Mr Jones is a 76-year-old Man
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.
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.
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)
2.List 7 important pieces of information you would require when receiving the handover from the theatre nurse.
3.Outline two nursing interventions you would undertake for each of the following four items below that will assist in the prevention of post-operative complications for Mr Jones in the first 24-48 hours post theatre recovery.
a)Pressure area care
c)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.
4.Identify and explain four non-verbal signs that Mr Jones may exhibit when experiencing unrelieved pain.
Mr Jones’ condition and Level of consciousness (LOC) starts to deteriorate.
When you arrive to do another set of observations you are concerned that he appears drowsy and has trouble responding to verbal stimuli.
5.Identify a minimum of two 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%.
6.Identify a minimum of two 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
7.Please describe your role in an emergency as the EN assigned to this patient.
8.Also, state who are the other routine members of the emergency response team.
9.Please state one of the first line drugs you may be asked to prepare for this emergency situation.
10.Please provide an example of what you would state in the progress notes following this incident
11.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 aspects of nursing care that are required when caring for a patient with a PICC line.
12.What education would you provide to the patient and his wife regarding the need for this treatment?