Mrs Sandra Thompson, is a 49-year old

Mrs Sandra Thompson, is a 49-year old lady who has just returned to your surgical ward post, a Total Abdominal Hysterectomy. She has no significant medical or surgical history apart from having a Tonsillectomy at age 10. Her surgery was uneventful. Her lower abdominal wound has an opsite dressing insitu and it is dry and intact. She has an indwelling catheter (IDC) which has drained 600mls of clear urine, over a 6-hour period and she has intravenous therapy (IVT), normal saline, running at 125 mls per hour. On return to ward her observations are: BP = 115/68, P = 89, RR = 20, SpO2 = 100%, Temp = 36.2, Pain = 2 out of 10. Six hours late you go to do another set of vitals on Sandra. She looks pale and states she “feels terrible”. Her vitals show: BP = 109/51, P = 110, RR = 24, SpO2 99%, Temp = 36.0 and when asked her to score her pain, she states it is 7 out of 10. On inspection of her abdominal dressing you find moderate break through bleeding and some distention and bruising around her wound site. Mrs Sandra Thompson has now fully recovered and is able to be discharged home from hospital. You are the community nurse that will be visiting her at home. She lives with her husband and her two grown up children Jake (17) and Samantha (20). Sandra normally works full time but has another two weeks off work before she is ready to return to her position as a primary school teacher. Although this is only your first visit as a community nurse, you did meet Sandra in hospital briefly to arrange her outpatient appointments. As you walk into Sandra’s house you notice that she looks hot and dishevelled. She is moving about the room holding her lower abdomen as she quickly tidies up and apologies for the mess. As you motion her to sit down, you notice she grimaces and lowers herself down gently. On questioning her, she tells you her pain score is 7 out of 10 at the wound site. She also states that she has never had pain like this before and the pain has been on and off for the past three days and she describes it as a “sharp, burning” pain. She says it usually is relieved by Endone and regular Panadol but she has now run out of her discharge medication. On inspecting her wound you note there is purulent discharge and there is some inflammation and redness around the wound borders. Sandra also confesses that perhaps she has been “doing too much in the leadup to your visit” – Based on the further information you have been given about Sandra’s situation at home, discuss three important cues that are concerning you. – After collecting the cues, processing the information you have and using your critical thinking what do you think is Sandra’s immediate problem -What two nursing goals could you establish that would be required for Sandra’s care moving forward? Explain your answer?

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