Critical Thinking Scenario
Mrs. Audrey Smith is a 75 year old female who arrived to the Emergency Department at 1045. She was found lying on the kitchen floor by a neighbour at 0925 and an ambulance was called immediately. Mrs. Smith stated that she had tripped over her dog.
Mrs. Smith has been diagnosed with a fractured left NOF (neck of femur), soft tissue injury and bruising to her left shoulder as well as a small haematoma to her left forehead. She is oriented to time, place and person. She is eye opening to commands and is able to understand and perform what is asked of her, for example when asked to perform deep breathing and coughing exercises, she responds to the instructions appropriately. GCS is 14. Neurological observations are ordered hourly.
Audrey. (preferred name), is transferred to your ward at 1400 with an IVT and IDC in situ. She is alert but anxious and speaks frequently about her dog, Rufus. Audrey is concerned that there will be no-one to care for him when her neighbour goes back to work. Surgery for arthroplasty - L hip is scheduled for 1700.
Patient Details
Name: Mrs. Audrey Smith
Address: 440 Collins St.
Melbourne Vic 3000
DOB: 31/12/38
Age: 75
Past Medical History
AF Hypertension
L CVA - 2008 T2DM - 2008
GORD
Osteoporosis
Total hysterectomy - 1995
Depression - 2011
Medication History
Digoxin 62.5 mcg OD
Warfarin 2 mg OD (INR result 2.0 in ED) Coversyl 5 mg OD
Vitamin D 1,000 units OD
Metformin 500mg BD (BSL 5 @ 1200) Esomeprazole 40 mg OD
Efexor 150 mg OD
Caltrate 600 mg OD Mylanta 15-30 mls prn
Allergies
Bactrim
Social History
Husband died in 2010
1 adult daughter who lives in Queensland & sees her mother infrequently Council home care once per fortnight
Attends Senior Citizens once per week with her neighbour
Past history
Social drinker
Non-smoker (25 years)
Nursing Assessment
Slight right-sided weakness
Chronic constipation
Mild to moderate urinary incontinence
Anorexia
Early morning wakening
You reassure Audrey that you will do your very best to meet her needs.
The Task
BASED ON THE SCENARIO YOU WILL:
1. Admit the patient using critical thinking skills interventions related to Audrey's: to assess and prioritise nursing
- Safety
- Hygiene & Comfort
- Nutrition
- Elimination
- Activity levels
- Psychosocial needs
All interventions must be accompanied by a relevant explanation.
2. Provide an explanation of the 8 diagnoses referred to in Mrs. Smith's past medical history. Indicate how they affect the care that you provide to Audrey.
3. Use critical thinking skills to discuss each of Audrey's prescribed drugs using the following criteria:
- Indications for use
- Nursing implications
- Indicate how they affect Audrey and the care that you provide to Audrey
4. Discuss the specific nursing actions you will implement to prepare Audrey for her surgery and explain your reasoning.
5. Discuss the immediate nursing interventions you will implement when Audrey returns to the ward at 2000 and explain your reasoning.
6. Mrs. Smith is to be discharged 10 days post-op. She will be admitted to a fast track rehab facility. Describe 4 nursing interventions you will implement to prepare Audrey for this transition and explain your reasoning.