As the registered nurse you now need

As the registered nurse you now need to complete the discharge information Mr. Jones will require to successfully continue his care. Consider the information you require in order to discuss a discharge summary and answer the following questions: What information will Mr. Jones require to continue and maintain a positive and healthy lifestyle? What factors make Mr. Jones a greater risk considering his cultural and social background? Considering the situation and Mr. Jones’ current position within the health setting what are the potential complications following discharge? Are there any additional health services Mr. Jones will/can be provided post discharge? What are some community services Mr Jones is able to access once home? Who will be required to arrange this? Meet Marty Jones from Farmdale. You are the registered nurse at an Aboriginal medical Service in Farmdale. Martin Jones, a 67 year old local man, presents to the clinic asking to see a health care worker. You and Stacey, an experienced Indigenous registered nurse, are assigned to assess Mr. Jones. He reports that he has been in good health until about two months ago when he started to feel weak and tired more rapidly than usual. On questioning, he admitted to getting up two or three times a night to urinate. He also is often thirsty at those times and drinks a glass of water each time. His weight had been average through high school, where he had been on the rugby league team. After leaving school, he had gradually gained weight over the years. His appetite remains good, but he is now losing weight and describes feeling weak. He reports that he gets pain in his feet, but the pain is worse at night and sometimes keeps him awake. It is burning in character and sometimes his toes feel numb. The tingling and numbness in his fingers is causing him problems at his work as an auto mechanic because he frequently drops small parts or has difficulty making fine manual adjustments to engines. His vision is blurry at times, especially in the afternoon. Apart from an appendectomy in 1976, he reports no surgeries or chronic illnesses. His last dental visit was 6 years ago. Both parents are deceased. His father died at age 69 from a massive stroke. His mother died at age 62 from end-stage kidney disease. She was found to have type 2 diabetes mellitus at age 48, and was marked by major complications including partial amputation of her right foot. She was on dialysis for three years before her death. Martin was primarily responsible for his mother’s care during her later years. He administered her insulin twice a day and transported her to and from the dialysis centre. Martin is the youngest of four children and weighed 4.6kgs (10 lb 3 oz) at birth. Both parents were overweight, as are his siblings, two of whom have diabetes. He is married and lives at home with his wife. He has three adult children. He works as an auto mechanic. He does not smoke. He drinks an occasional beer. He takes no medications, nutritional supplements or herbal remedies. Dr. Smith, the centre’s doctor, diagnoses Martin as having type 2 diabetes mellitus and starts him on Metformin 500mg tds. He refers him to the centre’s diabetes nurse for education. Mr Martin Jones, a 67 year old local man of Farmdale, who has been admitted to Farmdale hospital for an elective knee replacement following the diagnosis of osteoarthritis secondary to rheumatoid arthritis in his Right knee from a history sport injuries from playing football. He is two days post-operative following an elective right knee replacement. Mr Jones is a widow, is an elder and active member of the community and performs many hours of volunteer work every week for the Aboriginal community. He still drives and is responsible for a small area with meals on wheels. On admission, Mr Jones reported a 2-year history of considerable pain, including frequent flare ups and swelling, stiffnes and at times the knee appeared to “lock” when he was walking causing a creaking sound. Despite losing weight and various medication including methotrexate, sulphasalazine and diclofenac sodium with misoprostol combination drug. Pre-operative X-ray demonstrated severe loss of joint space. The surgery was relatively uncomplicated. The prosthesis position is appropriate, although moderate amount of blood loss occurred postoperatively. Yesterday, he became quite confused (Glasgow Coma Score=13 and today he developed dyspnoea. Temperature 37.5°C Heart rate 100bpm Respiratory rate 30 Blood pressure 110/86 Spo2 93% (RA) Mr Jones is having 1000 mL, q8h intravenous (IV) fluids and IV antibiotics. Also his SpO is decreasing, he has been commenced on oxygen via nasal prongs at 4L/min. He has been out of bed once since surgery. However, since the confusion has developed he has remained on ‘rest-in-bed’. His indwelling catheter remains insitu with urine output of approximately 45mL/hr. He is ordered Clexane and is supposed to be wearing thromboembolic deterrent stockings but they don’t appear to have been reapplied after his postoperative sponge. Mr Jones did not have sequential compression devices (SCDs,pronounced ‘skuds’) applied while he was in bed as there were no units available. Prior to his deterioration, he was performing q2h incentive spirometry with a Trflow while he was awake. Aventilation/perfusion scan has been booked for Mr Jones this afternoon. FULL BLOOD COUNT UNITS REFERENCE RANGE Haemoglobin 87 g/L 115-160 White cell count 5.2 X 109/L 4.0-11.0 Platelets 134 X 109/L 140-400 Haematocrit 0.29 0.33-0.47 Red cell count 3.70 X 109/L 3.80-5.20 Reticulocyte count 3.5 % 0.2-2.0 MCV 82 fL 80-100 Neutrophils 3.41 X 109/L 2.00-8.00 Lymphocytes 2.54 X 109/L 1.00-4.00 Monocytes 0.36 X 109/L 0.10-1.00 Eosinophils 0.24 X 109/L < 0.60 Basophils 0.09 X 109/L < 0.20 ESR 14 mm/h < 12 g ELECTROLYTES UNITS REFERENCE RANGE Sodium 146 mmol/L 135-145 Potassium 4.0 mmol/L 3.5-5.0 Chloride 101 mmol/L 96-109 Bicarbonate 23 mmol/L 22-26 Glucose (random) 5.2 mmol/L 3.5-8.0 Iron 7 µmol/L 7-29

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