Margaret is a 43 year old Mother of two children and has presented to the emergency department with intermittent upper right quadrant abdominal pain and bouts of nausea and vomiting. The pain, she states has been coming and going for a few days with little relief from over the counter analgesics. Margaret also mentions that at times the pain seems to be exacerbated by food.
Margaret has no relevant past medical history to date and believes although she lives a sedentary lifestyle she keeps herself generally healthy. On admission to ED her Vital signs are all classified within normal limits with slight elevation of her blood pressure, heart rate, temp of 37.8 and her pain scale at present is 8/10 and Margaret’s BMI is 30.
Based on Margaret’s symptoms the ED registrar has ordered full bloods with a fasting set of bloods when possible, an ultrasound and a CT scan of her abdomen. The results of the blood work reveal an abnormal LFT and high levels of LDL cholesterol; the fasting bloods could not be undertaken. The ultrasound and CT diagnostics show a mass in Margaret’s right upper quadrant indicative of gall stones.
Margaret is moved to the Short Stay ward awaiting surgical review, as the plan is for a Laparoscopic Cholecystectomy on the emergency theatre list.
Post Laparoscopic Cholecystectomy Margaret arrives in PACU. She is unconscious, spontaneously breathing with a guedel airway insitu and a Hudson mask at 6L. The head of bed is elevated to 30 degrees. Her initial vital signs show BP 160/85, Resp: 12, HR: 84, SaO2 97% and Temp 36.5. Handover depicts Margaret’s surgery to be uneventful, full anaesthetic administered, local anaesthetic to the 4 laparoscopic wound sites and a redivac drain that is draining minimal amounts.
As Margaret starts to rouse from the anaesthetic she begins to vomit bile and starts to become agitated. She motions that she cannot breathe, and is becoming increasingly distressed and anxious. Whilst reassuring the patient an anaesthetic review is conducted, 10mg of metoclopramide is ordered and given. Her SpO2is 95% so her O2in increased to 8L via Hudson mask.
Margaret is also indicating that she has strong pain, to which PACU has an IV morphine order of 1- 2mgs if required. An initial 2mg dose of morphine is given with minimal effect, a further 2 mg is administered 5 minutes later and on observation has good effect although it seems to be making Margaret quite drowsy.
After some time, Margaret is ready for discharge to the ward. The ward nurse is given a handover of Margaret with all relevant post-operative information that includes remaining nil orally until review, wound and drain assessment. She has IVHartmann’scharted at a 4/24hrly rate with further bags to follow. Her listed medications include IV/O ondansetron 4mg 4-6/24, metoclopramide 10mg 6/24, IV/O Paracetamol 1g 6-8/24, Tramadol IV 100mg 6/24 and IV Tobramycin 90mgs TDS
Margaret has had a comfortable stay on the ward overnight and is looking forward to being discharged in the coming days. She indicates that she would like to change her lifestyle and asks if there is perhaps someone she can see who can ‘put her on the right track’.Learnig outcomes and questions to answes
Assessment 1: Case Study
The assignment is to be presented in a question/answer format not as an essay (i.e. no introduction or conclusion). Each answer has a word limit; each answer must be supported with citations. Students must provide in-text referencing and a Reference List must be
provided at the end of the assignment.
Due date:March 22, 10am
Length and/or format:1500 words
Purpose:To assess learning outcomes as stipulated below.
Case Study Questions
1. Whilst the patient is in PACU, identify and discuss airway management (and rationales) as related to the case study (400 words).
2. In order of priority using evidence based literature, identify and discuss by Photo-zoom V10″ style=”border: none !important; display: inline-block !important; text-indent: 0px !important; float: none !important; font-weight: bold !important; height: auto !important; margin: 0px !important; min-height: 0px !important; min-width: 0px !important; padding: 0px !important; text-transform: uppercase !important; text-decoration: underline !important; vertical-align: baseline !important; width: auto !important; background: transparent !important;”>the nursing.akamaihd.net/items/it/img/arrow-10×10.png”> interventions (and rationales) required to care for the chosen patient in the first 24 hours upon returning to the ward. Nursing intervention/care presented needs to be accurate, relevant and specific to the chosen case study (800 words).
3. As part of your role as a primary nurse for your patient, you are required to initiate discharge planning. Identify the allied health professional/s you would refer your case study patient to and discuss the rationale behind your referral, what treatment may this health professional/s provide? (300 words)
Learning outcomes assessed:
2. Apply a clinical decision making framework in the assessment and prioritisation of by Photo-zoom V10″ style=”border: none !important; display: inline-block !important; text-indent: 0px !important; float: none !important; font-weight: bold !important; height: auto !important; margin: 0px !important; min-height: 0px !important; min-width: 0px !important; padding: 0px !important; text-transform: uppercase !important; text-decoration: underline !important; vertical-align: baseline !important; width: auto !important; background: transparent !important;”>health problems.akamaihd.net/items/it/img/arrow-10×10.png”> in individuals
5. Determine appropriate nursing therapies and describe medical and allied health interventions for selected episodic
health alterations and illnesses
6. Plan evidence-based, safe, person-centred care for individuals undergoing surgery including education and discharge
planning; (ACU Graduate Attribute: 5,6)
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