nursing surgical case study, 2000 words.
holisitic healthcare written essay
The following excerpts have been taking from a patient – Maisie Wilson’s, electronic medical record. Maisie Wilson DOB: 14/10/1948 Sex: F UR: 8075462 Ambulance Notes: 1620 hrs Arrived to find pt lying at bottom of the stairs on her left side. Facial laceration to left eyebrow approx. 3 cm. Pt reporting pain in L) hip and unable to get up. States she “tripped on the rug” just after 8am and has been on the floor since, denies falling down the stairs or LOC. Her husband found her about 1600 when he returned home. GCS 14 – (E4, V4, M6), orientated to place and person but confused to time. PEARL 2+, BP 150/83mmHg, PR 98 bpm, RR 16, SpO2 95% RA, Temp 36.3, Pain 7/10. Pt has been incontinent of urine and faeces. 1623 hrs IVC inserted and IV morphine 5mg given. C-spine collar placed. 1624 hrs Left leg externally rotated and shorter than right 1628 hrs PR 91 bpm regular, BP 145/75mmHg, RR 14, SpO2 95% RA IV morphine 5mg 1635 hrs Transferred to stretcher with spinal precautions, legs splinted for transport ED Notes: 1650 hrs, Nursing Notes: New patient Maisie Wilson, 74, admitted to ED via ambulance after a fall at home. Pt reports being “stuck on the floor” for about 8 hours until her husband found her and called the ambulance. Pt was found at bottom of staircase from upstairs bedroom but denies falling down the stairs, stated “I tripped on the rug and hit my head on the banister as I fell”. Pt unsure if LOC occurred but doesn’t think so. Incontinent of urine and faeces while on floor. Pt states hasn’t eaten or drunk anything today. History of HTN, osteoporosis, osteoarthritis, and a hysterectomy in 2009. Normally takes atenolol, Panadol osteo and alendronate but pt doesn’t think she had any tablets today. CNS: Pt alert but confused to place and time, orientated to person. GCS 14 – (E4, V4, M6) and PEARL 2+. Reports 6/10 pain to L) hip and 4/10 pain to head. Pt given IV morphine 5mg. Spinal precautions and collar insitu due to fall and head strike. Pt encouraged to lie still but attempting to get up or move around in the bed. Spinal precautions explained but little change to behaviour, pt unable to explain why she wants to get up. Pt can move all 4 limbs with normal strength except left leg which is weaker and painful on movement. No abnormal sensation reported. CVS: PR 100, BP 148/96, pulses palpable in all 4 limbs. Cool to touch centrally and peripherally, temp 36.4. Capillary refill <3 seconds to all limbs and colour normal. r)cubital fossa ivc inserted by ambulance, no signs of infection and dressing intact. resp: rr 19 and spo2 96% on ra. chest sounds clear. git: pt c/o thirst. given mouth care but nbm at this time. abdo soft and non tender, bowel sounds present. incontinent of faeces while on floor, pt denies normally having any problems with incontinence. renal: denies needing to void now, incontinent of urine earlier. endo: bgl 3.5mmol/l, no history of diabetes according to patient. skin: laceration to left forehead just above pt’s eyebrow, approx. 3cm long, awaiting dr review. dry blood to face and cut, oozing still when cleaned. bruising to l) side of face and l) hip noted. l) leg externally rotated and shorter than r) leg. grazes to arms noted but superficial and no dressings required. no other skin breakdown noted although awaiting log roll to check pt’s back. social: pt’s husband john, in attendance, bought in by ambulance. john stated he was out playing golf with friends today and found maisie on his return home. john is very teary and apologetic to patient, stating “i’m so sorry” and “this is my fault”. attempted to reassure john he did nothing wrong. john and maisie have a son, michael who lives in geelong. john has contacted michael who is coming in. they also have a daughter kathy who lives in canberra, she is waiting to hear from the doctors before she flies down as she is caring for her grandchildren this week. plan: log roll and complete wash and skin assessment of patient once morphine has reduced pain. for dr review and further tests. n.stewart (rn) 1700 hrs nursing notes: pt c/o nausea. iv ondansetron given as per dr. bed tilted head up while maintaining spinal precautions. further mouth care given as tongue and lips very dry and cracked. n.stewart (rn) 1720 hrs ed dr nguyen admitted post fall at home, on floor 8 hours. alert and restless. confused to time and place, orientated to person. head strike during fall. laceration to face – will need gluing together. chest clear, abdo soft fasting all day pain to l) hip, leg externally rotated and shortened plan: l) hip and pelvis xray head and spine ct iv fluid as charted glue to face laceration. nbm till results dr k. nguyen 1830 hrs addit: ct clear and no spinal tenderness on palpation, remove collar and cease spinal precautions. xray shows fracture to left nof. refer to ortho. pt will need open reduction and internal fixation. admit to ward, rib till post-surgery. still c/o significant hip pain despite regular morphine – refer to anaesthetics for fascia iliac nerve block. dr k. nguyen 1930 hrs anaesthetics dr kyle l) leg fascia iliac nerve block given. pt reports no allergies or previous surgery to area. ultrasound guided insertion of ropivacaine 0.375% 35ml completed using sterile technique. pt now reports pain 3/10. will need 15-minute monitoring for 2 hours then 4 hourly. report increased pain to on call anaesthetist overnight. dr kyle 4:49 pm thu 23 mar = ¢*acu australian catholic university t= nrsg258 2023 semester 1 national = participants signup groups u badges bb grades [3 information and resources 3 communication and support [do week 1 - introduction week 2 - case study 1 week 3 - case study 1 week 5 - case study 2 oo oo [3 week 4 - case study 1 oo oo brisbane campus a home ast calendar = my units t= academic integrity 2022 t= academic skills unit lx) leo.acu.edu.au @ 2. assessment 1 case study information students will appraise an individual's holistic health care needs and subsequent interventions and management to assist with the application of theory into practice. an excerpt of clinical notes and charts are provided in a folder on the leo assessment tile to provide the clinical information for the patient — maisie wilson. using this information answer all the following: o identify and discuss all 6 of maisie’s presurgical risks. what investigations does she need prior to surgery? explain how they are linked to her surgical risks. (400 words) discuss what is required for legal consent. with reference to the relevant legislation, explain why or why not maisie can provide consent? (200 words) identify two (2) medications used in this case study and provide: the mechanism of action side effects correct dosage o contraindications for both medications - discuss why they were prescribed for maisie. (600 words) o describe the biopsychosocial factors that will impact maisie and her family as a result of this accident. (may include spiritual or cultural elements). (500 words) 0 0 o [ ol ft 30%@ © a morgan creen @) n/ 4:50 pm thu 23 mar xy) ft 30%@ leo.acu.edu.au & assignment 1: written assessment based on a surgical case study due date: wednesday 29/03/2023 at 1400hrs weighting: 50% length and/or format: 2000 words ~~ +/- 10% purpose: this is a written essay based on a surgical case study. students will appraise an individual's holistic health care needs and subsequent interventions and management to assist with the application of theory into practice. an excerpt of clinical notes and charts are provided in the nrsg258 leo site to provide the clinical information for the patient — maisie wilson. using the information on leo answer all the following: e identify and discuss all 6 of maisie’s presurgical risks. what investigations does she need prior to surgery? explain how they are linked to her surgical risks. (400 words) e discuss what is required for legal consent. with reference to the relevant legislation, explain why or why not maisie can provide consent? (200 words) e identify two (2) medications used in this case study and provide: o the mechanism of action o side effects o correct dosage o contraindications for both medications - discuss why they were prescribed for maisie. (600 words) e describe the biopsychosocial factors that will impact maisie and her family as a result of this accident. (may include spiritual or cultural elements). (500 words) learning outcomes assessed: lo1, lo3, lo4, lo5, lo6 how to submit: students will submit their written assessment task via the turnitin link in the nrsg258 leo site national assessment tile. return of assignment: feedback and marks will be returned via turnitin 3 weeks after submission. if this is not possible, students will be notified via email or leo assessment criteria: this assessment task will be graded against a standardised criterion referenced rubric. please follow the criteria closely during the planning and development of your assessment task. (appendix 1). page 9 of 16.... extended unit ouiling.sehrsg2n sa einal moqrerater 2022330 8 australian catholic university 2023 seconds="" to="" all="" limbs="" and="" colour="" normal.="" r)cubital="" fossa="" ivc="" inserted="" by="" ambulance,="" no="" signs="" of="" infection="" and="" dressing="" intact.="" resp:="" rr="" 19="" and="" spo2="" 96%="" on="" ra.="" chest="" sounds="" clear.="" git:="" pt="" c/o="" thirst.="" given="" mouth="" care="" but="" nbm="" at="" this="" time.="" abdo="" soft="" and="" non="" tender,="" bowel="" sounds="" present.="" incontinent="" of="" faeces="" while="" on="" floor,="" pt="" denies="" normally="" having="" any="" problems="" with="" incontinence.="" renal:="" denies="" needing="" to="" void="" now,="" incontinent="" of="" urine="" earlier.="" endo:="" bgl="" 3.5mmol/l,="" no="" history="" of="" diabetes="" according="" to="" patient.="" skin:="" laceration="" to="" left="" forehead="" just="" above="" pt’s="" eyebrow,="" approx.="" 3cm="" long,="" awaiting="" dr="" review.="" dry="" blood="" to="" face="" and="" cut,="" oozing="" still="" when="" cleaned.="" bruising="" to="" l)="" side="" of="" face="" and="" l)="" hip="" noted.="" l)="" leg="" externally="" rotated="" and="" shorter="" than="" r)="" leg.="" grazes="" to="" arms="" noted="" but="" superficial="" and="" no="" dressings="" required.="" no="" other="" skin="" breakdown="" noted="" although="" awaiting="" log="" roll="" to="" check="" pt’s="" back.="" social:="" pt’s="" husband="" john,="" in="" attendance,="" bought="" in="" by="" ambulance.="" john="" stated="" he="" was="" out="" playing="" golf="" with="" friends="" today="" and="" found="" maisie="" on="" his="" return="" home.="" john="" is="" very="" teary="" and="" apologetic="" to="" patient,="" stating="" “i’m="" so="" sorry”="" and="" “this="" is="" my="" fault”.="" attempted="" to="" reassure="" john="" he="" did="" nothing="" wrong.="" john="" and="" maisie="" have="" a="" son,="" michael="" who="" lives="" in="" geelong.="" john="" has="" contacted="" michael="" who="" is="" coming="" in.="" they="" also="" have="" a="" daughter="" kathy="" who="" lives="" in="" canberra,="" she="" is="" waiting="" to="" hear="" from="" the="" doctors="" before="" she="" flies="" down="" as="" she="" is="" caring="" for="" her="" grandchildren="" this="" week.="" plan:="" log="" roll="" and="" complete="" wash="" and="" skin="" assessment="" of="" patient="" once="" morphine="" has="" reduced="" pain.="" for="" dr="" review="" and="" further="" tests.="" n.stewart="" (rn)="" 1700="" hrs="" nursing="" notes:="" pt="" c/o="" nausea.="" iv="" ondansetron="" given="" as="" per="" dr.="" bed="" tilted="" head="" up="" while="" maintaining="" spinal="" precautions.="" further="" mouth="" care="" given="" as="" tongue="" and="" lips="" very="" dry="" and="" cracked.="" n.stewart="" (rn)="" 1720="" hrs="" ed="" dr="" nguyen="" admitted="" post="" fall="" at="" home,="" on="" floor="" 8="" hours.="" alert="" and="" restless.="" confused="" to="" time="" and="" place,="" orientated="" to="" person.="" head="" strike="" during="" fall.="" laceration="" to="" face="" –="" will="" need="" gluing="" together.="" chest="" clear,="" abdo="" soft="" fasting="" all="" day="" pain="" to="" l)="" hip,="" leg="" externally="" rotated="" and="" shortened="" plan:="" l)="" hip="" and="" pelvis="" xray="" head="" and="" spine="" ct="" iv="" fluid="" as="" charted="" glue="" to="" face="" laceration.="" nbm="" till="" results="" dr="" k.="" nguyen="" 1830="" hrs="" addit:="" ct="" clear="" and="" no="" spinal="" tenderness="" on="" palpation,="" remove="" collar="" and="" cease="" spinal="" precautions.="" xray="" shows="" fracture="" to="" left="" nof.="" refer="" to="" ortho.="" pt="" will="" need="" open="" reduction="" and="" internal="" fixation.="" admit="" to="" ward,="" rib="" till="" post-surgery.="" still="" c/o="" significant="" hip="" pain="" despite="" regular="" morphine="" –="" refer="" to="" anaesthetics="" for="" fascia="" iliac="" nerve="" block.="" dr="" k.="" nguyen="" 1930="" hrs="" anaesthetics="" dr="" kyle="" l)="" leg="" fascia="" iliac="" nerve="" block="" given.="" pt="" reports="" no="" allergies="" or="" previous="" surgery="" to="" area.="" ultrasound="" guided="" insertion="" of="" ropivacaine="" 0.375%="" 35ml="" completed="" using="" sterile="" technique.="" pt="" now="" reports="" pain="" 3/10.="" will="" need="" 15-minute="" monitoring="" for="" 2="" hours="" then="" 4="" hourly.="" report="" increased="" pain="" to="" on="" call="" anaesthetist="" overnight.="" dr="" kyle="" 4:49="" pm="" thu="" 23="" mar="¢*ACU" australian="" catholic="" university="" t="NRSG258" 2023="" semester="" 1="" national="Participants" signup="" groups="" u="" badges="" bb="" grades="" [3="" information="" and="" resources="" 3="" communication="" and="" support="" [do="" week="" 1="" -="" introduction="" week="" 2="" -="" case="" study="" 1="" week="" 3="" -="" case="" study="" 1="" week="" 5="" -="" case="" study="" 2="" oo="" oo="" [3="" week="" 4="" -="" case="" study="" 1="" oo="" oo="" brisbane="" campus="" a="" home="" ast="" calendar="My" units="" t="Academic" integrity="" 2022="" t="Academic" skills="" unit="" lx)="" leo.acu.edu.au="" @="" 2.="" assessment="" 1="" case="" study="" information="" students="" will="" appraise="" an="" individual's="" holistic="" health="" care="" needs="" and="" subsequent="" interventions="" and="" management="" to="" assist="" with="" the="" application="" of="" theory="" into="" practice.="" an="" excerpt="" of="" clinical="" notes="" and="" charts="" are="" provided="" in="" a="" folder="" on="" the="" leo="" assessment="" tile="" to="" provide="" the="" clinical="" information="" for="" the="" patient="" —="" maisie="" wilson.="" using="" this="" information="" answer="" all="" the="" following:="" o="" identify="" and="" discuss="" all="" 6="" of="" maisie’s="" presurgical="" risks.="" what="" investigations="" does="" she="" need="" prior="" to="" surgery?="" explain="" how="" they="" are="" linked="" to="" her="" surgical="" risks.="" (400="" words)="" discuss="" what="" is="" required="" for="" legal="" consent.="" with="" reference="" to="" the="" relevant="" legislation,="" explain="" why="" or="" why="" not="" maisie="" can="" provide="" consent?="" (200="" words)="" identify="" two="" (2)="" medications="" used="" in="" this="" case="" study="" and="" provide:="" the="" mechanism="" of="" action="" side="" effects="" correct="" dosage="" o="" contraindications="" for="" both="" medications="" -="" discuss="" why="" they="" were="" prescribed="" for="" maisie.="" (600="" words)="" o="" describe="" the="" biopsychosocial="" factors="" that="" will="" impact="" maisie="" and="" her="" family="" as="" a="" result="" of="" this="" accident.="" (may="" include="" spiritual="" or="" cultural="" elements).="" (500="" words)="" 0="" 0="" o="" [="" ol="" ft="" 30%@="" ©="" a="" morgan="" creen="" @)="" n/="" 4:50="" pm="" thu="" 23="" mar="" xy)="" ft="" 30%@="" leo.acu.edu.au="" &="" assignment="" 1:="" written="" assessment="" based="" on="" a="" surgical="" case="" study="" due="" date:="" wednesday="" 29/03/2023="" at="" 1400hrs="" weighting:="" 50%="" length="" and/or="" format:="" 2000="" words="" ~~="" +/-="" 10%="" purpose:="" this="" is="" a="" written="" essay="" based="" on="" a="" surgical="" case="" study.="" students="" will="" appraise="" an="" individual's="" holistic="" health="" care="" needs="" and="" subsequent="" interventions="" and="" management="" to="" assist="" with="" the="" application="" of="" theory="" into="" practice.="" an="" excerpt="" of="" clinical="" notes="" and="" charts="" are="" provided="" in="" the="" nrsg258="" leo="" site="" to="" provide="" the="" clinical="" information="" for="" the="" patient="" —="" maisie="" wilson.="" using="" the="" information="" on="" leo="" answer="" all="" the="" following:="" e="" identify="" and="" discuss="" all="" 6="" of="" maisie’s="" presurgical="" risks.="" what="" investigations="" does="" she="" need="" prior="" to="" surgery?="" explain="" how="" they="" are="" linked="" to="" her="" surgical="" risks.="" (400="" words)="" e="" discuss="" what="" is="" required="" for="" legal="" consent.="" with="" reference="" to="" the="" relevant="" legislation,="" explain="" why="" or="" why="" not="" maisie="" can="" provide="" consent?="" (200="" words)="" e="" identify="" two="" (2)="" medications="" used="" in="" this="" case="" study="" and="" provide:="" o="" the="" mechanism="" of="" action="" o="" side="" effects="" o="" correct="" dosage="" o="" contraindications="" for="" both="" medications="" -="" discuss="" why="" they="" were="" prescribed="" for="" maisie.="" (600="" words)="" e="" describe="" the="" biopsychosocial="" factors="" that="" will="" impact="" maisie="" and="" her="" family="" as="" a="" result="" of="" this="" accident.="" (may="" include="" spiritual="" or="" cultural="" elements).="" (500="" words)="" learning="" outcomes="" assessed:="" lo1,="" lo3,="" lo4,="" lo5,="" lo6="" how="" to="" submit:="" students="" will="" submit="" their="" written="" assessment="" task="" via="" the="" turnitin="" link="" in="" the="" nrsg258="" leo="" site="" national="" assessment="" tile.="" return="" of="" assignment:="" feedback="" and="" marks="" will="" be="" returned="" via="" turnitin="" 3="" weeks="" after="" submission.="" if="" this="" is="" not="" possible,="" students="" will="" be="" notified="" via="" email="" or="" leo="" assessment="" criteria:="" this="" assessment="" task="" will="" be="" graded="" against="" a="" standardised="" criterion="" referenced="" rubric.="" please="" follow="" the="" criteria="" closely="" during="" the="" planning="" and="" development="" of="" your="" assessment="" task.="" (appendix="" 1).="" page="" 9="" of="" 16....="" extended="" unit="" ouiling.sehrsg2n="" sa="" einal="" moqrerater="" 2022330="" 8="" australian="" catholic="" university="">