Case Study - Kathleen Johnson
HISTORY:
Kathleen Johnson is 45 years old and works in a library part-time returning books to the shelves. Kathleen is very overweight (BMI 40kg/m2) and has Type 2 diabetes, which she tries to control with diet. Kathleen is the sole carer for her father, who has dementia. Kathleen admits to consuming up to four bottles of beer a night, several glasses of whisky as well as smoking a packet of cigarettes a day and drinking several cups of coffee, which she says is to help her cope with stress of managing her father, her diabetes and her appearance.
Kathleen was admitted to hospital for sleeve gastrectomy surgery for weight loss.
After 2 hours in the post-anaesthetic recovery room (PARU) and an uneventful recovery, Kathleen was transferred to the ward, where you have been allocated to her care.
PRESENTATION TO THE WARD:
On return to the ward Kathleen's observations are as follows:
- Respirations 28 breaths per minute
- BP 190/100
- Pulse 130 beats per minute
- Temperature remains 35.1oC
- Pain score 7/10
- Indwelling urinary catheter (IDC) 5mls in the last hour
- Nasogastric tube 50mls of gastric fluid
It is planned for Kathleen to be discharged after two days on the ward.
Questions to be addressed: In relation to Kathleen Johnson:
Q1. Discuss the aetiology and pathophysiology of the patient's presenting condition.
Q2. Critically discuss the underlying pathophysiology of the patient's post-operative deterioration. Prioritize, outline and justify the appropriate nursing management of the patient during this time.
Q3. Identify three (3) members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement.