HLTENN005 Case Study

HLTENN005 Case Study

Started: Jul 9 at 18:05

Quiz Instructions

Below you will find 25 short answer questions you will be required to complete for the unit HLTENN005 - Contribute to nursing care of a person with complex needs. You will need to research and investigate topics that relate to Chronic conditions, treatments and complex nursing interventions.

Flag question: Spacer

Mr Burrows is a 52-year-old Indigenous Studies teacher from the local high school. He has been admitted for a pre-booked laparoscopic prostatectomy with Dr Thompson at the NTA Hospital Sydney. He has stage 3 Prostate Cancer Dr Thompson will decide after the surgery if Ian will require radiation Therapy. Below is his history:

Personal Details

Name: Ian Burrows Marital Status: Married 15 years

Age: 50 Ethnicity: Aboriginal Australian

Next of Kin: Liz Burrows (wife) Occupation: High School Teacher

Medical History

Osteoarthritis, Irritable Bowel Syndrome, wears glasses (short sighted), history of DVT, Hypertension and Chronic Asthmatic.

Current Medications

Serevent one puff twice daily

Salbutamol 1-2 puffs every 3 hours as needed

Metoprolol- 50mgs daily amOmeprazole 20mg daily am

Panadol osteo two tablets TDS

Diagnostic Tests

Bloods FBC, ELFT, cross match 1 x PRBC

Pre op ECG

Vital Signs

BP 155/85, Pulse 88 bpm, temperature 36.6C, respirations 18, O2 sa 97% on room air, weight 135kgs

You have been asked to prepare Mr Burrows for theatre. Discuss the following procedures in relation to the patients history

Flag question: Question 1

Question 11 pts

What body systems will be affected by his surgery and what are the complications from them? (List at least 5)

Urinary Incontinence

Mr Burrow is likely to experience urge continence after laparoscopic prostatectomy. This could lead to a strong urge to urinate and possibly loss of bladder control.

Erectile dysfunction

There is a likelihood for Mr. Burrows to lose the ability of maintaining an erection after the laparoscopic prostatectomy has been done.

Urethra Stricture

This may happen in the event the urethra gets injured during the process. This would consequently lead to a narrowing of the urethra which would result in straining, pain and a divided stream when passing urine.

Intestines

Part of the intestines might be injured during the surgery which could lead to infections in the abdomen.

Retrograde ejaculation

This happens when semen flows into the bladder instead of flowing out of the penis. This means the patient may not be in a position to father children through sex.

Flag question: Question 2

Question 21 pts

Mr Burrows will have a closed system, low suction drains (bellovac) inserted post operatively. List 3 different types of drains and the nursing cares for them?

1.Jackson-Pratt - (such as a chest tube)

The nurses role is to help the patient empty the drain at least twice a day and helping in stripping the tube.

2. Penrose Drain

In this case, the nurse is mandated to ensure high level hygiene of the skin where the penrose drain is placed. The nurse should also help the patient dress at least two times every day.

3. Percutaneous drains

In this case, the nurses role is to manage the percutaneoustubes and the skin issues commonly related with such tubes.

Question 31 pts

With Mr Burrows pre-operative bloods, he requires the Urea and Electrolytes to be checked. Why is this so?

This is important in evaluating the functional status of the kidney before the surgery commences. Essentially, electrolytes and Urea tests provide critical information on the renal functioning, chiefly in homeostasis and excretion. Apparently, creatinine levels are a major factor that help in making a determination of the estimated rates in glomerular filtration, which is the basic marker for kidney health.

Question 41 pts

Mr Burrows is to have anti-embolic stockings fitted to assist in the prevention of deep vein thrombosis. Explain how to put anti-embolic stockings on him and his current risk factors?

Position client in supine position for about a half an hour before applying stockings.

Explain to the client the purpose of the antiembolic stockings and work to protect his privacy

Measure for proper fit before first application. Measure length (heel to groin) and width (calf and thigh) and compare to manufacturer's printed material to ensure proper fit

Apply a light dusting of powderto ensure the legs are dry.

Turn the stocking inside out, tucking the foot inside

Ease foot section over the client's toe and heel, adjusting as needed for appropriate smooth fit

Pull the stocking over the leg in a gentle manner, removing all wrinkles

Evaluate toes for warmth and circulation. Check area at top of stocking for binding

Antiembolic stockings should be removed at least twice daily.

Possible Risk Factors

Cardiac failure

Fragile skin

Risk for Dermatitis

Allergic Reactions

Flag question: Question 5

Question 51 pts

What are four (4) signs of an abnormal rhythm?

A fluttering in the chest

Racing heartbeat

Slow heartbeat

Fatigue

Flag question: Spacer

It is now day 2 post op. for Mr burrows he has the following insitu:

IVT Hartmanns Running at 125ml/hr

4 Lap sites with small dressing, small ooze on 1 site

IDC draining into a 3L free flow bag, 250ml rose coloured urine

Bello vac drain insitu, suture intact, currently drained 50mls blood

PCA with morphine and metoclopramide running at 2ml/hr with a bolus dose of 2ml

He has developed a persistent cough with a thick yellow sputum, the Physiotherapist has been to see him and commenced him on incentive spirometry and asked Dr Thompson to review him for possible lower respiratory tract infection? His vital signs are as follows:

BP 110/60, Temp 38.2C, Pulse 110, Resps 18 & Laboured, O2 93% RA

Mr Burrows appears diaphoretic and in pain when he coughs.

Flag question: Question 6

Question 61 pts

How could he have contracted a chest infection post operatively?

Chest infections are either caused by a virus or bacteria. General anaesthestics after a surgery affect the normal manner in which phlegm

is moved out of the lungs. Considering that Mr Burrows feels pain when coughing, it means that there is a possibility of phlegm building up in the lungs, and thus facilitate the development of an infection within the phlegm.

Question 71 pts

The physiotherapist has commenced Incentive Spirometry, what is this and how would you explain it to your patient?

Incentive Spirometry is a medical procedure that entails the use of a handheld medical device to measure the volume of the patients breath. I will explain to the patient that the procedure is necessary as it helps his lungs to recover after surgery and keeps the lungs fluid. The patient is expected to breathe from the incentive spirometer tool after which a piston inside the device rises to measure the breath.

Question 81 pts

Explain how you would collect a sputum specimen off Mr. Burrows?

I will ask Mr. Burrow to take a deep breath, hold the air for about 5 seconds, and breathe out slowly. He will then take another deep breath, and cough hard until some sputum comes up into his mouth. I will then ask him to spit the sputum into the plastic cup.

Flag question: Question 9

Question 91 pts

The sputum specimen has come back positive with MRSA. What type of precautions should you now take with all his cares?

In the event of positive MRSA tests, contacts should be discontinued with Mr Burrows. Contact precautions or guarantine should be subjected to the patient to prevent transmission of MRSA to the healthcare provider and the healthcare settings in general.

Flag question: Question 10

Question 101 pts

The Dr has now requested the removal of the Bello vac drain & IDC. What infection control precautions are required for these procedures?

Ensure the bag is sealed with a cap and placed in a suitable container

Dispose the bag according to the doctors instructions

The Bellovac should be emptied before its fully expanded

Always check that the upper clamp (inlet) is open except when reactivating or opening the bellows.

Flag question: Question 11

Question 111 pts

With the IDC removal Mr Burrows must undergo a Trial of void. Explain what this is using the following site as a reference - Clinical Guideline (Community) Working with People with Chronic & Complex Health Care Needs: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/191067/ACI_TOV_Comunity_Jan13.pdf (Links to an external site.)

Also referred as Trial Without Catheter, A Trial of Void entails he removal of the urethral catheter and an evaluation of the patients capability to urinate spontaneously. In the event this is successful, it may lead to the patient delaying or avoiding surgical intervention and probably give way for his condition to be managed medically.

Flag question: Question 12

Question 121 pts

Mr Burrows may require a bladder washout at some stage in the near future if he is to go home with a urinary catheter. Why would he need this and what would the nursing interventions be?

Mr Burrows will need a bladder washout if the urinary catheter reaches a point where it does not drain correctly or when there is a lot of sediment in the urine. In this case, the nurse should guide the patient on how the procedure is done including the equipments needed and how they are handled.

Flag question: Question 13

Question 131 pts

If Mr Burrows is to go home with a suprapubic catheter, what nursing interventions do you need to perform and list two (2) resources that Mr Burrows may access to assist him with the supply of urinary equipment?

Show the patient how to apply bandages around the site

Advice the patient on maintaining hygiene, washing cathererCheck for kinks, and move around the tubing when not draining

Ensure the catherer is well placed.

Resources

Abbey Group

Medshop Australia

Flag question: Question 14

Question 141 pts

Mr Burrows is very concerned about going home with an IDC in and what his family are going to think as well as the implications to his marriage. He says that he is feeling very anxious about the IDC coming out and if anything will ever work again. Explain two (2) nursing interventions you can do to assist with the emotional, psychosocial wellbeing and support for Mr Burrows, keeping in mind his cultural heritage.

I will show that I really care for his concerns and do what I can to advice him why this is necessary for his health and the welfare of his family

I will strongly connext with the patient and that of his family, ensuring that the signficiant others are aware of his condition and why they need to stand with him for his welfare.

Flag question: Question 15

Question 151 pts

Explain below how Mr Burrows other conditions may affect his health?

Osteoarthritis

This often leads to chronic pain, including stiffness and joint pain which may escalate to become severe and make doing daily tasks difficult.

Irritable Bowel Syndrome

This condition normally affects the digestive system and leads to such health issues as stomach cramps, constipation, diarrhoea, and bloating. This may be a lifelong problem

Wears glasses

Wearing glasses for a long time could lead to damaging of eyes.

Hypertension

Hypertension increases the risk of a heart attack, cardiac arrest and heart failure.

Flag question: Question 16

Question 161 pts

List and define a common disorder of the ears?

Swimmers ear

Also called otitis externa, swimmers ear is an infection that develops between the eardrum and the outer- ear.

Blocked Ears

This is when the body produces excessive earwax which becomes stuck in front of the eardrum and makes it tough to remove.

Meniere's Disease

This is a condition that results from too much build-up of fluid in the inner ear. This leads to problems related to hearing and balance alongside the sensation or pressure inside the ear.

OtosclerosisThis is a condition related to abnormal bone growth to the inner ear.

Infections to the Middle Ear

While Swimmers ear mainly affect the outer ear, there are also inner ear infections that take place between the eardrum and cochlear.

Flag question: Question 17

Question 171 pts

List and define a common nervous system disorder?

Vascular disorders- These are conditions or ailments that affect the circulatory system. They include conditions such as subdural haemorrhage, transient ischemic attack (TIA), extradural haemorrhage, stroke, and subarachnoid haemorrhage.

Flag question: Question 18

Question 181 pts

Explain the process for emptying and changing an ostomy bag?

Begin by putting a waterproof pad under their side closest to theostomyto tap any spills. A towel or plasticbagworks just as well. The next process is putting the container under the bags opening and opening the end of the bag carefully.The contents of the bag should be allowed to follow into the container. It may be necessary to push the bag on so that the contents can be emptied totally.

Flag question: Question 19

Question 191 pts

Explain the insertion and removal process of a nasogastric tube?

Nasogastric Tube is usually inserted for the purpose of decompressing the stomach and preventing vomiting after a major surgery. The surgeon puts a tube with a camera on the end through the patients nose, and down the throat into the stomach. To remove this tube, the nurse should unpin tube from the patients grown and remove the adhesive tape from the patients nose in a careful manner. The healthcare officers should attach a flush and syringe with 10 mL regular saline solution. Instruct the patient to deep a deep breath and hold it, carefully and quickly remove the tube when the patient is still holding breath.

Flag question: Question 20

Question 201 pts

What is the difference between using a nasogastric tube to feed a patient and a percutaneous feeding tube?

A nasogastric tube refers to a thin tube that goes in through the patients nose, down their throat and into the stomach. This is ideal for a patient who needs feeding for between 2 to 3 weeks. On the other hand, a percutaneous feeding tube is needed for a patient who has a long term problem with eating and swallowing food. The PEG tube goes into the patients stomach through an opening made on the abdomen or outside the patients tummy.

Flag question: Question 21

Question 211 pts

List the steps involved in venepuncture to collect bloods from a patient

Label the tube with the patient's details

Put tourniquet on the patient about. 3-4' above the venipuncture site.

Ask patient to form a fist so that veins are more prominent.

After finding the vein, venipuncture site with alcohol using circular motion

Assemble needle and vacuum tube holder

Insert the collection tube into the holder until the tube reaches the needle

Remove cap from needle.

Use thumb to draw skin tight about 1-2 below the venipuncture site

Hold the skin tight Insert the needle, bevel side up, into the venin

Push the tube completely onto the needle. Blood should begin to flow into the tube until vacuum tourniquet is exhausted

Release the tourniquet

After opening the patients hand, place dry gauge over the venipuncture site and slowly remove the needle

Apply mild pressure to the pad

Apply bandage or continue applying mild pressure until bleeding has stopped

Properly dispose of all contaminates supplies in sharp / biohazard container

Place request form and specimen in biohazard bagFlag question: Question 22

Question 221 pts

Outline the differences between critical thinking, creative thinking and problem-solving

Creative thinking generally refers to being original, going beyond the limitations and being fresh in your ideas. On the other hand, critical thinking entails making analysis and evaluation of a particular thinking. While creative thinking is basically generative in purpose, critical thinking is evaluating and analytical in purpose. Lastly, problem solving refers to the means by which solutions are made up to remove hurdles that inhibit achievement of ultimate goals.

Flag question: Question 23

Question 231 pts

If a Doctor orders a medication for a patient eg; cephalexin (antibiotic) and the patient has an allergy to penicillin, what would your action be?

My reaction would be to discontinue the medication with immediate effect, noting down the reactions and report them to the physician.

Flag question: Question 24

Question 241 pts

What Assessment is required when someone deteriorates and has an episode of loss of consciousness and why?

In this case, the core assessment includes closely monitoring changes in the physiological observations, identifying signs of psychological and physical decline. In this regard, the healthcare provider can use The National Early Warning System (RCP, 2012) which a formal tool for analysing the level of a patients deterioration. The system is based on the objective physiological parameters that are being scored in accord to the level of deviation from the normal. The weighting of the scores depends on the severity of deviation.