CASE STUDY Mr George Amdel On a

CASE STUDY Mr George Amdel On a cold, wet winter evening Mr George Amdel, a 64 year-old homeless person, was struck and dragged by a speeding car as he crossed the street. He was taken to the hospital accident and emergency department by ambulance. Following triage and initial assessment, he waited 10 hours before surgical treatment of his injury. Mr Amdel’s left tibia is broken (an open fracture) and there are lacerations and abrasions on his right side, arm, and leg. His left leg is in a temporary plaster cast, and several lacerations have been sutured. A next-of-kin is not nominated in his admission record. He has no fixed place of address. He expresses concern for his backpack which contains all his worldly goods. This backpack was not with him when he was admitted. He occasionally stays at a Catholic Organisation Outreach Centre in the City Centre. He has become friendly with another homeless person who occasionally stays at the same Outreach Centre. He only knows that this person’s first name is Bill. Mr Amdel used to attend a Catholic Church. Mr Amdel is admitted to your ward for aftercare and evaluation. In particular, he needs to be assessed for referrals to appropriate specialist health care professionals to identify and manage his various acute and on-going medical problems and his social and financial situation. It is 0700 hours. You have just arrived on duty for the day. Mr Amdel is one of your patients for the day. You will care for Mr Amdel until your shift ends at 1530. Mr Amdel grimaces when he tries to move his legs, but does not verbalise pain. Mr Amdel speaks with a prominent accent. He says he has not eaten for two days but last had a drink, which was alcohol, just prior to his accident. He has an indwelling catheter insitu as he was unable to void prior to going to surgery. He recalls that his last bowel action was three days ago. Mr Amdel’s observations on admission to the ward at 0700: Temperature: 38 degrees Pulse: 80 per minute and irregular BP: 150/90 mm Hg Respirations: 28 per minute with productive cough Oximetry: 95% in room air Height: 180 cm Weight: 60 kg. Blood Glucose Level – 11 mmol/l Neurovascular observations of left leg satisfactory Other results/ Laboratory Blood Tests Haemoglobin (Hb) – 11 g/100 ml INR – 1.5 Leukocyte count – 18.8 x 10 9/l Thrombocyte count – 100 x 109/l Serum bilirubin 23 umol/L Other data available: IV therapy commenced in the operating theatre – now maintenance therapy Urinalysis – catheter specimen – amber colour, pH 5, SG 1020, positive for protein and ketones – all other findings normal May take light diet and fluids as tolerated Urinary catheter to be removed in 24 hours Non-weight bearing until follow-up by Doctor in 24 hours time English is second language – emigrated from Albania 20 years ago Wears glasses for far-sightedness and has bilateral cataracts Diagnosed with chronic bronchitis two years ago Smoker – on average 10 per day Alcohol intake – on average one bottle (750 mls) of spirit alcohol a day Prescribed medications – stopped taking anti-hypertensive medications because he stated “could not be bothered to get them” Allergic to aspirin, honey and peanuts – all elicit an anaphylactic response. Previous admission to hospital was six months ago for an emergency appendicectomy. The Doctor has noted that he has hepatomegaly His only clothing was thrown away due to damage and blood stains General appearance – tall and thin; balding but with long, unkempt facial hair; missing upper and lower incisors; inflamed eye-lids; yellowish complexion but pale lips; numerous bruises and old scabbed lesions on exposed parts of arms and legs; barrel-chested and using accessory muscles to breath Shortly after his admission to the ward, Mr Amdel complains of burning sensation in his chest area. He states that the pain is 7 on a scale from 0-10 (0 = no pain, 10 = severe pain). Then he vomits. There is fresh blood in the vomitus. Volume of emesis is 230 mls. A. ASSESSMENT (based ONLY on information provided): COMMUNICATION a) ASSESSMENT DATA: (2 Marks) b) NURSING INTERVENTION: 2. BREATHING a) ASSESSMENT DATA: b) NURSING INTERVENTION: 3. CIRCULATION a) ASSESSMENT DATA: b) NURSING INTERVENTION: 4. EATING AND DRINKING a) ASSESSMENT DATA: b) NURSING INTERVENTION: 5. Elimination a) ASSESSMENT DATA: b) NURSING INTERVENTION: 6. Mobility a) ASSESSMENT DATA: b) NURSING INTERVENTION: 7. Rest & Sleep – a) ASSESSMENT DATA: b) NURSING INTERVENTION: 8. Pain – a) ASSESSMENT DATA: b) NURSING INTERVENTION: 9. Medication a) ASSESSMENT DATA: b) NURSING INTERVENTION: 10. Wounds a) ASSESSMENT DATA: b) NURSING INTERVENTION: SCIENCE HEALTH SCIENCE NURSING NURSING HLTAAP003

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