PLEASE READ THE CASE STUDY INFORMATION AND ASSIGNMENT INSTRUCTIONS CAREFULLY, BEFORE YOU BEGIN.

Preoperatively:

Identity – Mr Peter Thompson, DOB 3/2/57

This is Mr Peter Thompson, he is a 67-year-old man. He has NKA (Nil Known Allergies). He lives at, 5 Park Tce, Alberton, South Australia.

Situation – Mr Thompson has a two day history of increasing abdominal discomfort. He has not had his bowels open for 5 days and is not able to pass wind. He presented to emergency department this morning, at 0800, due to his increasing abdominal discomfort. He also reported having no appetite, feeling nauseous, fatigued and lethargic.  Investigations in the ED revealed a small bowel obstruction.

Background – Mr Thompson lives alone. He has two supportive children, a daughter Hanna, who is 30 years old and a son Thomas, who is 28 years old. His wife, Cheryl, of 44 years passed away 5 weeks ago following a prolonged battle with cancer. Mr Thompson had worked as a store manager but resigned from work, in the final months of his wife’s life, to stay home and care for her.

Assessment – Mr Thompson is admitted to your ward with acute abdominal pain. His diagnosis, a small bowel obstruction, requiring surgery tonight (a possible complication from previous bowel surgery, following a traumatic abdominal injury 15 years ago).

You are on the Late shift when Mr Thompson arrives to the ward, you take his nursing history and admission. In doing so you conduct a top to toe assessment, including vital signs. Mr Thompson’s vital signs are stable, except for an increased respiratory rate. Vital signs are HR 76 bpm, regular, BP 145/75, Resps 26 bpm, Sa02 99% on room air, Temp 36.3 degrees Celsius. Mr Thompson feels nauseated and has a pain score of 6/10. His abdomen is firm to palpate and distended. He is sitting in a semi fowler’s position, in bed. Mr Thompson has a naso gastric tube insitu. It is on free drainage. A small amount of yellow/green fluid has drained.

He has fasted since 0800.

PMHy

Type 2 Diabetes (on oral medication)

Laparotomy, small bowel resection 15 years ago

Mild Hypertension

Asthma

High cholesterol – all of which are normally well controlled.

Presbyopia – he has worn glasses for the past 20 years.

Obesity

Medications

Ipratropium bromide (Atrovent) and Salbutamol oral inhalers.

Metformin 500mg daily

Captopril 25mg daily

Atorvastatin 20 mg daily

 

Allergies

Nil Known Allergies (NKA)

Recommendation –Please prepare Mr Thompson for his peri-operative journey – considering the pre-operative and post-operative care/ recovery.

Post Operatively – Mr Peter Thompson has just returned to the ward – 1900 on 13/3/23

Identity – This is Mr Peter Thompson, a 67 year old man, DOB 3/2/57. He has NKA (Nil Known Allergies).

Situation – Mr Thompson has just returned to the ward – 1900 on 13/3/23, following a small bowel resection and division of adhesions.

Background –Mr Thompson’s surgery was straight forward and uncomplicated. He has just spent 60 minutes in the Post Aneasthetics Recovery Unit (PARU), where he has had an uneventful recovery. During this time he received 80mcg of intravenous (I/V) Fentanyl for his pain and 2mg IV Tropisteron (an antiemetic). He had a pain score of 6/10 at that time. His pain settled quickly to 1/10.

Assessment – Mr Thompson’s vital signs are currently HR 96 bpm, regular, BP 158/83, Resps 16bpm ( shallow breaths), Sa02 98% on 2/LO2 via nasal specs , temp 36.5 degrees Celsius. Mr Thompson is awake, alert and oriented with sedation score of 0 to 1 out of 3.

Mr Thompson feels nauseated and has a pain score of 4/10. His abdomen is firm to gently palpate and less distended, than pre-operatively. He has a midline abdominal surgical wound, secured with staples and a secondary “Hypafix” dressing. Mr Thompson has a Naso Gastric tube insitu. It is attached to a free drainage bag. The naso gastric tube has drained a small amount of greenish fluid.

Mr Thompson can perform a weak cough, when asked to do so. He does not seem to cough unless prompted.

Mr Thompson has an IVT insitu, jelco in right cubital fossa. His jelco was inserted, this morning at 0830. His IVT is Hartmanns Lactate Ringer Solution, running 1000mLs over 8 hours. It was commenced at 1900, on return to the ward. As per his IVT order chart.

Mr Thompson has an antiemetic ordered – Ondansetron 8mg IV, 6 hourly, PRN. His pain relief order is for– Fentanyl 50mcg to 100mcg S/C 4 hourly PRN and Paracetamol 1000mg IV 6 hourly. Mr Thompson has the antibiotic – Metrondiazole 500mg TDS as well as his normal medications as listed above.

Mr Thompson has an IDC insitu draining amber urine – approximately 40mls/hr.

Recommendation – Please carry out comprehensive post-op care for MR Thompson. You will achieve this by answering the assignment details below.

CASE STUDY INSTRUCTIONS FOR STUDENTS

PLEASE ADDRESS THE FOLLOWING POINTS:

1. Offer a brief introduction (100 to 200 words approximately) and conclusion ( 100 to 200 words, approximately).

Part A – PRE-OPERATIVELY: 500 words (approximately, this is a guide only)

2. 2. Please briefly identify and evaluate, (hence use the literature to assess the importance of) the care Mr Thompson will require to prepare him for theatre, including – documentation, nursing care and pre-operative patient education.

Part B – POST-OPERATIVELY – It is important Mr Thompson’s post-operative care is thoroughly planned. To do this, please: 

3. Identify and justify the immediate post-operative care Mr Thompson requires in the first 4 hours, on his return to your surgical ward, from the PARU/Recovery Unit.To validate the care required, please use the literature to support and describe the importance of the nursing care you have identified. So why is this nursing care important to the patient’s well-being? Consider his post-operative presentation, which is described in the post-operative handover (ISBAR details), including his vital signs. In your description of your post-operative care clearly determine and justify the nursing care Mr Thompson requires, on the ward, in this first 4 hours post PARU.
   500 to 600 words (approximately, this is a guide only).

4. Please choose 1 of the following –

• • Identify the documentation tools you will use and evaluate their importance. 400 words (approximately, this is a guide only).
  • Post-operative education is very important. Please identify and discuss the post op education you will provide to Mr Thompson, in these first four hours Mr Thompson is back on the ward. 400 words (approximately, this is a guide only).
  • Finally, how would you identify if Mr Thompson is becoming unwell post/ deteriorating operatively? Consider and describe various possible complicationsMr Thompson could be at risk of. To do this consider both his past medical history and post-operative presentation. 400 words (approximately, this is a guide only).

Please write an academic paper, you may use “Part A” and “Part B” headings.

• Referenced via Harvard Reference style, per the Adelaide Nursing School Style and Referencing Guide ( found under the Modules tab).
• Please write in full, grammatically correct sentences, using professional terminology. Do not use nursing jargon, acronyms or abbreviations.If you wish to use an acronym, please first write it in full then introduce the acronymn in brackets, ie intravenous therapy (IVT).
• It is essential you support your information and recommendations, with in text citations from the literature.
• A full reference list is required at the end of this assignment.
• Please use at least 3 to 6 peer reviewed journal articles, not more than 10 years old. In addition, reference to reliable nursing/ medical textbooks is acceptable.
• Link to UofA library databases – https://libguides.adelaide.edu.au/nursing
• Resources such as Wikapedia, my Dr, RNCentra, Nurselabs and other blogs are not acceptable.
• This is a 2000 word paper. Remember, University policy allows 10% over or below the stated word count.