John Wong is an 80 year old male of Chinese origin. John smokes 10 cigarettes per day. His medical history includes hypothyroidism and osteoporosis. Recently he has been unstable on his gait and has difficulties with simple tasks such as getting up to his house stairs and even getting up from chairs.
In the last 4 weeks, he has noticed that he has been having difficulty in passing urine. He was referred to a Renal Physician by his local GP. A prostate biopsy was taken which showed a Benign Prostate hyperplasia. It was recommended that he undergo a Transurethral Resection of the Prostate (TURP). John's surgery was uneventful.
After John's surgery, he was transferred to the PACU. He was placed in a supine position with a number of blankets on top of him as he was shivering. It was noted that he was wheezing and had a non-productive cough. His observations were T 36.5c, HR 90, RR 30, BP 150/90 and SpO2 91%.
After the nursing staff have resolved John's situation, he is transferred to the surgical unit. Post-operative orders include pain relief (PRN Endone and Paracetamol), and Continuous Bladder Irrigation for 24 hours to ensure rose' urine output. Four hours upon John's arrival to the ward, He is observed to be in pain and distressed. He is diaphoretic and is unsettled. He said that his bladder feels full and he feels the urge to urinate. A set of Observations were T 36.9c, HR 91, RR 28, BP 146/91 & SPO2 98%. On review of his documentation it is found that his fluid status has a positive 500ml balance and his urine is of red colour. There are blood clots in his urine.
Learnig outcomes and questions to answers
Assessment 1: Case Study
The assignment is to be presented in a question/answer format not as an essay (i.e. no introduction or conclusion). Each answer has a word limit; each answer must be supported with citations. Students must provide in-text referencing and a Reference List must be provided at the end of the assignment.
Length and/or format:1500 words
Purpose: To assess learning outcomes as stipulated below.
Case Study Questions
1. Whilst the patient is in PACU, identify and discuss airway management (and rationales) as related to the case study.
2. In order of priority using evidence based literature, identify and discuss the nursing interventions (and rationales) required to care for the chosen patient in the first 24 hours upon returning to the ward. Nursing intervention/care presented needs to be accurate, relevant and specific to the chosen case study
3. As part of your role as a primary nurse for your patient, you are required to initiate discharge planning. Identify the allied health professional/s you would refer your case study patient to and discuss the rationale behind your referral, what treatment may this health professional/s provide?
Learning outcomes assessed:
1. Apply a clinical decision making framework in the assessment and prioritisation of health problems in individuals undergoing surgery;
2. Determine appropriate nursing therapies and describe medical and allied health interventions for selected episodic health alterations and illnesses
3. Plan evidence-based, safe, person-centred care for individuals undergoing surgery including education and discharge planning; (ACU Graduate Attribute: 5,6)