PLEASE READ THE CASE STUDY INFORMATION AND ASSIGNMENT INSTRUCTIONS CAREFULLY, BEFORE YOU BEGIN.
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.
Type 2 Diabetes (on oral medication)
Laparotomy, small bowel resection 15 years ago
High cholesterol – all of which are normally well controlled.
Presbyopia – he has worn glasses for the past 20 years.
Ipratropium bromide (Atrovent) and Salbutamol oral inhalers.
Metformin 500mg daily
Captopril 25mg daily
Atorvastatin 20 mg daily
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:
Part A – PRE-OPERATIVELY: 500 words (approximately, this is a guide only)
Part B – POST-OPERATIVELY – It is important Mr Thompson’s post-operative care is thoroughly planned. To do this, please:
Please write an academic paper, you may use “Part A” and “Part B” headings.