NSB024 NURSING PRACTICE IN CONTEXT 4 ASSESSMENT 1 – Written Assignment Length: 2,200 words (? 10%) Weighting: 50% Learning Outcomes Assessed: 1, 2, 3 & 5 Case Scenario Mr George Jensen, a 65-year old male, was brought into Emergency Department with an open fracture of his right tibia and fibula after falling from his roof while clearing the gutters. The following data were obtained on his admission: Objective Data Past Medical Admission History Social History ? ? ? ? ? ? ? ? Weight 122 kgs Height 190 cms BMI 33 Diminished peripheral pulses eGFR 78mls/min/1.73m Hb 11.3gms/dl BP 155/100 HR 110 ? Diagnosed with type 2 diabetes mellitus 2 years ago – on oral hypoglycaemics ? Hypertension Current Medications: ? Glibenclamide, 5mgs, Mane ? Captopril, 50mgs, BD ? Simvastatin 40mgs, Nocte, ? Rantidine 150mgs, BD ? Aspirin 75mgs, Mane ? Has 3 children and an ex-wife who live out of state; ? Has been working as a real estate agent 20hrs/wk. ? Consumes 15units of alcohol/day ? Smokes 20 roll-up cigarettes per day for last 10 years. He was taken to theatre as an emergency case where he had an open reduction and external fixation of his fractures. He has returned to your ward at 5.30am post-operatively. You have arrived on the morning shift to find: ASSESSMENT DATA ? His right leg is cool to touch; ? Pain Score is 7 on a scale of 1-10; ? Fracture site and pin sites have serous ooze with notable swelling of his right leg; ? Blood glucose level of 17mmols/ltr; ? His post-operative vital signs are currently, HR 107BPM, BP 104/55mmHg, temp 37.9°C Axilla, SaO2 95%, FiO2 6 ltires via Hudson mask, Resp rate 24BPM; ? Hartmans solution running at 125mls/hr via triple lumen central line situated in the right internal jugular. ? Insulin and dextrose infusion running at 2mls/hr (2 units/hr); ? Urine output via a Foley IDC is 1ml/kg/hr and dilute. Applying your knowledge and understanding of Type 2 Diabetes, fractures and hypertension, you are asked to write an academic essay applying the following principles throughout your discussion: 1. Explain, the pathophysiology of Mr Jensen’s post-operative hypovolemia and how some of his post-operative assessment data might have contributed to this. In addition explain how the body might compensate for this physiologically (approximately 800 words). 2. Identify Mr Jensen’s actual PRIORITY problems. Justify each problem based on the data collected from Mr Jensen’s assessment data (approximately 400 words). 3. For each problem identified, describe one (1) nursing goal for his care (approximately 200 words). 4. Choose two (2) of the identified goals, and justify, with a synthesis and an analysis of the evidence-based literature, nursing interventions with rationales to assist in achieving the identified goals. (approximately 800 words). ASSIGNMENT TIPS The most important thing you must consider for this assignment is that it is sequential. This means you cannot answer the questions out of sequence, the assignment won’t make sense to the marker if you attempt to do this. For example to answer Q3 you should have answered Q2 first and so on. Q1: Is asking you to consider how the stress of the operation might affect his blood pressure. Q2: Is asking you to consider the most important problems – remember ABCDE. Q3: Is asking you to identify patient centred nursing goals for the problems you have identified from Q2 – I would strongly urge you to review the PowerPoint on Goal Setting as to how to write a concise patient centred nursing goal. Q4: Is asking you to only pick 2 of those nursing goals (any 2 the choice is yours) and using the literature provide an evidencedbased rationale as to why these interventions are appropriate in this case. • Minimum 20 references; • Can use books as references but maximum of 5 and must be no later than 5 years old; • Can use reputable medical/nursing based websites – 5 maximum; • Can reference journal articles up to 10 years old; • The assignment is a case study so can use question and answer format – no need for introduction and conclusion; • APA referencing as per QUT referencing policy.