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B63281 Acute -Nursing the Surgical Patients

University: London School Of Management Education

  • Unit No: 8
  • Level: High school
  • Pages: 3 / Words 807
  • Paper Type: Dissertation
  • Course Code: B63281
  • Downloads: 599
Brief :

TASK SUMMARY

  • The assessment's maximum word count is 2000.

SCENARIO

Teacher Mrs. Wendy Green, 64, conferred to her general practitioner approximately three weeks ago with a history of three months of abdominal pain and diarrhoea. A tumour in the ascending colon was discovered through a colonoscopy and CT scan. An open right hemi-colectomy was planned for Wendy.

To answer the assignment questions, please refer to the following pre- and post-operative assessment data.

Objective Data

Past Medical History

Social History

Weight reported 92kgs

Height reported 168 cm

BP 155/100

HR 88

RR 18

Temp 38.8C

Urinalysis - normal

Current Medication

Simvastatin 40mg nocte

Captopril 100 mg mane

Aspirin 100 mg mane

Ventolin prn

Hypercholesterolemia

Hypertension

Asthma

Obstructive sleep apnoea (OSA) confirmed with sleep study January 2011

Uses CPAP machine at night

Myocardial infarction (MI) 2007 with left coronary artery stenting

Married with 2 grown children

Teacher

Consumes 6 units of alcohol per day

Independent with daily cares

Smokes 10 cigarettes/day

Family history

Father RIP bowel cancer

Mother 84 years of age: history of cardiac disease

Postoperative clinical data

In 2000, Wendy underwent an open right hemi colectomy for a poorly differentiated adenocarcinoma of the ascending colon, which resulted in lymph node metastasis in four of the 28 dissected lymph nodes. After Wendy's surgery, you are the listed nurse who is taking care of her on the day shift.

Observations 0800

Medications

Post-operative orders

BP 90/55mmHg

Pulse: 110 and regular Respiratory rate: 12/min shallow SpO2 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 600ml

Urine output via a Foley IDC: 10-15 mls/hour <1ml/kg/hour last three hours

Pain score 6 on a scale of 0-10

Midline abdominal dressing (minimal ooze)

Simvastatin 40mg nocte

Captopril 100 mg/day

Aspirin 100 mg mane

Fentanyl PCA 20mcg bolus: 5 minute lockout

Regular paracetamol 1G QID (PO/IV)

Tramadol 50-100mg QID prn (PO/IV)

Oxygen 2L via nasal prongs

Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 80ml/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 Bryant

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

From this case study you are required to perform this structure.

INTRODUCTION ( 100 words)

Background in reference to essay and define the  issues which is to be addressed in the discussion.

Part A: Examine the scenario to determine potential clinical issues & relatable nursing care (1100 words)

This section has an emphasis on the first 24 hours of post-surgical care and involves prioritising nursing care for Wendy.

  • Determine THREE PRECEDENCEclinical issues for Wendy e.g. at danger of severe pain
  • find out the NURSING PARTICIPATIONfor each of the 3clinical issues g. Promote deep breathing exercises hourly
  • Render PRINCIPLEfor each nursing intervention. justify your interventions.

Part B: Discharge planning (700 words)

  • Design and grade discharge proposal for
  • In the discharge plan, consider the suitable post-operative education forWendyinvolve the surgical procedure.  Briefly provide a discharge idea and instruction about medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification.
  • Refer the generic information.  Be concise and suited in your proposal but also  analyse the information in the scenario and relate this to the discharge plan.  

Answer on:

NURSE 100 Nursing the Surgical Patient

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