Case study
This assignment challenges you to critically analyse the given clinical data and use the nursing process to develop priorities of care for a post-operative patient. You are required to identify priorities of care, identify, and describe appropriate assessments and synthesise these into a holistic person-centred care approach to nursing care.
This assignment requires a scholarly approach to academic writing using evidence to inform your decisions, and formatting and presentation of a standard expected at tertiary level study
Mrs. Kimberly Carey a 42 year-old-female, was admitted this morning to the surgical ward, where you are working as a Registered Nurse (RN). Her admission notes outline that she was admitted to the ward for management of acute cholecystitis whilst waiting for her scheduled laparoscopic cholecystectomy.
Kimberly is a mother to two primary school aged children and works part-time as a librarian at the National Library of Australia. Kimberly has a supportive husband, Bob, who works in the Australian Public Service with the Australian Taxation Office. Kimberly is a practicing Jehovah’s Witness.
Kimberly has a medical history of diagnosed asthma, anxiety and obesity (current BMI is 30 kg/m2). Kimberly was noted to have been feeling anxious about her surgery pre-operatively, specifically outlining concerns regarding difficulty performing usual caring role, work commitments and changes to body image due to scaring.
The laparoscopic cholecystectomy has concluded and, following a four (4)-hour operation, she has returned to the Surgical Ward. The Post-Anaesthetic Care Unit (PACU) RN is currently providing you with a clinical handover and informs you that Kimberly required an open cholecystectomy for a gangrenous gallbladder. You review the surgical site with the PACU RN and you note a surgical wound to her right sub-costal region that is closed with staples and covered by a clear Comfeel® dressing. You note that the dressing is intact with a small amount of blood along the incisional wound. There is also an Exudrain®, on suction, from the surgical site.
Kimberly currently has a Fentanyl PCA insitu and is receiving intravenous fluid therapy. The PACU RN informs you that Kimberly received a total of 80mcg of fentanyl in PACU before the PCA was commenced.
Kimberly is also receiving supplemental oxygen therapy via nasal prongs at 2 litres/min. She is drowsy but rouses to your voice and describes pain at her surgical site as 8 out of 10. Kimberly’s husband (Bob) expresses concern about her drowsy condition and is asking you whether it is normal to have so much fluid collecting in the drain.
Vital sign observations on return to ward.
- HR: 105 bpm
- NIBP: 90/60 mmHg
- RR: 20 breaths/min
- SPO2: 97% @ 2lpm via NP
- T: 37.3 ⁰C
Medications charted on NIMC.
- Flixotide 100mcg inhale BD.
- Ventolin 5mg inhale PRN/QID.
- Fentanyl PCA 10mcg/mL IV, bolus dose 20mcg with lockout time 5min.
- Enoxaparin 40mg S/C Nocte To commence DAY 2 post-operatively.
- Cephazolin 1g IV TDS.
Part
A: Provide a verbal and visual nursing handover using the ISBAR format, as though you are giving this ISBAR handover to a Registered Nurse colleague of the case study patient. Your ISBAR handover must clearly address key safety concerns related to the case study provided. Your ISBAR handover must not exceed four (4) minutes in duration and include only information that is stated in the case study. It is important that the ISBAR format is evident within handover and is clear and easily understood with video on. The students face must be visible. Use .mp4 or .mov video file to submit the assessment.
B: You are required to submit a 1500-word response to the case study that demonstrates critical analysis of the given clinical data, use of the nursing process to prioritise your approach to nursing care, and synthesis of these points into a holistic person-centred care approach that is relevant to the post operative phase of a perioperative patient.
C: You are to include, as an attachment to the case study, a one (1) page concept map identifying relationships between Kimberlys’ psychosocial and mental health concerns. Include nursing interventions to address these concerns in brief dot points.
Using the exemplar below, create a concept map where Kimberly is within the center. Your concept map will branch off into the following sections (i) Nursing education (ii) Mental health concerns post operatively (iii) Recovery and rehabilitation (iv) Family and other psychosocial concerns. In each section you will briefly identify how you will manage and anticipate complications within these areas within short sentences or dot points.
