Case Study 0700: Nadia is required to

Case Study 0700: Nadia is required to go for emergency surgery due to a bowel perforation. 1500: Nadia returns to the ward post bowel surgery she is awake and orientated to time and place. IVF in-situ via right PICC line, IDC draining concentrated urine. N/G tube is to remain in situ and is draining small amounts of bile coloured fluid. Nadia also has an epidural infusion for pain at a rate of 8mls/ hour which is keeping her comfortable. Abdominal wound is covered with a small dressing, nil visible ooze. Three weeks after surgery Mrs Cassino remains in hospital. Her abdominal wound has broken down due to poor nutrition and requires daily packing. The Doctors are now requesting Nasogastric feeding for her as she is severally underweight and malnourished. The Registered nurse inserts a fine bore Nasogastric feeding tube, and an X-Ray has confirmed correct placement of the tube. The Doctor has confirmed the nasogastric placement and is happy for feeding to commence via the NG tube. The doctor asks you to commence Nasogastric feeds on Nadia. Nadia is not happy having a nasogastric tube as she finds it uncomfortable and thinks that people are looking at her, due to the tube in her nose and a bag of nasogastric feeds being attached. You notice that Nadia is constantly pulling at her nasogastric tube, as she wants it out. You find Nadia in bed lying flat, the tape on her nose has been dislodged, and her NG feed is still being administered. She is having difficulty in breathing, and her chest sounds moist. A set of observations reveal BP 165/90, P130, RR 28, and Spo2 92%. Due to the poor nutritional state of Nadia, the Doctors are requesting that Nadia is to be discharged with continuing Nasogastric feeding next week. As the Enrolled nurse, you need to provide education and training to Nadia and her daughter to ensure patient safety after discharge. You are also responsible for organising discharge planning for Nadia. Questions Part A) explain how you would prepare and educate Nadia/family before surgery: Your answer must include: Pre-operative assessment and education. Part B) Once you have accepted care hand-over on Nadia onto your ward from recovery room, list the initial assessments that needed to be undertaken on Nadia Nadia may need hourly clinical observations, list the necessary observations required. Part C) Explain in detail the steps to manage a compromised airway. Part D) Describe and discuss enteral feeding. Your answer must include: The rationale for enteral feeding, two Nursing interventions related to enteral feeding and two examples of different types of feeds Part E) Considering about particularly Nadia’s deteriorating condition, list and describe five (5) key priorities and how you would modify your nursing care to address these needs. Priority Modified nursing care/ nursing interventions Management of airway and breathing Monitoring vital signs Nasogastric tube dislodgment – risk of malnutrition Wound management Psychological distress Part F) List and discuss five (5) key topics you would you include when educating Nadia and her family to promote the understanding that the health care being given is to regain optimal health outcomes? Nasogastric tube care Pain management Wound care Psychological support Mobilisation/deep breathing and coughing exercises Part G) Describe and discuss two (2) types or examples psychological support and care that Nadia may require due to the impact of her acute health issues. 1. 2. Part H) What is post-operative pain management? List and explain two (2) types of pain assessment tools you may use in assessing Nadia’s pain. 1. 2. SCIENCE HEALTH SCIENCE NURSING NURSING HLTENN011

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