solved

CASE STUDY 1
Janice is a 54-year-old woman admitted to the Emergency Department at 1520 with suspected acute intoxication.
You arrive at 1430 to commence an afternoon shift and are allocated to care for Janice. As the ED is busy, Janice has not had initial observations taken. You observe that Janice’s speech is slurred, and her clothes smell strongly of alcohol. She has multiple abrasions and a head contusion.
Question 1: For Janice’s case, what assessment are needed for each element? Complete the below table
A comprehensive or complete health assessment
An interval or abbreviated assessment
A problem-focused assessment
An assessment for special populations
Question 2: A medical officer asks you to conduct a neurological assessment on Janice. What is the neurological assessment? Why this assessment is needed for this case?
Case Study 2 – Part 1
24/07/2018
1100: Nadia Canssino is a 76-year-old NESB lady admitted to your ward from Accident and Emergency. Nadia is able to understand a small amount of English and lives with her daughter. Nadia presented with a Bowel Obstruction which may require surgery in 2 days if it does not resolve on its own. Nadia’s observations on admission to your ward are Temperature 36.7, Pulse 98, BP 156/89, Respiration 22, Spo2 96% on Room Air, Weight is 43kgs. Nadia is complaining of abdominal pain on arrival to the ward and requests pain relief.
1300: Nadia is to remain NBM with IV fluids over 6 hours for hydration. Intravenous Catheter (IVC) is in-situ to left arm, site is NAD. Nasogastric tube is insitu on free drainage and 4th hourly aspiration. IDC in-situ and is draining adequate amounts of urine every hour. Nadia remains NBM. Nadia’s IDC and Nasogastric hourly output is as below:
IDC N/G IVF
1300 25mls 100mls 166
1400 20mls 166
1500 30mls 166
1600 32mls 166
1700 20mls 250mls 166
1800 40mls
1900 5mls
2000 10mls 100mls
1645: Nadia complains of a painful red and swollen left arm and the IVC is removed at 1700. The Doctor attempts to insert another IVC for Nadia however after 4 attempts the doctor decides that Nadia will need a PICC line inserted but is unable to organise it until tomorrow. Therefore, Nadia has no IVC access until tomorrow.
2000: Nadia complains of feeling unwell, she looks pale and clammy. Observations T 38.6, P 120, BP 100/55, Respiration 25, Spo2 92% room air. A critical review is called for Nadia.
2030: Temp 38.5, P 130, BP 92/50, Respiration 26, Spo2 89% with O2 therapy at 4 liters via nasal prongs. Nadia is continuing to deteriorate, and you need call for an emergency response for her (as per organisation procedures) as her level of consciousness is decreasing.
Question 3: What should be included in the nursing health assessment?
Question 4: Develop an action plan (nursing care plan) according to the chart below. Complete the below table
Nursing Diagnosis
Nursing Intervention
Evaluation of Interventions (Your answer must include the impact of the intervention)
Case Study 2 – PART 2
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.
Question 5:Provide a brief explanation as to how to educate Nadia/family before surgery:
Your answer must include pre-operative assessment and education.
Question 6: 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.
Question 7: Explain in detail the steps to manage a compromised airway.
Question 8: 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. Complete the below table
Priority Modified nursing care/ nursing interventions
Management of airway and breathing
Monitoring vital signs
Nasogastric tube dislodgment – risk of malnutrition
Wound management
Psychological distress
Question 9: List and discuss five (5) key topics to include when educating Nadia and her family to promote the understanding that the health care being given is to regain optimal health outcomes? Complete the below table
Nasogastric tube care
Pain management
Wound care
Psychological support
Mobilisation/deep breathing and coughing exercises
Question 10: 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.
Question 11: What is post-operative pain management? List and explain two (2) types of pain assessment tools in assessing Nadia’s pain.
Question 12: Identify and describe the role and responsibility of four (4) of the emergency team members in workplace or (Clinical placement)
Question 13: List and briefly describe four (4) items found on the emergency arrest trolley in area of nursing. How often is the emergency trolley/equipment checked in your area of nursing?
Question 14: List of Nursing Management of ACS (Acute Coronary Syndrome).
Question 15: Explain the following codes in an emergency – Code Red; Code Blue; Code Purple; Code Yellow; Code Black; Code Brown; Code Orange.
Question 16: List the appropriate steps to attend a patient is experiencing pulmonary arrest in workplace?

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."