The Scenario:

You are the admitting nurse for Mrs. Akimoto. She is 72 year old, obese patient who is admitted for repair of fractured NOF. She is booked in for an open reduction, due to go to theatre in one hour time. Mrs Akimoto has been previously diagnosed with Type 1 diabetes.

Q1. Identify (8) eight important assessments and/or forms you should perform and/or fill out as part of the admission. (This is to exclude name, age, and address.) 100 to 150 words

Q2. In your health assessment of Mrs Akimoto, name four (4) physiological things do you need to assess for each of the following areas: 100 to 150words

A. Respiration

B. Pulse

C. Neurological status

Q3. Identify four (4) hazards/risks in the operating theatre to the patient and/or staff. 50 to 100 words

Q4. What are 2 common types of skin prep use in surgery?

Mrs Akimoto has an uneventful operation and recovery in PACU.

She returns to your ward.

Q5. List 10 observations / assessments / information you need to receive during handover from the PACU nursing staff on Mrs Akimoto's return to the ward. (excludes Vital Obs).

Post operative orders/presentation:

Obs, 8/24 IVT, PCA (Morphine 1mg per ml), 4/24 BSL's, IDC on hourly burette measures, Bellovac x 2 on free drainage, IVABs, check XR and Hb in am, SCUDS and Charnley pillow insitu. She also has a wound site and 2 drainage site dressings, dry and intact.

Q6.

A. What is the regime for general post-op vital signs?

B. What are 10 observations that would be required for Mrs Akimoto's management other than vital signs?

C. Give a rationale for each of the 10 observation identified.

Q7. After settling Mrs Akimoto into her room, on the second set of observations she starts complaining of severe pain at the wound site.

A. Identify and give a rational for four (4) possible effects of untreated pain on her body related to recovery.

Q8. Identify four (4) non-verbal signs that Mrs Akimoto may exhibit when experiencing unrelieved pain?

Q9. With her pain unrelieved, Mrs Akimoto starts to become angry and verbally abusive. When you answer her call bell, you find she has pulled out her IDC and is trying to climb out of her bed.

A. What are three (3) actions will you take to ensure her SAFETY?

Q10. In the second hour post op, you check Mrs. Akimoto's dressing and observe the dressing has filled with bloody ooze that was not present on your last observation and has leaked out of the dressing. (100 to 150 words)

A. Identify and give a rational regarding four (4) actions you will take on discovering this bloody ooze?

Q11. In the fourth hour post op, you notice that Mrs Akimoto's respiratory rate has decreased to 8/min and her oxygen saturation has dropped to 89%. (100 to 150 words)

A. Identify and give the pathophysiology behind why this complication could be the cause of this deterioration?

B. Identify six (6) nursing interventions you would perform in this situation?

Q12. Two days later, Mrs Akimoto complains of pain in her right chest on inspiration and shortness of breath. (150 to 200 words)

A. Identify the complication that Mrs Akimoto is experience and give a rational for your answer.

B. What are five (5) nursing interventions that you should perform?

C. Identify four (4) preventive measures for the identified complication.

Q13. After you come back from your dinner break, you enter Mrs Akimoto's room to find her unresponsive. ( 100 to 150 words)

A. As an Enrolled Nurse, what are four (4) ways you could contribute to the emergency management of Mrs Akimoto?

B. What equipment may be brought to the bedside to assist in Mrs Akimoto's care?

C. Name the two (2) first line drugs found on the resuscitation trolley.

D. Identify the actions of these 2 drugs and their route of administrations.

Q14. Three days later you are assigned to care for Mrs Akimoto. You observe her wound and notice that the dressing is clean and dry although around her drain site dressing it is reddened and she states that it stings. (25 - 50 words)

A. What could be the wound complication?

B. What three (3) other signs and symptoms would confirm your diagnosis?

Q15.

A. What four (4) changes to the presentation of the wound and patient would make you suspect an expanding infection process is occurring?

B. Identify the name of a generalised infection in the blood stream and its treatment.

C. What is the potential side effect of this generalised infection if left untreated?

Q16.

A. Identify four (4) concerns Mrs Akimoto may have regarding her discharge.

B. Name three (3) supporting health care team members and identify how they can assist her specifically with those concerns.