Scenario Mrs Bennett is a 76-year-old, obese

Scenario Mrs Bennett is a 76-year-old, obese patient who is admitted for repair of fractured Neck of femur fractures (NOF). She is booked in for an open reduction and is due to go to the theatre in one-hour time. Mrs Bennett has a medical history of Type 1 diabetes. You are the Enrolled Nurse caring for Mrs Bennett in the surgical ward. Q1. Identify 5 interventions you need to perform specifically as part of the pre-operative nursing management for Mrs Bennett, that take into account the potential postoperative complications she may experience due to her health condition of Type 1 diabetes,obesity and age. Mrs Bennett has an uneventful operation and recovery in PACU. She returns to your ward. Q2. List 10 observations/assessments/information you would undertake or discuss with the PACU nursing staff on Mrs Bennett’s return to the ward (exclude vital signs). Post-operative orders/presentation: Observations, 8/24 IVT, PCA (Morphine 1mg per ml), 4/24 BSL’s, IDC on hourly burette measures, Bellovac x 2 on free drainage, IVABs, check XR and Haemoglobin (Hb) in am, SCUDS and Charnley pillow insitu. She also has a wound site and 2 drainage site dressings, dry and intact. Q3. Identify the regime for general post-operative vital signs of Mrs Bennett to ensure you meet the post- operative orders/presentation listed above. Q4. List ten 10 post-anaesthetic observations that would be required for Mrs Bennett’s management other than vital signs. Describe how the gathered information needs to be documented and reported. Q5. Provide a response to the following: a. Identify and give a rationale for there 3 major adverse effects of untreated pain on Mrs Bennett’s recovery and daily living activities, that you would explain to her and her family. After settling Mrs Bennett into her room, on the second set of observations she starts complaining of severe pain at the wound site. You assess Mrs Bennett’s pain level and the rate is 7. Mrs Bennett is very anxious and concerned about her health.You report and discuss the concern with the RN, and she requires you to explain the effects of the health problems to Mrs Bennett and her family. b. State the 2 ways in which you can confirm the accuracy of adverse effects that you identified above with Mrs Bennett and her family. Q6. Care of a person in the acute care environment is a holistic approach. In addition to providing treatments for recovery from diseases, psychological support benefits patients’ health. Consider this statement and provide a response to the following. a. Identify 4 signs that you can observe to identify the psychological impacts of pain on Mrs Bennett. b. List at least three (3) psychological support you can provide to Mrs Bennett. With her pain unrelieved, Mrs Bennett starts to become angry and verbally abusive. When you answer her call bell,you find she has pulled out her IDC and is trying to climb out of her bed. Q7. What are the priorities of nursing interventions in this situation to ensure Mrs Bennett’s safety? Provide 5 examples. Q8. Identify and give a rationale of 4 actions you will take on treating this bloody ooze? In the fourth hour post op, you notice that Mrs Bennett’s respiratory rate has decreased to 8/min and her oxygen saturation has dropped to 89%. You report this complication to the RN and medical team, and discuss the potential pathophysiological changes and nursing interventions with them. Q9. Identify the pathophysiologic changes behind this complication? In the second hour post op, you check Mrs Bennett’s dressing and observe the dressing has filled with bloody ooze that was not present on your last observation and has leaked out of the dressing. Q10. Identify 6 nursing interventions you would perform in this situation. Two days later, Mrs Bennett complains of pain in her right chest on inspiration and shortness of breath. Q11. Identify the post-operative complication that Mrs Bennett may be experiencing and give a rationale for your answer, taking Mrs Bennett’s medical history into account. Q12. What are 5 nursing interventions that you should perform to treat this identified post-operative complication? Q13. Identify 4 preventive measures that you can educate Mrs Bennett and her family to reduce the risks associated with this identified post-operative complication. After you come back from your dinner break, you enter Mrs Bennett’s room to find her unresponsive. You identify and report this emergence situation immediately to the RN and emergency response team, and provide a first aid according to the requests from the team. Q14. What equipment may be brought to the bedside to assist in Mrs Bennett’s care? Provide at least 3 examples. Q15. Name 2 first line drugs found on the resuscitation trolley, and their normal doses and route of administration. Q16. Describe the indications and purposes of performing the following 7 skills in the above scenario for Mrs Bennette: Pre-operative care Recovery room care and handover Post-operative care Suctioning of an oral cavity Tracheostomy Care Assist a patient to use CPAP in the general ward or community Care of the unconscious patient Q17. Describe at least 3 safety considerations for potential problems during performing the above mentioned skills to demonstrate the problem-solving skills and the ability to link theory to practice.

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