Paula Smith is a 67 year old female who underwent a bowel resection. Perioperatively, she refused epidural anaesthesia placement, so morphine was in
Paula Smith is a 67 year old female who underwent a bowel resection. Perioperatively, she refused epidural anaesthesia placement, so morphine was initiated via patient controlled analgesia (PCA) as an alternative method for post-operative pain management.
On post operative day 3, the abdomen remained distended. Paula was belching intermittently and had been placed on a clear fluid diet. She only tolerated minimal fluids orally due to severe nausea. During the night, Paula vomited 800 ml of bilious liquid. She started to become restless and short of breath and subsequently turned pale and clammy.
A nurse at the scene recorded her vital signs: Temperature- 35.8 C, Blood pressure- 92/42mmHg, Heart rate- 128bpm, Respiratory- 28/minute and spO2- 94% on room air. Paula also complained of pain - 6/10 on a numeric pain scale. The nurse immediately called the medical emergency team (MET) as Paulas vital signs met the criteria for MET call.
The MET team inserted an intravenous cannula and administered 250ml of the volume-expander gelofusine intravenously. A nasogastric tube was also inserted for lavage to minimise discomfort from the severe nausea and frequent vomiting. Paula was diagnosed with paralytic ileus after diagnostic studies performed during the MET call.
Past medical history includes chronic heart failure and hypertension.
Current medications:
Metoclopramide 10mg IV TDS
Ondansetron 4-8mg IV PRN
Alvimopan 12mg IV BD
Perindopril 2.5mg mane
Paracetamol 1g QID PRN
Ibuprofen 200-400mg TDS PRN
Plan:
Insert an indwelling catheter
Record strict fluid balance
Monitor any signs of complications
Measure hourly urine output for the next 24 hours.
HYPERLINK "https://nta.instructure.com/courses/68/quizzes/347/take" Flag question: Question 19
Question 193pts
Explain why it was important for the nurse to call the medical emergency team (MET) urgently. What was the life threatening condition that Paula might have been at risk of at the time of the MET call?
ans:
question20 Discuss the pathophysiology of the life threatening condition in Paulas case. (3 points)
List three (3) signs or symptoms of the condition that were seen in Paula. (3 points)
the abdomen remained distended.
Paula was belching intermittently and had been placed on a clear fluid diet.
She only tolerated minimal fluids orally due to severe nausea.
Paula vomited 800 ml of bilious liquid. She started to become restless and short of breath and subsequently turned pale and clammy.
Paulas life threatening condition (identified in question 1 & 2) can lead to a cardiac arrest in acute care settings if not treated immediately. Describe what is involved during Advanced Life Support (ALS) in relation to:
question 21 a. Cardiopulmonary resuscitation ratio: 30 compressions : 2 breaths
22. b. Breaths can be delivered via
23. c. Airway may be maintained by
24. d Medications used when heart rhythm is shockable according to the Advance Life Support Algorithm:Adrenaline after second shock, then every second loop
25. e Medication used when heart rhythm is non shockable according to the Advance Life Support Algorithm
26 f. Eight (8) conditions that should be considered and corrected
during CPR according to the Advance Life Support Algorithm.
27g. Give (5) five post resuscitation care according to the Advance Life Support Algorithm.
Describe NURSING INTERVENTIONSand EXPECTED OUTCOMES in relation to Paulas condition on the following listed problems:
28a. Severe nausea and vomiting
Nursing Interventions Rationales
EXPECTED OUTOME:
29 b. Insertion of indwelling catheter & an hourly urine output measurement
EXPECTED OUTCIOME
30 c. Uncontrolled pain with patient controlled analgesia (PCA
EXPECTED OUTCOME:
31 List at least five (5) equipment required for a female urinary catheterisation.
Lucia Alberti is a 58 year old female who arrived at the orthopaedic ward as a day of surgery admission (DOSA) with her son and husband at 8 am. She is scheduled to have an elective total knee arthroplasty at midday today. She has been fasting from 6 am.
Her vital signs: Temperature- 36.8 C, Blood pressure- 155/84mmHg, Heart rate- 65bpm, Respiratory- 20/minute, spO2- 95% on room air, Nil complaints of pain and Blood glucose level 7.8mmol at the time of admission. An intravenous cannula has been inserted and 5% dextrose intravenous infusion has commenced while Lucia is fasting for operation.
The nurse also identified that Lucia is not very clear about the post operative expected outcomes.
Past medical history includes type 2 diabetes mellitus, coronary heart disease, angina, hypercholesterolemia and COPD
Current medications are listed as below. Aspirin has been withheld for the last 2 weeks. The anesthetist asked a nurse to administer Metoprolol 25mg with sips of water up to 2 hours before the surgery. Her respiratory medications and other topical medications to be given as charted until the procedure.
Name of the medication Dose Frequency Route
Insulin glargine 36 units mane Subcutaneous
Novorapid12 units Midday Subcutaneous
Gliclazide 60mg mane PO
Simvastatin 40mg nocte PO
Aspirin 100mg mane PO
Metoprolol 25mg BD PO
Polytear1 drop TDS Top: Left eye
Atropine 1 drop Daily sublingual
Seretide MDI 125/25 2 puffs BD Inhale
It is now midday, and a nurse in charge has just received a call from the operating room that an emergency trauma surgery must be performed before Lucias procedure. A nurse who is looking after Lucia has been asked to advise Lucia and her family of the unexpected delay. When the nurse explains the delay, her son becomes irritated and loudly asks the nurse What do you mean my mum has to wait for the operation for we dont know how many more hours? Where is the surgeon? Bring the surgeon right now! I need to tell the surgeon that my mum has diabetes and has to eat regularly!
HYPERLINK "https://nta.instructure.com/courses/68/quizzes/347/take" Flag question: Question 32
Question 327pts
Describe at least seven (7) immediate pre-operative preparationrequired for Lucia, and briefly state the rationale for each.(7 marks/ 300 words)
33. Write an admission note entry for Lucia. Ensure the note follows legal requirements. (3 marks) (100 to 200 words).
.
34.
The nurse who admitted Lucia identified that Lucia does not have good understanding in regards to postoperative expected outcomes. Discuss how the nurse should manage this situation.
(2 marks) (50 to 100 words)
35. Describe pathophysiology of angina. (2 marks) (40 to 100 words)
Angina
36. Discuss the rationale of continuing:
a. Metoprolol 25mg:
b. Atropine :.
c. Seretide preoperatively
(1 mark each 3 marks) (total 80 to 150 words)
37.
Discuss how the nurse should respond to Lucias son when he expressed his frustration and verbal aggression (2 marks) (60 words)
38. Describe the immediate post-operative care that should be performed for Lucia. (5 marks) (150 words)
.
39. State 3 (three) healthcare professionals and their roles by whom Lucia may be referred to during her recovery. (3 marks)
