NUR5111 Contemporary Nursing Practice 1


Case Information:

Today you are working an early shift on a general surgical ward. You are allocated to the care of Mrs Julie Frank who was transferred to the ward four days ago post a hemicolectomy.



  • Mrs Frank is a 74 year old female
  • She lives at home with her husband
  • She has 2 children, aged 37, and 45 who live overseas.



  • Julie was admitted four days ago, following severe abdominal pains and constipation. She underwent an open hemicolectomy three days ago.
  • Julie expresses concern that she needs to return home to care for her husband Tom who has Alzheimer’s. Tom gets very anxious and confused when Julie is not home.
  • Julie has a wound dressing on her abdomen at her surgical site. It is due to be changed this shift.
  • Julie currently has no supports at home as she states it is ‘her job to look after her husband’
  • Julie normally walks with a walking stick but hasn’t mobilised much since theatre, mainly due to pain.
  • Julie has a temporary stoma site with colostomy bag. She is still not confident in caring for it.



  • History of hypertension, ulcerative colitis, osteoarthritis, asthma and hypercholesterolemia, heart failure.
  • Allergic to penicillin (anaphylaxis)
  • Previous anxiety and depressive episodes
  • Medications


  • Perindopril 4mg mane
  • Frusemide 40mg mane
  • Prednisolone 25mg mane
  • Seretide 250/25 2 puffs BD
  • Simvastatin 40mg Nocte
  • Oxycodone SR 10mg BD
  • Oxycodone IR 5-10mg TDS PRN



  • You receive handover from the nurse on night duty. The night duty nurse states that Mrs Frank didn’t sleep much and has been restless
  • Vital signs at 2330hrs:
    • Respiratory rate: 24
    • T37.7C
    • Pulse rate: 88,
    • Blood pressure: 130/80
    • Sp02 92% room air
    • Pain score: 0/10



  • The ward has been very busy and Mrs Frank still needs a full nursing assessment.
  • Referrals to the allied health team as appropriate

The Event

It is 0730 and you have received handover on your patient. You go in to see Julie and find her sitting up in bed and clutching her chest tightly. She says her chest feels ‘tight’ and it is ‘difficult to breathe’.

Construct your assignment considering the following guided questions. You may use the headings as provided to frame your work.


During this stage the nurse begins to collect relevant information by asking relevant history questions and performing a health assessment.

  • Apply the components of a primary assessment to your patient based on your findings (at 0730).
  • Choose three priority systems to assess and provide rationale for your decision. Look for clues in the case information/handover to ensure your choice is relevant to the case scenario.
  • Construct two priority health history questions for each system, with specific reference to the systems you have chosen. Provide a rationale for each question. Explain how the question will add to your understanding of Mrs Frank’s clinical condition.

Identifying Health Problems

In this stage, the nurse synthesises all the information that has been collected and identifies the most urgent patient problems.

  • Discuss the assessment findings that may alert you to physiological deterioration, and explain why the findings are concerning.
  • Identify and prioritise three actual patient problems and provide rationale for your prioritising of each patient problem.
  • Identify two potential problems for this patient and provide rationale for these.

Planning and Implementing Care

During this phase, the nurse selects the most appropriate course of action.

  • Discuss eight key evidence-based nursing interventions including rationales for each intervention.
    • Interventions may relate to Mrs Frank’s presentation at 0730 or be based on the ‘bigger picture’ of her needs during admission
    • Interventions must be prioritised.

Evaluating Care

The stage requires nurses to evaluate the proposed nursing interventions and determine whether the patient’s condition has improved.

  • What assessment findings would indicate that the eight nursing interventions you have suggested, have been effective?
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