Case study essay - final PDF

Preview

Summary

Case study essay on a post-operative patient. I received 76% for this assignment. Hope it helps....

Description

Assignment Cover Sheet  The information on this coversheet will be included in Turnitin’s plagiarism analysis, however your lectures are aware of this and will disregard it

Student Details 1

Student Number

0

3

8

9

Osborne

Family Name

5

4

5

Conor Gary

Given Name

Unit Details Unit Code

NCS2101

Adult Health

Karen McCarthy

Name of Lecturer Topic of Assignment Course

Unit Title

Case study

3/09/2018

Due Date Group or Tutorial (if applicable)

Bachelor of Science (Nursing)

Campus

JO

I certify that the attached assignment is my own work and that any material drawn from other sources has been acknowledged. This work has not previously been submitted for assessment in any other unit or course. Copyright in assignments remains my property. I grant permission to the University to make copies of assignments for assessment, review and/or record keeping purposes. I note that the University reserves the right to check my assignment for plagiarism. Should the reproduction of all or part of an assignment be required by the University for any purpose other than those mentioned above, appropriate authorisation will be sought from me on the relevant form.

Manual Submission If handing in an assignment in a paper or other physical form, sign here to indicate that you have read this form, filled it in completely and that you certify as above. Signature

Office Use Only

Date

Electronic Submission OR, if submitting this paper electronically as per instructions for the unit, place an ‘X’ in the box below to indicate that you have read this form and filled it in completely and that you certify as above. Please include this page with your submission. Any responses to this submission will be sent to your ECU email address. Agreement:



Select check box:

Date

3/09/18

For procedures and penalties on late assignments please refer to the University Adm iss ion, Enr olm ent and Academic Progress Rules - rule 24 and the ECU Course and Unit Delivery and Assessment Policy

This information will be included in Turnitin’s plagiarism analysis, however your lecturers will disregard it.

This section is for lecturers to complete. It is intended to give you feedback on your written communication skills and, unless otherwise stated, does not earn marks towards your grade. The ECU English Language Proficiency Measure (Feb 2014) Levels of proficiency

Low proficiency

Aspects of writing (Indicate with an X main area(s) needing improvement)

Incorrect or inappropriate aspects of writing obscure meaning in many places. Significant editing needed to clarify the meaning, along with extensive proofreading to correct technical

Developing proficiency Incorrect or inappropriate aspects of writing obscure meaning in some places. Some editing needed to clarify the meaning, along with extensive

Sentence structure

 

2. sentence length



3. phrase/clause order



4. use of conjunctions



5. word order



6. punctuation

Moderate proficiency

High proficiency

Aspects of writing are mostly accurate. Mistakes rarely affect clarity of meaning. Minor editing needed to clarify the meaning, along with careful proofreading to correct technical errors

Aspects of writing are appropriate and optimally constructed, allowing clarity of meaning. Meaning is clear and needs only a light proofread to correct technical errors

1. sentence completeness

Word use



7. word choice



8. word form



9. word omission/redundancy

  

10. verb tense/agreement 11. spelling 12. apostrophes

Sentence Structure

Word Use

1.Sentence completeness: sentence includes subject, verb a complete thought.

7.Word choice: words are correct and appropriate for the context.

2.Sentence length: length is appropriate to context or disciple

n 8. Word form: correct part of speech is used, e.g., [to] affect / [the] effect.

3.Phrase/clause order: parts of the sentence (phrases and clauses) are ordered logically. 4.Use of conjunctions: linking words are used correctly to show the relationship between ideas.

9.Word omission/redundancy: words should not be missing or be unnecessarily repetitive. 10. Verb tense/agreement: correct use of verbs that

5.Word order: words are ordered correctly in a sentence.

indicate time and correct word forms that agree

6.Punctuation: the correct use of full stops, commas, semicolons, colons and capitals.

grammatically with other words in the sentence.

This information will be included in Turnitin’s plagiarism analysis, however your lecturers will disregard it.

Assignment title:

Case study essay

Unit code and Title:

NCS2101 Adult Health

Lecturer:

Karen McCarthy

Student Name:

Conor Gary Osborne

Student Number:

10389545

Date of Submission:

3/09/2018

Word Count:

Table of Contents

Introduction

1

Background

1

Management

2

Assessment

2

Nursing diagnoses priority one

3

Planning

4

Implementations

4

Evaluation

6

Nursing diagnoses priority two

6

Planning

7

Implementations

7

Evaluation

9

Potential complications

9

Post-operative education

10

Involvement of interdisciplinary team.

10

Conclusion

11

References

11

1 Introduction Appropriate post-operative nursing plays a crucial role in the surgical procedure, as well as post-operative patient outcomes (Brown, Edwards, Seaton, & Buckley, 2014). In order to provide such care, that is also safe and effective, it is ideal to design a suitable nursing management plan, individual to the post-operative patient (Brown et al., 2014). To create an individualised plan in regards to the patient identified in the case study, the most ideal method would be incorporate the nursing process (Brown et al., 2014). The nursing process takes into account the patient’s assessment data, including: objective and subjective data about the patient; assessment of all of the patient’s body systems; and assessment of the patient’s activities of daily living (ADLs). From there, nursing diagnoses, in relation to the assessment data, are identified and prioritised. Planning in the form of outcomes and criteria will then be identified, and methods on their implementation discussed. Finally, an evaluation of the patient’s outcomes, against the planned outcomes, will be examined. Following this process is imperative to ensure the development of a concrete nursing management plan, as well as safe and effective care for the patient.

Background Hi, my name’s Conor Osborne; I’m a student nurse, and I would like to handover Kylie Melville, a forty seven year old patient, who’s recently returned from surgery. Kylie has recently returned from surgery for a septoplasty and a right ethmoidectomy, and is currently awake, alert, and has a moderate amount of sanguineous ooze located on her nasal bolster. All of her current observations are within normal parameters, with the exception of her oxygen saturation, which is currently ninety one percent in her radial artery (Brown et al., 2014). Kylie has a history of ‘not being able to breath well through her nose’ which disrupts her

2 sleep; and, when exerting herself, she ‘cannot get enough air in’ and has to mouth-breathe, and implement deep breathing techniques to steady her breathing pattern, so that she doesn’t get dizzy. She also has a history of sensitivity to codeine, which causes temperature flushes, nausea, malaise and dizziness. She is not on any medication, and has no other medical conditions. As per Kylie’s anaesthetist’s order, she has been prescribed Paracetamol one gram IV/orally six hourly, Celecoxib two hundred milligrams orally twice daily (BD), Tramadol one hundred milligrams sustained release tablets orally BD when necessary, and bung IV therapy when the present bag is finished. Can you read back the information given, to confirm it has been understood?

Management Assessment A thorough assessment of Kylie, post-operatively, is imperative to ensuring that any problems are identified, diagnosed, prioritised and treated (Brown et al., 2014). This will involve obtaining both objective and subjective data about the patient. The SAMPLE mnemonic can be used to obtain objective data – including: the patient’s symptoms, allergies, medications, history, last meal, and the events leading up to presentation (Brown et al., 2014). All of this information has been identified, apart from Kylie’s past history, and last meal which the nursing staff should ask Kylie about. Objective data will pertain to assessment of Kylie’s vital signs, all body systems and activities of daily live (ADLs). Kylie’s vital signs are all within normal ranges – with the exception of her oxygen saturation, which is currently ninety one percent - normal levels existing at above ninety four percent (Brown et al., 2014). It is also vital so assess all of Kylie’s body systems, including: her central nervous, cardiovascular, respiratory, gastrointestinal, renal, musculoskeletal, integumentary and

3 psychosocial systems, in order to gain a comprehensive picture of her overall health status (Brown et al., 2014). Finally, Kylie’s ADLs should be assessed - which include: her ability to maintain a safe environment, communicate, breath, eat/drink, eliminate, clean/dress herself, control her body temperature, mobilise, work/play, express sexuality, sleep, and dying (Potter, Perry, Stockert, & Hall, 2015). Other objective information that has not been identified, but will be required for a comprehensive assessment, include: a Braden Scale pressure injury risk assessment (due to immobilisation after surgery (Shafipour, Ramezanpour, Gorji, & Moosazadeh, 2016)), falls risk assessment (due to post-operative analgesia (Mata, Azevedo, Policarpo, & Moraes, 2017)), fluid balance chart (as urinary retention is a common complication post-surgery (Steggall, Treacy, & Jones, 2013)), and a peripheral intravenous assessment score (to identify/assess any developments of infection in the IV cannula, located in Kylie’s left arm). Once the patient has been thoroughly assessed, the nurse is then able to make an educated diagnoses, in relation to the assessment data.

Nursing diagnosis priority one Diagnoses are drawn from the assessment data, and should then be prioritised using a prioritising tool (Potter et al., 2015). In Kylie’s case, the primary survey has been used as the prioritising tool. The primary survey tool prioritises nursing problems according to the mnemonic ABCDE – which stands for: airways, breathing, circulation, disability, and exposure (Thim et al., 2012). In accordance with the primary survey prioritisation method, the most pertinent problem for Kylie, is in regards to her breathing - specifically, her oxygen saturation levels. That’s why the first nursing diagnoses to be addressed is impaired gas exchange, related to surgery, as evidenced by patient’s low post-operative oxygen saturation levels.

4

Planning Appropriate planning provides a platform to establish the projected outcomes, the criteria upon which to evaluate, and guides the choice of interventions (Potter et al., 2015). An effective method of planning, is developing goals, using the SMART goal setting format (Health Direct, 2016). In accordance with the SMART format - goals need to be: specific, measureable, attainable, realistic, and time bound (Health Direct, 2016). With this in mind, the following goals, in relation Kylie’s low oxygen saturation have been developed and prioritised. The first goal would be to immediately increase Kylie’s oxygen saturation to normal levels, as evidenced by an oxygen saturation reading above ninety four percent. The second goal is to continue to keep Kylie’s oxygen saturation levels within normal parameters for the next two hours following their initial increase, as evidenced by maintaining an oxygen saturation reading above ninety four percent for two hours. The third goal is to educate Kylie in measures to increase and maintain her oxygen saturation, as evidenced by her ability to verbalise, in her own words, the instructions given to maintain her oxygen saturation, as given by the nurse.

Implementations In order to meet the set goals and outcomes stated in the planning phase, the nurse must implement appropriate interventions, specific to the patient’s needs (Potter et al., 2015). Kylie’s first goal requires immediate elevation of her oxygen saturation to normal levels. The first intervention to implement would be to sit Kylie upright, in a semi-Fowler’s position, as evidence shows that sitting in an upright position permits an increased thoracic capacity,

5 assisting to improve oxygenation (Ceylan, Khorshid, Gunes, & Zaybak, 2016). Secondly, oxygen therapy, via a non-rebreather mask, would be implemented, as this will deliver more oxygen to the lungs and therefore, the body – improving oxygen saturation (Royal Perth Hospital, 2015). Thirdly, Kylie should be encouraged to perform the pursed lip breathing (PLB) technique, as evidence indicates that PLB improves gas exchange and oxygenation (Nespoulet et al., 2013). These implementations would assist in immediately improving Kylie’s oxygen saturation.

Kylie’s second goal requires keeping her oxygen saturation within normal parameters for two hours following her initial oxygen saturation increase. The first intervention implemented, would be assessing the rate, quality and depth of Kylie’s respirations, as decreases in any of those categories can affect gas exchange and decrease her oxygen saturation (Brown et al., 2014). Secondly, Kylie would be referred to a physiotherapist, to engage in breathing exercises, as this promotes thoracic expansion and oxygenation (Sultanpuram, Alaparthi, Krishnakumar, & Ottayil, 2016). Thirdly, Kylie should ambulate, when possible, as ambulation has been shown to improve oxygen saturation by promoting lung expansion (Yeung, 2016). Implementing these interventions would assist in keeping Kylie’s oxygen saturation levels within normal parameters.

Kylie’s third goal requires educating her on how to maintain her oxygen saturation levels. Firstly, Kylie should be educated on how to assess her own oxygen saturation with a pulse oximeter, so Kylie is able to detect any changes on her oxygen saturation, and take appropriate actions if they fall (Gulanick & Myers, 2017) . Secondly, she should be equipped with breathing exercises, and educated on the importance of doing them daily, as breathing

6 exercises significantly improve oxygenation (Pettersson, Faager, & Westerdahl, 2015). Thirdly, Kylie should be educated on the importance of good nutrition post-surgery, specifically, getting enough iron in her diet, as iron levels have a direct effect on oxygen levels (Lakhal-Littleton, & Robbins, 2017). Implementing these interventions should educate Kylie on how to maintain her oxygen saturation levels.

Evaluation The final step in the nursing process involves evaluating the effectiveness of the interventions implemented, which is determined by assessing whether or not the patient’s goals and expected outcomes were achieved (Potter et al., 2015). In regards to Kylie’s first goal, evaluation of immediate increase in oxygen saturation to normal levels would be evidenced by immediate elevation of her oxygen saturation above ninety four percent; as scanned by oximeter, and documented in the vitals chart and patient notes. Kylie’s second goal is requires evaluation of maintaining an oxygen saturation level within normal parameter for two hours following their initial increase, as evidenced by Kylie’s engagement with the physiotherapist and ambulation, as well as her oxygen saturation not falling below ninety four percent. Kylie’s third goal requires evaluation of Kylie’s education on maintaining her oxygen saturation levels, as evidenced by Kylie verbalising, in her own words, how to measure her oxygen saturation, perform breathing exercises, and the importance of good nutrition. If any of the goals are not met, the interventions my need to be discontinued or modified, or, the goals revised.

Nursing diagnosis priority two

7 The second diagnoses was drawn from the assessment data, and prioritised using the same primary survey tool, as mentioned in the first diagnoses. In accordance with the primary survey tool prioritisation method, the second most significant problem to address is in relation to Kylie’s cardiovascular system – in particular, the sanguineous ooze coming from her nose. That’s why the second nursing diagnoses to be addressed is risk for bleeding, in relation to surgery, as evidenced by moderate sanguineous ooze on Kylie’s nasal bolster.

Planning Effective planning requires the development of goals in order to identify expected outcomes, and assist in the choice of interventions (Potter et al., 2015). As previously mentioned, an effectual method of developing goals involves using the SMART goal setting format (Health Direct, 2016). In accordance with the SMART goal setting format, the following goals in relation to Kylie’s risk of bleeding, have been developed and prioritised. The first goal would be to immediately slow the bleeding coming from Kylie’s nose, as evidenced by a reduction in blood present at her nasal bolster site. The second goal is to ensure Kylie remains at a reduced risk of bleeding for the next one to two days, as evidenced by vital signs and platelet count both remaining within normal parameters, and avoiding any activities that inspire bleeding (Potter et al., 2015). The third goal is to educate Kylie in measures to maintain a reduced risk of bleeding upon discharge, as evidenced by her ability to verbalise, in her own words, the instructions given, in order to do so, as given by the nurse.

Implementations

8 Appropriate interventions assist in meeting the patients outcomes designed in the planning phase (Potter et al., 2015). Kylie’s first goal requires slowing of the bleeding presenting from Kylie’s nose. The first intervention to implement, is warm water irrigation, which has been shown to compress bleeding nasal vessels, via edema of the nasal mucosa (Traboulsi, Alam, & Hadi, 2015). Secondly, applying a cold compress at the back of Kylie’s neck, as this will assist by constricting blood vessel, thereby reducing blood flow and bleeding (Krajina & Chrobok, 2014). Thirdly, the application of a nasal vasoconstrictive agent will slow the bleeding, by constricting the nasal blood vessels (Krajina & Chrobok, 2014). Utilising these interventions should assist in reducing the bleeding out of Kylie’s nose.

Kylie’s second goal requires ensuring that she remains at a reduced risk of bleeding. The first intervention employed to achieve this, would be to monitor Kylie’s vital signs, as blood loss can trigger o...