pain; the second is urinary trouble, with 478 cc of residual urine and a suspicion of prostate enlargement. Pain falls to 3 or below, and he learns to use a PCA. Mr. Shin, 38, is admitted on 15 September 2021 with cirrhosis after heavy drinking — about five bottles of soju a day — having lost day-labour work and been living in the underpass at Seoul Station.
He arrives with jaundice, confusion, 300 cc of vomited blood, and melaena, and with sodium at 117 mEq/L and potassium at 2.6. Safety, nutrition, and fluid come first. A third case, Ms. Kim, 59, is admitted through the emergency room after an overdose of sleeping pills, with a major depressive disorder.
— Contents and key concepts
Mr. Park, 84, after a fall in the bathroom
Three days earlier, Mr. Park, 84, slipped in the bathroom and broke his left arm. He went first to a small clinic, then, on advice, to the outpatient desk of a larger hospital, and was admitted. He has lived alone since his wife died five years earlier. He does not drink. He smokes a pack a day, and has done so for more than twenty years. He has had no formal schooling, and he has no religion. He is 157 centimetres tall and 49 kilograms, on the thin side, and he walks with a cane.
His past is long. A left-leg fracture in 1953, a gastric perforation in 1968, a bowel obstruction in 1973, hypertension in 2017, a femoral fracture and a meningioma in 2018, and diabetes in 2020. In the recent stretch the diabetes and the blood pressure had been under steady care. Family history is not known. On admission his blood pressure was 140/100 mmHg, his temperature 36.3°C, his pulse 112 a minute, and his breathing 20 a minute, a little outside the usual range. His main complaint is ongoing pain in the left arm, scored 6 on the NRS at first. That pain limits what he can do, and it can slow recovery as a whole.
Pain, urine, and a body that will not move easily
The first main nursing diagnosis is acute pain, tied to the pain after surgery on the broken left arm. The plan is to bring the NRS score to 4 or below within twenty-four hours, checking three times a day, giving prescribed pain medicine when it is needed, using cold, and teaching him to use a PCA so that he can manage the pain himself. After the teaching he uses the pump whenever the pain eases enough to need it, and he can manage it on his own. On review the score has fallen to 3 or below, and no extra doses are required.
The second diagnosis is a disturbance of urinary function, tied to difficulty passing urine and a feeling that the bladder has not emptied. A bladder scan finds 478 cc of residual urine. Urine tests show high white cells and protein, and after a urology consult an enlarged prostate is suspected. He is taught to take Tamsulosin exactly as prescribed, and is encouraged to drink enough. After the medicine, urine is watched, and fluid intake is kept up. A nelaton catheter is used; passing urine becomes smoother, and residual volume falls. A later aim is a residual volume of 50 cc or less, with the discomfort after voiding gone.
There is also impaired physical mobility, tied to being still after surgery. The broken left arm, the pain, and bed rest limit how he can move. Pain control, a return of mobility, and better urinary function are treated as the three strands that, planned together and fitted to his state, most affect how fast he recovers. At every step, careful thinking about what the findings actually mean is treated as part of the work, not an extra.
Mr. Shin, admitted with cirrhosis on 15 September 2021, and Ms. Kim beside him
Mr. Shin, 38, is admitted on 15 September 2021 with cirrhosis after heavy drinking. He had been a day labourer, then lost the work, and was living in the underpass at Seoul Station. He drank about five bottles of soju a day, smoked two packs of cigarettes, and slept and ate very irregularly. For a month he had had a poor appetite, nausea, vomiting, and jaundice. On the day of admission he vomits 300 cc of blood, and has melaena two or three times. He arrives in a confused state, with jaundice over the body, dry skin, and signs of anaemia, and with a poor appetite, nausea, vomiting, and black stools among the main symptoms. He tries to pull out a Foley catheter and an intravenous line. Electrolyte imbalance and a severe lack of nutrition are also found. Sodium is 117 mEq/L and potassium 2.6 mEq/L, a serious imbalance that is read as leading to a deficit of body fluid. In cirrhosis the liver’s work is weaker, and the balance of water and electrolytes in the body is easily broken. An imbalance of that kind can bring muscle cramps, fatigue, and an irregular heartbeat, and, left alone, can run into grave complications.
The first nursing problems are difficulty keeping himself safe, tied to the confused state; a lack of nutrition from the poor appetite; a fluid imbalance from the electrolytes; fatigue from anaemia; and ongoing dependence on alcohol. Safety and food come first. In the confused state, restraints are used at first, with regular observation, to keep him safe and to protect the Foley catheter and the intravenous line. Intravenous fluid is given to restore electrolytes, and blood figures are written down. A high-energy, then a high-protein, diet is offered, with intravenous nutrition and supplements if needed. Weight is taken every day, and he and anyone with him are taught why the extra nutrition matters. Activity is also planned so that fatigue is not ignored. On review, the confusion has eased enough that restraints are used less often, and safety can be kept. Electrolyte and anaemia figures improve, nutrition improves by degrees, intake rises somewhat, weight loss stops, and his general state steadies. Cirrhosis, in this reading, is not only damage to the liver. It is a whole-body illness, and safety, food, and a fluid balance that will hold is among the first things nursing has to secure.
Beside these two, Ms. Kim, 59, is admitted through the emergency room after an overdose of sleeping pills. She has a major depressive disorder: low mood, listlessness, and a suicidal impulse. For a month she has had a poor appetite and insomnia. In hospital she barely speaks to other patients, stays mostly alone, and is listless. She is thin, and her manner is withdrawn. The first work is regular observation to lower the risk of suicide, with counselling and medicine together. Nutrition supplements and a medicine to help her sleep are named so that appetite and the quality of sleep can be rebuilt, and so that ordinary activity can begin again. The same Korean report, at fuller length, is on CampusDown.
Sources
- A Korean nursing write-up of three critical-thinking cases: Mr. Park, 84, after a fall and a fracture of the left arm; Mr. Shin, 38, admitted on 15 September 2021 with cirrhosis; and Ms. Kim, 59, admitted after an overdose, with a major depressive disorder.
Last updated: 14 November 2026
Frequently asked questions
What happened to Mr. Park after the fall?
He is 84. Three days earlier he slipped in the bathroom and broke his left arm. He went first to a small clinic, then to the outpatient desk of a larger hospital, and was admitted. He has lived alone since his wife died five years earlier. He does not drink, smokes a pack a day and has done so for more than twenty years, has had no formal schooling, and has no religion. He is 157 centimetres tall and 49 kilograms, and he walks with a cane. His past includes a left-leg fracture in 1953, a gastric perforation in 1968, a bowel obstruction in 1973, hypertension in 2017, a femoral fracture and a meningioma in 2018, and diabetes in 2020; the diabetes and the blood pressure had been under steady care. On admission his blood pressure was 140/100 mmHg, his temperature 36.3°C, his pulse 112 a minute, his breathing 20 a minute — a little outside the usual range. His main complaint is pain in the left arm, 6 on the NRS at first.
What nursing diagnoses were set, and how did they move?
The first is acute pain tied to the pain after surgery. The aim is to bring the NRS score to 4 or below within twenty-four hours, with a check three times a day, prescribed pain medicine when needed, cold therapy, and teaching so that he can use a PCA himself. The score falls to 3 or below, and he manages the pain with the PCA and no extra doses. The second is urinary trouble tied to difficulty passing urine. A bladder scan finds 478 cc of residual urine; urine tests show high white cells and protein, and after a urology consult an enlarged prostate is suspected. He is taught to take Tamsulosin as prescribed, and to drink enough. After a nelaton catheter, passing urine becomes easier, and residual volume falls; the later aim is 50 cc or less, with the discomfort after voiding gone. A further problem is impaired physical mobility tied to being still after surgery: the broken left arm, the pain, and bed rest limit how he can move. Pain control, a return of mobility, and better urinary function are treated as the path that most affects how fast he recovers.
What does Mr. Shin’s cirrhosis admission show, and how does Ms. Kim’s case sit beside it?
Mr. Shin, 38, is admitted on 15 September 2021 with cirrhosis after heavy drinking, about five bottles of soju a day, and two packs of cigarettes. He had been a day labourer, then unemployed, and was living in the underpass at Seoul Station, with very irregular sleep and meals. For a month he had had a poor appetite, nausea, vomiting, and jaundice. On the day of admission he vomits 300 cc of blood and has melaena two or three times. He arrives confused, with jaundice over the body, dry skin, and signs of anaemia, and he tries to pull out a Foley catheter and an intravenous line. Sodium is 117 mEq/L and potassium 2.6 mEq/L, a serious imbalance that is read as a deficit of body fluid. Nursing priorities are safety — observation and, at first, restraints to protect the lines — then intravenous fluid to restore electrolytes, a high-protein, high-energy diet with intravenous nutrition if needed, daily weights, and teaching about why the food matters. Confusion eases enough that restraints are used less often; electrolyte and anaemia figures improve, intake rises, weight loss stops, and his general state steadies. Beside these two, Ms. Kim, 59, is admitted through the emergency room after an overdose of sleeping pills, with a major depressive disorder: low mood, listlessness, suicidal impulse, a month of poor appetite and insomnia. She is thin, stays alone, and barely speaks to other patients. Regular observation for suicide risk, counselling and medicine together, nutrition supplements, and help with sleep are named as the work that has to come first.
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