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
Range of motion
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
Knife cut to fingers while chopping tomatoes
Staphylococcus and Streptococcus bacteria.
Urinary tract obstruction
Prolonged Vomiting and diarrhoea due to infection
3 days in bed without any range of movement activities
Bloodstream infection (bacteremia)
Toxic Shock Syndrome
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
General, local, epidural and spinal
Anaesthetic and peripheral nerve block
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.
Presentation Movies as medium of Mass Communication Film correspondence might be considered as a social procedure whereby a transmitted flag is gotten essentially through visual receptors (and, frequently, solid receptors) and is then regarded as a message from which substance or significance is gathered. Film, as an emblematic shape, is a procedure of correspondence that utilizes film, the medium, with its innovation of optics, emulsions, and cameras, to deliver a bit of celluloid with a variable-thickness silver nitrate surface. It is man who makes film correspondence. This definition proposes that a bit of film, all by itself, is pointless that importance exists just in an exceptional social and intellectual connection between a producer and a watcher. This relationship happens when a watcher regards a film not as unimportant signs activating perceptual mindfulness and natural reactions, however as message units that have been assembled purposefully and from which importance might be derived. Film is maybe the standard of all works of art, most prevalent and most open, particularly in India, a nation which creates most number of movies in a year contrasted with some other nation (notwithstanding Hollywood, maybe), and a nation where we have a huge base of film opening up to the world. Film, more than some other workmanship, has the ability to impact individuals. Hence, it is essential to see how the nation, its kin and its yearnings are spoken to in the film delivered in the nation. Film as a medium of mass correspondence can be seen at various levels, filling distinctive needs. It very well may be a fine art, a stimulation, a social report or a social study. Film can be these and in the meantime be a way to something different – a mirror unto our lives, indicating us precisely how we work as society. Standard Vs Alternative Cinema Mainstream movies can best be characterized as business films that are made by real amusement studios or organizations that are claimed by universal media aggregates. As a result of better financing, these movies can manage the cost of more costly performing artists, wide discharges or restricted discharges, and are sold at well known retail locations. This has turned out to be known as the studio framework. Movies made by significant studios or organizations that are not claimed by a media aggregate but rather are conveyed by an organization possessed by a media combination are additionally viewed as standard and are regularly alluded to as standard free movies. As a standard medium (film needs cash to be created. Along these lines, it must speak to the standard gathering of people, who will pay in the cinema world) film must, above all else, advance to the standard crowd. The meaning of standard shifts from society to society, from culture to culture. Comprehensively, it implies speaking to the pervasive states of mind, qualities, and practices of a general public or gathering, for instance, standard ethical quality. A social develop, when connected to craftsmanship, standard may mean something that is accessible to the overall population, or something that has connections to corporate or business elements. Sexuality in Hindi standard movies alludes to the introduction in films of sexuality or suggestion and sex acts, including love scenes. Suggestive scenes have been displayed in movies since the quiet time of cinematography. Numerous on-screen characters and on-screen characters have uncovered in any event parts of their bodies or dressed and carried on in manners considered explicitly provocative by contemporary benchmarks sooner or later in their professions. A few movies containing sexual moments have been scrutinized by religious gatherings or restricted by Govt. or on the other hand both. Sexuality in film has been displayed in numerous sorts of film; while in a few classifications sexuality is once in a while delineated. Sex in movies can be recognized to an explicit film and furthermore from nakedness in film, bareness can be introduced in a sexualized setting, for instance nakedness in naturalism would regularly be viewed as non-sexual. In India, media outlets is a critical piece of current India and is expressive of Indian culture when all is said in done. Generally Indian movies have come up short on the candid portrayal of sex; up to this point, notwithstanding kissing scenes were viewed as forbidden. Then again assault scenes or demonstrating rape were delineated transparently. As of now some Indian states demonstrate delicate center sexual scenes and bareness in movies, while different zones don't. Standard movies are still to a great extent cooked for the majority of India, anyway outside movies containing sexuality are viewed by Indians on account of a similar procedure of glamorization of film excitement that happened in Hollywood, Indian film, mostly Hindi-speaking Bollywood industry is additionally starting to include sexual suggestions. A Brief History of Bollywood Sex and Romance Bollywood works of art can't be beaten for their clear sentimental pressure, where insinuate contacting was supplanted with the lovely, well mannered allusion of hot rain and wet dress. Indians are so held about what occurs between consenting grown-ups, considering India is the second most crowded nation on the planet. In some ways, in any case, Hindi movie producers have turned out to be more loose in their states of mind, as more youthful, Western-affected ages become an adult and make waves in an industry based on convention. Beforehand inconspicuous "taboos" like pre-marriage sex, onscreen nakedness and even spouse swapping have inquisitively been passed by the Central Board of Film Certification, the strict guard dog likeness the MPAA that has filled in as an edit since the mid '50s. Assembled underneath is a glance at the milestone minutes and patterns that have cocked eyebrows through Bollywood history. Bollywood in the 70's and 80's was getting to be westernized. In those days the presence of a plain white brassiere spoke to the prohibited idea of onscreen toplessness. An on-screen character wearing only her over-the-bear rock holder who turned out the lights, for example, would suggest that she would before long be demonstrating her bosoms to her sweetheart. On the off chance that anybody understood the intensity of such dressed titillation, it was Raj Kapoor, whose movies started to stretch the limits late in his directorial profession. His unparalleled 1973 high schooler sentiment "Bobby" made a medium-term stick up vibe of Dimple Kapadia when she showed up in a two-piece, and 1978′s "Satyam, Shivam, Sundaram" (which confronted a difficult task with the edit load up, and was scrutinized by some as being exploitative) saw Zeenat Aman in a scarcely there sari that challenged material science by remaining on. His last film, 1985′s "Smash Teri Ganga Mali" brought on additional discussion when 16-year-old star Mandakini showed up showering in a cascade, wearing just a transparent white. Today, two-piece angels are unmistakably pervasive in Bollywood culture, and 2000′s "Hera Pheri" even portrayed male sunbathers in swimming outfits, mixed up as young ladies from a separation by the film's hero. Up until the '50s, if Bollywood stars needed to express love or even desire onscreen, fastening each other's hands and gazing longingly was about as racy as it got. Embracing and light face touching turned into the following jump over the accompanying three decades, yet it wasn't until the '90s that kissing was extremely recognized, not to mention done. A lady may lean in for lip benefit, however would modestly flee before the arrangement was fixed, or else the real demonstration would be canvassed by a shroud at the time previously. While this, as well, is evolving today (genius performing artist Aamir Khan even has a kissing statement put in his co-stars' agreements; on the off chance that they won't kiss him, they can't act inverse him), puckering up can even now be disagreeable. Padmini Kolhapure stood out as truly newsworthy when she simply gave Prince Charles a peck on the cheek, and after Aishwarya Rai got close with Hrithik Roshan in 2006′s "Dhoom 2," vulgarity cases were recorded. "Thing numbers," or profoundly sexualized, peppy Bollywood melodies with suggestive verses and movement, started springing up in the late '80s and particularly in the '90s. Intended to stimulate, enthusiasm for the business films they show up in, thing numbers are remain solitary masterpieces with no significance to their motion pictures' plots, including either appearance appearances from well known stars — or all the more normally, "thing young ladies." Here, typification ought not to be mistaken for the provocative artists in progressively uncovering garments have turned into somewhat less trashed today, as some have utilized the feature as a springboard into driving jobs. Among the approved performers, at that point, comes the idea of "skin appear," what India vaguely calls any thought of on-screen characters and even on-screen characters now, who will display more than what the traditionalist benchmarks manage. Set out exposed entertainers like Bipasha Basu in 'Jism' and the questionably candid Mallika Sherawat in 'Murder' have accomplished reputation for their meagerly clad limit pushing alone. Elective Lifestyles Bollywood plots have absolutely advanced, less fixated on orchestrated relational unions and more on youthful urbanites dating and clubbing. Be that as it may, these are still gradual steps contrasted with what has been acquainted with in Western culture. India still remains closeted in changing sexual inclinations. In 2003 "Kal No Naa Ho" treated homosexuality with droll, and the ongoing "Dostana" concerns two fakers in a similar vein, yet little walks have been made to convey genuineness and receptiveness to the film. In 2005 "My Brother… Nikhil" inconspicuously conveyed attention to the AIDS emergency, yet it never could have existed without the colossally questionable 1996 arrival of Deepa Mehta's "Fire," the main Bollywood film to portray homosexuality. At the point when the last film opened, there were furious challenges and broad vandalism — motion picture theaters demonstrating the film were fiercely raged, with windows crushed and notices consumed. While it's difficult to accept such prejudice over so little could exist in the cutting edge time. This too needs to possibly be thought about that "Kabhi Alvida Na Kehna" (which made waves for its dealings in infidelity an>GET ANSWER