HLT54115 Diploma Of Nursing


Case Scenario

Mrs. Maria O’Reilly is a 70 year old lady admitted to the surgical ward for an elective left total hip replacement (THR).

Mrs O’Reilly presents with a medical history of Coronary Artery Disease, Hypertension, mild Congestive Cardiac Failure and Type II Diabetes.

The patient lives independently in a unit and is currently able to perform ADL’s unassisted. Mrs O’Reilly’s daughter is very supportive and lives locally therefore

easily accompanying Maria to Doctor’s appointments and assisting with shopping needs.

Mrs O’Reilly performs a blood glucose level three (3) times per day and the readings are predominantly between 5-7mmol.

Mrs O’Reilly has been recently widowed and English is the patient’s second language.

Current Medications include:

  • Tenormin 50mg daily
  • Aspirin 100mg daily
  • Metformin 500mg TDS
  • Frusemide 40mg daily
  • Potassium 600mg BD
  • Paracetamol 1G QID prn
  • Oxycodone 5 – 10mg 6/24ly prn
  • Metoclopramide 10mg 6/24ly prn

Admission preoperative vital signs include:

  • BP: 140/85, Pulse: 60bpm, Respiratory rate: 18bpm,   Temperature: 36.6, BGL: 5.0mmol
  • Pre-op ECG – sinus rhythm rate 62
  • Chest – X-ray – lung fields clear

ISBAR hand over report Day 3 Postoperative states:

  • Uneventful recovery post L)THR pain is well controlled with oral analgesia.
  • The patient tolerates only SOOB for 30 minute intervals, with the assistance of 2 nurses. Currently the patient remains resting in bed.
  • Wound dressing remains intact with nil ooze evident. No IVT or IDUC. Patient is tolerating minimal amounts of water orally and is voiding on a bed pan with assistance. Bowel chart indicates no passing of stools post operatively.
  • On commencement of the shift Mrs. O’Reilly reports feeling nauseated and states “My tummy feels sore and I feel sick”. On assessment the patient’s abdomen is distended and the patient flinches on palpation. On auscultation there is an absence of bowel sounds.
  • Immediately following the nurses’ assessment Mrs. O’Reilly vomits approximately 250mls of bile coloured fluid which has a faecal odour.

Current vital signs (after the patient vomits) include:

  • Bp: 135/80, Pulse: 90, Respiratory rate: 22, Temperature: 38, BGL: 7.3mmol. Oxygen saturations 93% on room air.

The nurse reports Mrs. O’Reilly’s condition to the Nurse Unit Manager and the Doctor assigned to the patient. Based on the nurses’ report and Doctor’s assessment of Maria, the Doctor has documented the following orders in the patient’s medical history:

  • Patient to be NBM until further review
  • Insert size 12 nasogastric tube and place on free drainage with 4/24manual aspirations
  • Insert urinary indwelling catheter
  • Prepare equipment for commencement of Normal Saline 1000mls IVT
  • Commence strict 1/24 FBC
  1. Discuss Mrs. O’Reilly’s postoperative potential medical problem and factors which could contribute to the development of this issue.Discuss the rationale for the insertion of a nasogastric tube for Mrs. O’Reilly.
  2. Discuss the ‘best practice’ technique for the insertion of a nasogastric tube. Include in the answer the nursing care required to maintain this appliance using evidence based practice. Ensure that all answers are case scenario specific.
  3. Discuss the best practice technique for the insertion of an indwelling catheter and the potential complications of urinary catheterisation. Use evidence based practice.
  4. Discuss the meaning of advocacy and explain individual strategies one can utilise to advocate for Mrs. O’Reilly when performing nursing interventions.
  5. Discuss potential rationales for each of Mrs. O’Reilly’s use of current medications. The following points should be included in the answer.
  • Include the drug family/group, indication and reason for this patient being prescribed this medication
  • Consider potential drug interactions and discuss contraindications relevant to this patient
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