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NRSG258 ASSESSMENT 1: CASE STUDY 1 – Joan Middleton

Case Study 1: Joan Middleton


Joan Middleton is 45 years old and works in a supermarket stocking shelves. Joan is obese (BMI 37) and has Type 2 diabetes, which she tries to control with diet. Joan is the sole provider for her three children; all aged less than 10 years. Joan’s parents live nearby and occasionally assist in caring for Joan’s children.

Joan presented to the emergency department (ED) with acute cholecystitis. Her symptoms included severe nausea and vomiting, severe pain, tenderness and guarding in the right upper quadrant of her abdomen and a temperature of 38.9oC. She was transferred to the operating theatre and underwent an emergency laparoscopic cholecystectomy.

After 2 hours in the post-anaesthetic recovery room (PARU) and an uneventful recovery, Joan was transferred to the ward, where you have been allocated to her care.


On return to the ward Joan’s observations are as follows:

  1. Pain 8/10
  2. Respirations 26
  3. BP 90/50
  4. Pulse 130
  5. Temperature remains 38.9oC.

It is planned for Joan to be discharged after two days on the ward.

Questions to be addressed:

In relation to Joan Middleton:

  • Discuss the factors that may have contributed to the patient’s presenting episodic health alteration.
  •  Critically discuss the appropriate nursing management during this episodic health alteration.
  • Explain the roles of the key members of the interdisciplinary health care team that you would involve in the care of your patient, and provide justification for their involvement.

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