Assignment Task
The goal of this case study is for you to apply knowledge of pathophysiology processes of disease and the use of evidence-based literature to the provision of patient-centred care for a patient with a selected health condition. You will also critically appraise the professional standards that influence health care delivery. You will demonstrate academic writing principles and apply appropriate APA7 referencing style.
It is expected you will:
- Briefly explain the relevance of the selected issue to the case study patient. Consider: what assessment data from the case study supports you choosing this as an issue or potential issue? How are they connected? Hint: you should be using evidence-based literature to help you explain the connections between pathophysiology and patient assessment data. Why are we seeing what we are seeing?
- Discuss the nursing interventions/actions required for the patient in the case study to address your identified Supply rationales (reasons why) each intervention is appropriate for this case study patient. Support your discussion with current, evidence-based literature. Your discussion needs to include some discussion on how you would evaluate how successful your nursing interventions were. Consider: What improvements in what specific assessment data would we like to see?
- Additionally, consider an individualised discharge plan for the patient in the case study, which includes ongoing goals and/or requirements. Consider: what needs to be in place before this patient can safely return home and we can improve the chances of her not re-presenting with the same or a connected problem? This should be brief. It could form the conclusion of your paper.
- Integrate and apply the relevant NSQHS and NMBA standards to decision making and nursing Consider: how does this action/intervention demonstrate the nurse’s fulfillment of this standard? How are they connected? There is no set number of these, but it is expected that you would include at least one different standard for each patient issue discussed plus the discharge planning. It is strongly recommended you integrate these into your discussion on the nursing care provided and NOT in a separate section at the end of the paper. There is an exemplar (example) of what this might look like in the Canvas Assignments page.
Case Study
Mrs Gladys Smith, 86-year-old female
Brought in by ambulance from a nursing home to the emergency department with abdominal pain of 8/10 and distension, vomiting and constipation of 8 days duration. Nursing Home staff arranged the transfer after her symptoms had failed to settle.
She is a widow and has no children.
An abdominal x-ray has confirmed a left lower large bowel obstruction secondary to faecal impaction from constipation.
Mrs Smith is scheduled for a bowel resection and stoma formation on tomorrow’s surgical list ( 18 hours from now ).
Mrs Smith is not oriented to place or time. She is withdrawn and quiet but appears frightened with sudden noises or when addressed directly. She has been diagnosed with hypo-active delirium post hospital presentation.
Preoperative bloods and a urinalysis have been completed with no abnormalities detected
History: Had a fall at the nursing home six months ago which resulted in a hip fracture. That has all been repaired and is well healed. However, Mrs Smith has an ongoing fear of falling and is very reluctant to mobilise. Prefers to stay sitting in her chair or in her bed. Osteoporosis, Chronic Back Pain; Obesity, usually incontinent of urine.
Medications: Calcium supplement 1200 mg with vitamin D daily, alendronate sodium 10
mg daily, Morphine Sulfate pentahydrate (MS Contin) SR (slow release) 30 mg twice daily.
BP 130/74 HR 95 RR 24 Temp 37.2 Oxygen Saturations 95% on Room Air Abdominal Assessment: abdomen is distended with reduced bowel sounds on auscultation.
Global tenderness in all four abdominal quadrants, but markedly worse in left lower quadrant, Mass palpable on palpation.
Abdo Xray confirms Bowel obstruction secondary to faecal impaction/constipation. Nil faeces in rectum on digital examination
GCS 14, patient not orientated to time and place.
Mrs Smith has been given 3 doses of 25 mcg of IV Fentanyl over the 3 hours and her pain is now 2/10.
Full assistance is required for hygiene cares.
IV therapy running Hartmanns solution at 60 ml/hr
Naso-gastric tube inserted, attached to free drainage bag draining moderate amounts. Nausea and vomiting now settled. (This underlined information is ONLY here for context for you. Please do NOT address the care or management of IV therapy or
nasogastric tubes in your paper.)
Nil by Mouth
Preparation for OT for bowel resection in the am.