University : University of Southern Queensland UniLearnO is not sponsored or endorsed by this college or university.
Subject Code : NUR2203
Country : Australia
Assignment Task

 

Objectives 

  • Demonstrate the use of research evidence for nursing practice applied to the care of a surgical patient
  • Augment skills in clinical decision making and reasoning through synthesizing and analysing information required to care for a surgical patient 
  • Apply appropriate assessment, problem-solving, planning, prioritizing of interventions to care for the selected client scenario chosen
  • Demonstrate the nurse’s role in monitoring and implementing prioritized nursing interventions in response to identified patient needs
  • Demonstrate the ability to communicate specific patient care issues succinctly according to scholarly writing and referencing convention.

 

Purpose

  • Standard 1: Thinks critically and analyses nursing practice.
  • RNs use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks.
  • Standard 4: Comprehensively conducts assessments. RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.
  • Standard 6: Provides safe, appropriate and responsive quality nursing practice.
  • RNs provide and may delegate, quality and ethical goal-directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.
  • Standard 7: Evaluates outcomes to inform nursing practice.
  • RNs take responsibility for the evaluation of practice based on agreed priorities, goals, plans and outcomes and revises practice accordingly.

 

Case Study

Mr George Jensen a 66-year-old retired Plummer presented to the emergency department with a 48-hour history of vomiting, severe abdominal pain and diarrhea. A CT scan revealed an obstructing right sided colonic mass. George was taken to surgery later in the day for an emergency laparotomy.  

Please refer to the following pre and post-operative assessment data to answer the assignment questions. 

 

Pre-operative clinical data

 

Objective Data

Past Medical History

Social History

  • Weight reported 110kgs

  • Height reported 178 cm

  • BP 155/100

  • HR 110

  • RR 18

  • Temp 38.8C

  • Urinalysis - normal

Current Medication

  • Simvastatin 40mg nocte

  • Captopril 100 mg/day

  • Aspirin 75mg mane 

  • Hypercholesterolemia

  • Hypertension

  • Obstructive sleep apnoea (OSA) confirmed with sleep study January 2019

  • Myocardial infarction (MI) in 2005 with right coronary artery stenting.

  • Divorced with 2 grown children

  • Working as a Plummer 20hrs/week

  • Smokes 15 roll up cigarettes a day last 30 years 

  • Consumes 15 units of alcohol per day

  • Independent with daily cares 

Family history

  • Father RIP lymphoma 

  • Mother 84 years of age: history of bowel cancer 

 

Postoperative clinical data

George returned from theatre at 2000 following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis in two out of 28 dissected lymph nodes.  You are the nurse looking after George on the night shift.  

 

  • BP 96/55mmHg

  • Pulse: 107 and regular Respiratory rate: 12/min shallow SaO2 95% 2 litres via nasal prongs, Temperature 37.8°C Axilla, 

  • Sedation score = 1-2

  • Vacudrain in-situ 400  ml in bag

  • Estimated blood loss (EBL) in OT 400ml

  • Urine output via a Foley IDC: 15-20 mls/hour <1ml>

  • Pain score 6 on a scale of 0-10

  • Midline abdominal dressing (minimal ooze)

  • Simvastatin 40mg nocte

  • Captopril 100 mg/day

  • Aspirin 75 mg mane

  • Fentanyl PCA 20mcg bolus: 5 minute lockout

  • Regular paracetamol 1G QID (PO/IV)

  • Oxygen 4L via nasal prongs

  • Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 100mls/hour

  • IV Cefoxitin 2gms TDS

  • Midline abdominal dressing 

  • Mobilise day 1 with physiotherapist

  • Sips of fluid only

  • Remove IDC 0800, day 1

  • DVT prophylaxis –TED stockings  

  • Pain management

  • GP follow up 2/52

  • OPD appointment 6/52 with Dr Bowler

  • George will have 20 doses of adjuvant chemotherapy as an outpatient over the next three months.







 

 

 

This assignment requires you to consider the case scenario of George Jensen who has undergone a laparotomy.

Your answer will concentrate on the first 24 hours of post-surgical care.

1. Provide an INTRODUCTION (approximately 100 words) 

An introduction will provide clear scope about the direction of your assignment.  This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion. 

 

Part A: Analyse the case to identify potential clinical issues and relevant nursing care (1100 words)

This section will focus on the first 24 hours of post-surgical care and involves prioritising nursing care for George.  Consider George’s co-morbidities including smoking, obstructive sleep apnoea (OSA), previous MI, hypertension and hypercholesterolemia in the context of having a general anaesthetic (GA) and in identifying your clinical issues.

  • Identify THREE (3) PRIORITY clinical issues for George e.g. at risk of severe pain
  • Identify NURSING INTERVENTIONS for each of the three clinical issues e.g. Encourage deep breathing exercises hourly
  • Provide RATIONALES for each nursing intervention. Rationales justify your interventions and are referenced. For example, the intervention: Encourage deep breathing exercises including use of the spirometry hourly; provide a rationale further promotes normal lung expansion and increases oxygen levels, is useful in preventing pneumonia and atelectasis

 

Part B: Discharge planning (700 words)

  • Plan and prioritise discharge advice for George.
  • In the discharge plan, consider the appropriate post-operative education for George including the surgical procedure.  Concisely provide a discharge plan and education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification
  • Refrain from merely providing generic information.  Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan.  

 

 

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  • Posted on : March 22nd, 2019
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