Short Answer Test (SAT)

Word limit: 1000 words

Aim of assessment

The purpose of this short answer test in-class assessment is to enable the student to demonstrate:

An understanding of the principles of perioperative nursing care in relation to a person who has Crohn’s disease (Learning outcome 1).

An understanding of alterations in body fluid homeostasis and the management of fluid balance in the perioperative period (Learning outcome 1).

An understanding of the role of the nurse in the perioperative period in relation to a person who has Crohn’s disease (Learning outcome 2).

An understanding of the pathophysiology of Crohn’s disease (Learning outcome 5).

An understanding of pharmacological agents that may be used in the perioperative care of a person who has Crohn’s disease (Learning outcome 6).

An understanding of how safe and effective administration of pharmacological agents support people in perioperative care (Learning outcome 1, 6 & 7).

An evaluation of relevant literature to support an understanding of the pathophysiology, pharmacological and nursing management of a person experiencing Crohn’s disease and is able to express this in a clear and succinct writing style (Learning outcome 9).

Details

Lucy is a 19 year old university student. She has been admitted to hospital with a six (6) day history of lower right quadrant abdominal cramping pain increasing with intensity, diarrhoea with blood, anorexia, fatigue, nausea and episodes of vomiting. Lucy states that she was diagnosed with Crohn’s disease at age 15. She has had two previous hospital admissions for acute exacerbations of Crohn’s disease with clinical manifestations of diarrhoea, abdominal pain and vomiting. Her Crohn’s disease has been managed with a combination of diet, medication and medical monitoring. Remission of her Crohn’s disease was maintained by oral mesalazine (Mesasal). Lucy currently rates her pain as 9/10. On examination, Lucy was pale, her extremities were cool, and her skin was dry with poor turgor. Her abdomen was distended and tender. A mass was palpable in the lower right abdominal quadrant. 

Observations on admission

• Blood pressure: 95/60 • Pulse rate: 110 beats/minute • Respiratory rate: 22 breaths/minute • Temperature: 37.7C • Sa02: 98% in room air • Weight: 62 kilograms • Height: 165 cm • Urinalysis: • specific gravity: 1040 • dark coloured urine • no other abnormalities noted

Initial pathology results

• Haemoglobin: 105 g/L (117 – 157 g/L) • Haematocrit: 49% (35 – 47%) • WBC 15000/mm3 ( 3500 – 11000 mm3) • Erythrocyte sedimentation rate (ESR): 28mm/hour (0 – 20 mm/hour) • C-reactive protein (CRP): 30mg/dl (20 mg/dl) • Albumin: 28g/L (35 – 50 g/L)

The MO orders the following

• fentanyl 75mcg IMI QID PRN • metoclopramide (Maxolon) 10mg IMI TDS • 1000mL 0.9% normal saline over 8 hours • nil by mouth

Lucy was prepared and sent for an urgent colonoscopy, upper barium x-ray and abdominal CT scan. A bowel obstruction at the proximal end of the ascending colon at the ileocecal junction was diagnosed. A balloon dilation of the obstructed colon was attempted, but was unsuccessful. Lucy was scheduled for a surgical resection of the affected proximal ascending colon and end-to-end anastomosis of her colon.

Question 1. 10 marks (250 words) Explain the pathogenesis of Crohn’s disease that has led to the development of Lucy’s obstruction of the proximal ascending colon. (Learning outcome 5; NMBA competency standards 2.6, 3.1, 4.2)

Question 2. 10 marks (250 words) Explain the pathophysiological processes that lead to Lucy’s conscious perception of pain in her lower right abdominal quadrant. (Learning outcomes 1, 5; NMBA competency standards 2.6, 4.2, 3.1)

Question 3. 5 marks (165 words) Describe the characteristics of the intravenous fluid that was ordered for Lucy, and the specific rationale, related to the details of the case study, for the administration of this intravenous fluid to Lucy. (Learning outcome 1, 2; NMBA competency standards 2.6, 3.1, 4.2, 5.2, 5.3)

Question 4. 5 marks (165 words) Describe the mechanism of action of fentanyl in relation to its administration to Lucy. (Learning outcome 6; NMBA competency standards 1.1, 2.6, 3.1, 4.2)

Question 5. 5 marks (165 words) Prioritise the nursing responsibilities and associated rationales related to the administration of fentanyl to Lucy. (Learning outcome 7; NMBA competency standards 1.1, 1.2, 1.3, 2.2, 2.5, 2.6, 5.2, 5.3, 6.1, 7.4)

NOTE - WORD LIMIT There is a total word limit of 1000 words for the SAT. If you exceed the word limit by more than 10% the marker will stop marking at 1100 words (word limit of 1000 words + 10%). This assessment does not require in text citations or a reference list. 

Attachment:- 401010-LG-AUT-2016.pdf