University : TAFE Queensland UniLearnO is not sponsored or endorsed by this college or university.
Subject Code : HLTENN011
Country : Australia
Assignment Task
 

CASE STUDY
Mr Jones is a 76-year-old man with a history of smoking who was admitted to an acute care ward with a history of severe abdominal pain of approximately six hours. Mr Jones exhibits tenderness of the left lumbar/epigastric region and describes his pain as sharp and rated as 7 out of 10.
On assessment, you notice Mr Jones’s abdomen has become distended and auscultation reveals no bowel sounds. He is tachycardic 115, hypertensive 165/80, febrile 38.5o C and tachypnoeic 26.
Mr Jones begins to vomit. You contact the surgical registrar immediately. After the registrar assesses him, an abdominal X-ray and ultrasound is taken and insertion of a nasogastric tube NGT is ordered. You are required to insert a Salem-sump NGT, place it on free drainage and document in the notes.
It has been documented by the surgical registrar that Mr Jones needs be kept strictly Nil by Mouth (NBM) until review by a surgeon and a strict fluid balance chart needs to be maintained.

Case study - Questions
-Please discuss why it is important to be aware of Mr Jones history prior to going to theatre?
Medication.
Lifestyle
Any health conditins

- What are three (3) common abdominal complications that may require insertion of a NGT for abdominal drainage?
- What nursing interventions are required when caring for a patient with a NGT?
Intervention required when caring for a patient with NGT-
- Why is Mr Jones Nil by Mouth (NBM) and why is it important to maintain a strict fluid balance chart?
The surgeon arrives to review Mr Jones and after examination and review of the x-ray and ultrasound the decision is made to take Mr Jones to theatre as he has a small bowel obstruction. As yet the cause unknown.
- Discuss 3 preoperative nursing procedures you would undertake specifically for a patient being prepared for theatre for a small bowel obstruction. Pathway for small bowel obstruction
- Discuss the pathophysiology related to small bowel obstruction.
- How would you explain this to Mr Jones using language appropriate for a patient?
- Please discuss what education you would provide Mr Jones with preoperatively in regards to the 3 elements below, and how this will assist with Mr Jones care postoperatively.
Pain relief /
Lung function /
Mobilisation post theatre

- When Mr Jones returns from Theatre the following is noted
Vital observations BP 100/60, HR 85bpm Resp rate 12bpm, Temp 36, O2 92%, 8/24 IVT, PCA (Morphine 1mg per ml), IDC on hourly burette measures, Wound dressing dry and intact with Bellovac x 1 on free drainage, IVABs, check XR and Hb in am, Sequential Compression Device (SCD)
List 7 important pieces of information you would require when receiving the handover from the theatre nurse.
What the drug id=s
What surgery
Outline two (2) nursing interventions you would undertake for each of the following four (4) items below that will assist in the prevention of post-operative complications for Mr Jones in the first 24-48 hours post theatre recovery.
Pressure area care
Lung function
Range of motion
Psychological support

- After settling Mr Jones into his room, on the second set of observations he starts complaining of severe pain at the wound site. Identify four (4) non-verbal signs that Mr Jones may exhibit when experiencing unrelieved pain.

 

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  • Posted on : August 16th, 2019
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