Monitor person with acute problem

Part A
Mr Jones is a 76-year-old man with a history of smoking who was admitted to an acute care ward with a history of severe abdominal pain of approximately six hours. Mr Jones exhibits tenderness of the left lumbar/epigastric region and describes his pain as sharp and rated as 7 out of 10.
On assessment, you notice Mr Jones’s abdomen has become distended and auscultation reveals no bowel sounds. He is tachycardic 115, hypertensive 165/80, febrile 38.5o C and tachypnoeic 26.
Mr Jones begins to vomit. You contact the surgical registrar immediately. After the registrar assesses him, an abdominal X-ray and ultrasound is taken and insertion of a nasogastric tube NGT is ordered. You are required to insert a Salem-sump NGT, place it on free drainage and document in the notes.
It has been documented by the surgical registrar that Mr Jones needs be kept strictly Nil by Mouth (NBM) until review by a surgeon and a strict fluid balance chart needs to be maintained.

Part A – Questions

Please discuss why it is important to be aware of Mr Jones history prior to going to theatre? (50 words)

What are three (3) common abdominal complications that may require insertion of a NGT for abdominal drainage?

What nursing interventions are required when caring for a patient with a NGT?

Why is Mr Jones Nil by Mouth (NBM) and why is it important to maintain a strict fluid balance chart?

The surgeon arrives to review Mr Jones and after examination and review of the x-ray and ultrasound the decision is made to take Mr Jones to theatre as he has a small bowel obstruction. As yet the cause unknown.

Discuss 3 preoperative nursing procedures you would undertake specifically for a patient being prepared for theatre for a small bowel obstruction.

a. Discuss the pathophysiology related to small bowel obstruction. (minimum 50 words)

b. How would you explain this to Mr Jones using language appropriate for a patient?

Please discuss what education you would provide Mr Jones with preoperatively in regards to the 3 elements below, and how this will assist with Mr Jones care postoperatively. (150 words)
Pain relief / Lung function / Mobilisation post theatre

When Mr Jones returns from Theatre the following is noted
Vital observations BP 100/60, HR 85bpm Resp rate 12bpm, Temp 36, O2 92%, 8/24 IVT, PCA (Morphine 1mg per ml), IDC on hourly burette measures, Wound dressing dry and intact with Bellovac x 1 on free drainage, IVABs, check XR and Hb in am, Sequential Compression Device (SCD)

List 7 important pieces of information you would require when receiving the handover from the theatre nurse.

Outline two (2) nursing interventions you would undertake for each of the following four (4) items below that will assist in the prevention of post-operative complications for Mr Jones in the first 24-48 hours post theatre recovery.
Pressure area care

Lung function

Range of motion

Psychological support

After settling Mr Jones into his room, on the second set of observations he starts complaining of severe pain at the wound site.
Identify four (4) non-verbal signs that Mr Jones may exhibit when experiencing unrelieved pain. (approx 50 words)

Mr Jones’ condition and Level of consciousness (LOC) starts to deteriorate.
When you arrive to complete another set of observations you are concerned that he appears drowsy and has trouble responding to verbal stimuli.
Identify a minimum of two (2) nursing interventions you would perform at this point.

Mr Jones continues to deterioration rapidly. Heart rate 45bpm, respiratory rate is 8bpm with oxygen saturation decreased to 83%.
Identify a minimum of two (2) nursing interventions you would perform at this point.

Mr Jones is now in full respiratory and cardiac arrest, he is attended to by the medical emergency team and revived
Please describe your role in an emergency as the EN assigned to this patient.

Also, state who are the other routine members of the emergency response team.

Please state one of the first line drugs you may be asked to prepare for this emergency situation.

Please provide an example of what you would state in the progress notes following this incident

You have had 5 days off. On your return, you are assigned to care for Mr Jones again. You are handed over the following:
Mr Jones has recovered from cardiac arrest
He is awake and alert
He was returned to theatre three days ago for further bowel surgery resulting in the creation of an ileostomy
He remains NBM and has been NBM for the last six (6) days
The doctor has written up orders to commence Parenteral nutrition
His observations are stable and within normal limits for Mr Jones
Mr Jones’ wife has been by his side for the last 48 hours.
a. What steps do you need to take in setting up for commencement of parenteral nutrition?

b. State four (4) aspects of nursing care that are required when caring for a patient with a PICC line.

What education would you provide to the patient and his wife regarding the need for this treatment?

Part B General Questions – please answer the following
Match the acute conditions listed with the correct cause (please note that most of these conditions will have more than one cause)

Acute renal disorder Burns Myocardial infarction Sepsis
Deep vein thrombosis, venous thromboembolism Haemorrhage Acute respiratory disorders Shock
Dehydration Angina Renal calculi Acute gastrointestinal disorders
Cellulitis Head injury Acute pain Fractures
Acute unconscious state Acute neurological disorder

Acute conditions Causes
Bronchitis
Stroke
Chest pain
Encephalitis
Fire
Knife cut to fingers while chopping tomatoes
Staphylococcus and Streptococcus bacteria.
Urinary tract obstruction
Broken arm
Prolonged Vomiting and diarrhoea due to infection
Appendicitis
3 days in bed without any range of movement activities
Bloodstream infection (bacteremia)
Toxic Shock Syndrome
Hemophilia
Falling from a ladder
Formation of solid crystals from the salts in urine
Formation of a blood clot (thrombosis inside a coronary artery, or one of its branches)

What are four (4) basic principles of Surgical Nursing that you as the EN need to practice?

Demonstrate your knowledge of the following surgical procedures by providing a brief description and example for each.
Surgical procedure Knowledge evidence
Elective surgery
Emergency surgery
General, local, epidural and spinal
Anaesthetic and peripheral nerve block
Amputation
Open reduction
Hip replacement
Craniotomy
Tonsillectomy
Appendectomy
Laparotomy
Hysterectomy
Prostatectomy
Cataract extraction
Internal bleeding due to trauma

a. When performing Tracheostomy suctioning / clearing of airways for a patient why is it important to allow for time between suctions if more than one is needed?

b. State three (3) nursing considerations you would perform in regards to the Chest drain insertion site
(must be checked for a patient with the Underwater seal drainage system).

c. State two (2) nursing considerations for the start of your shift with a patient who has an Intercostal catheter.

d. Briefly discuss complications that may arise from the following if you are not monitoring the nursing care correctly.
CPAP

BIPAP

PICC line

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample Solution

ACED ESSAYS