TASK SUMMARY
- maximum word count for this assessment is 2000 words.
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.
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Objective Data |
Past Medical History |
Social History |
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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.
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Observations 0800 |
Medications |
Post-operative orders |
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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
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