University : Western Sydney University UniLearnO is not sponsored or endorsed by this college or university.
Subject Code : 401207
Country : Australia
Assignment Task:

Outcome 
1
Apply the principles of perioperative nursing to the role of the nurse in the perioperative period 
2 Explain the safe and effective use of pharmacological agents across the lifespan in the perioperative period 
3 Discuss non-pharmacological comfort measures that may be used during the perioperative period 
4 Discuss the pathophysiology of gastrointestinal conditions across the lifespan 
5 Discuss breast and bowel conditions across the lifespan 
6 Discuss the pathophysiology of arthritis, musculoskeletal conditions, and cancer across the lifespan 
7 Discuss injury prevention and control as they relate to pathophysiology across the lifespan 
8 Use information literacy skills to access and evaluate relevant evidence-based literature on the provision of effective nursing management of people across the lifespan in the perioperative period.

Case Study: 
Jordan James is a 25-year-old male. Jordan has been admitted to hospital with a five-day history of right lower abdominal cramping pain, a feeling of abdominal bloating, nausea and vomiting, and an increased amount of abdominal gurgling and rumbling. Jordan stated that over recent weeks, he has experienced persistent diarrhea, lower right abdominal pain, and tenderness, fatigue, and malaise. Jordan stated he has not been able to keep up with his work demands and is not getting quality rest and sleep. Due to his diarrhea and current vomiting Jordan states that he has been reluctant to eat or drink much during the past five (5) days. He reported that he has lost seven kilograms in the last three weeks. 
Jordan was diagnosed with Crohn’s disease when he was 17 years old. His Crohn’s disease was diagnosed after Jordan presented to his general practitioner (GP) with a perianal abscess. Since his diagnosis and surgical management of his perianal abscess, Jordan’s Crohn’s disease has been managed with pharmacological (infliximab) and dietary strategies, and medical monitoring. During this time, Jordan has had a number of exacerbations of Crohn’s disease. 
Jordan’s observations on admission were: 
· Blood pressure: 92/52 mm/Hg 
· Pulse rate: 112 beats/minute 
· Weak peripheral pulses 
· Respiratory rate: 24 breaths/minute 
· Temperature: 38.3C 
· Sa02: 97% in room air 
· Weight: 75 kilograms 
· Height: 188 cm 
· Urinalysis: 
o specific gravity: 1035 
o dark-colored urine 
o no other abnormalities noted 
On examination, Jordan had a distended abdomen, a tender mass in his right lower abdominal quadrant and audible bowel sounds. His skin was pale and dry with poor turgor. His extremities were cool to touch. The medical officer (MO) noted that Jordan had poor capillary refill and flat neck veins. The MO ordered some preliminary blood tests and an abdominal CT scan. 
Initial pathology results 
· Haemoglobin: 7.9mmol/L (8.1 - 11.2mmol/L) 
· Haematocrit: 51% (35 - 47%) 
· WBC: 13.9 X 109/L (4.3 - 10.8 X 109/L) 
· Erythrocyte sedimentation rate (ESR): 26.5mm/hour (0 - 13 mm/hour) 
· C-reactive protein (CRP): 30.7mg/dl (20 mg/dl) 
· Albumin: 30.5g/L (35 - 50 g/L) 
The MO returns to discuss the results of the CT scan with Jordan. Jordan has developed a stricture causing bowel obstruction in his terminal ileum. Jordan is referred to a gastroenterological surgeon. The surgeon explains to Jordan that he will require surgical resection of the affected ileum and end-to-end anastomosis of the ends of the ileum. The surgeon also tells Jordan that he has numerous large patches of inflamed mucosa and submucosa throughout his small bowel and colon. 
The MO orders the following 
· pethidine 75mg IMI QID PRN 
· metoclopramide (’Maxolon’) 10mg IMI TDS 
· 1000mL Hartman’s solution over 6 hours via IVI 
· methylprednisolone 20mg IVI TDS 
· nil by mouth 
Guided questions (401207)

1. Explain the structural and functional changes in the disease process that led to Jordan’s weight loss. 
Student answers must be supported by relevant academic references. References are not included in the word limit. 

2. Explain the pain pathway and how Morphine alters the conscious perception of pain. Student's answers must be supported by relevant academic references. References are not included in the word limit. 

3. Explain the clinical manifestations that may indicate the deterioration of Jordan’s Crohn’s condition and explain why they occur. Student's answers must be supported by relevant academic references. References are not included in the word limit. 

4. Explain the characteristics of the intravenous fluid that was ordered for Jordan and explain the rationale for the administration of the IV fluid relating to Jordan’s specific fluid balance. Student's answers must be supported by relevant academic references. References are not included in the word limit. 

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  • Posted on : March 05th, 2019

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