CAP203 Care of the person with an acute illness:Post-operative care Case study

Assessment Task

In this assessment, you will apply your knowledge and understanding of postoperative nursing care. After analysing a case study you will answer a series of questions. Please refer to the Task Instructions for details on how to complete this task.

Context

The Registered Nurse plays an important role in the postoperative care of a person.
This assessment provides you with the opportunity to apply theory to a clinical scenario. To complete this assessment you will need to apply clinical reasoning processes as you examine and analyse a case study. You will be required to analyse the data provided, research the surgical procedure and anaesthetic administered as well as post-operative nursing care principles. This information will then be used to discuss the holistic nursing care of the person during the post-operative period of an acute care admission.

Individual 1200 words (+/- 10%)

You will need to use the following processes from the clinical reasoning cycle to complete the assessment:

•  process information
•  identify problems/issues
•  take action
•  evaluate outcomes
•  reflect on process and new learning

Instructions

To complete this assessment, you will need to examine and analyse the case study presented below and provide responses to the questions asked.

Case study

Maria Romano is a 76 year old woman who sustained an Intertrochanteric fracture of the Right femur after she fell when watering her garden. She sustained a small laceration to her lower left leg when she fell. Maria's Blood Glucose level on admission was 9 mmol/L. Maria's medical history includes osteoporosis, glaucoma and she has recently been diagnosed with early dementia. She has no significant surgical history. Maria lives with her daughter Paulina and Paulina's husband Sam.

Maria's current medications include Aspirin 75mgs daily, Alendronate Sodium 10mg orally daily & Latanoprost eye drops to both eyes nocte. Preoperatively, Paulina shared her concerns regarding Maria's low weight and recent frequent falls. Maria has a walking frames but rarely uses it. Maria shared concerns about her garden and who will care for it while she is in hospital.

Maria has undergone an Open Reduction and Internal fixation (ORIF) of the fractured Right Neck of Femur under Spinal and General Anaesthesia. Maria was nauseated in the Post anaesthetic care unit (PACU) and vomited a small amount of green fluid. IV Metoclopramide was administered with good effect. Post-operative surgical antibiotic prophylaxis and pharmaceutical and mechanical thromboprophylaxis are ordered. An intravenous PCA of Morphine is ordered together with regular Paracetamol. The surgeon has ordered the drain tube to removed on Post-Operative day 2 (after review) Discharge is scheduled for post-operative day 5.

Observations on return to the ward

Airway: patent Respiratory rate: 16 breaths/min Oxygen saturation: 97% on room air Heart rate: 84 beats/min Blood pressure: 100/60 mmHg Capillary refill: 2 seconds Intravenous therapy Cephalic vein Left arm: Hartmanns solution 8 hourly Dressing to Right hip: Intact with small amount of bright red ooze on dressing Redivac drain tube in situ: patent – 200 mL of bright red drainage Bromage score: 2 Dermatome level: L2 Right foot pale, cool to touch, pedal pulse present, slight paraesthesia in toes Graduated compression stockings in situ Alert: orientated to time and place Pain score: 1/10 on rest, 3/10 on movement Temperature: 36 C Maria sustains a skin tear to her lower right arm as you release the bed rails after transferring her to her room.

Questions

1. Discuss the elements of open disclosure that are required in this situation. (100 words).

2. Identify four postoperative/anaesthetic problems or issues from the data presented. Briefly discuss the factors that pre-dispose Maria to these problems* (200 words).

3. Discuss the nursing interventions that you would employ to prevent/manage the identified problems. Ensure a rationale is provided for each intervention* (650 words)*

4. Discuss how you would evaluate the effectiveness of these nursing interventions (150 words)*

Evaluation

5. Reflect on what you have learnt from completing this case study and how this learning will inform your clinical practice (100 words)

Formatting

•  A cover page must be included which includes; subject name and code, assessment number, student name, student number and word count
•  Present your assessment in 12-point font, Arial or Times New Roman, 1.5 line spaced and a minimum of 2.5cm margins.
•  Page numbers should be included in the footer along with student ID number

Structure

•  For each question, you should provide a brief separate heading (please do not include the questions in the assessment).
•  Ensure that your answers are concise and relate to the case study provided. Each question has been given an estimated word count to give you direction in the amount of information you need to provide.
•  Answers to questions 2, 3 & 4 must be presented in a table (see suggested format below)
•  Bullet points can be utilised in your responses.
•  You are not required to provide an introduction or conclusion for this assessment.