Mr Ben Brown, a 68-year-old part-time landscape gardener presented to his GP (General Practitioner) four weeks ago with a 3-month history of abdominal pain and diarrhoea. A colonoscopy and CT (Computed Tomography) scan revealed extensive diverticular

Assessment

Nursing the gastrointestinal surgical patient

Assignment Objectives

CLO 1. Evaluate the pathophysiological, pharmacotherapy
and non-pharmacological management of acute exacerbation of illness, chronic
diseases and complex conditions.

CLO 2. Evaluate the principles of professional nursing
practice for people with diverse health concerns within the Australian
contexts, including a selection of regional, rural and National Health
Priorities across the lifespan including the needs of culturally diverse,
disadvantaged, and vulnerable groups with acute, chronic and complex
conditions.

Assessment Purpose

The purpose of this assignment is to develop your critical
thinking skills and clinical decision-making abilities in the care of a
client with complex needs.  In doing
so, you are examining and applying the following standards for registered
nurses for a patient episode of care. 
Read the case study below and answer the questions with subheadings in
essay style

Standard 1: Thinks critically and analyses
nursing practice.

RNs (Registered Nurses) use a variety of thinking
strategies and the best available evidence in making decisions and providing
safe, quality nursing practice within person-centred and evidence-based
frameworks.

Standard 4:  Comprehensively conducts assessments

RNs accurately conduct comprehensive and systematic assessments.
They analyse information and data and communicate outcomes as the basis for
practice.

Standard 6: Provides safe, appropriate, and
responsive quality nursing practice.

RNs provide and may delegate, quality and ethical goal
directed actions. These are based on comprehensive
and systematic assessment, and the best available evidence to achieve planned
and agreed outcomes.

Standard 7: Evaluates outcomes to inform
nursing practice.

RNs take responsibility for the
evaluation of practice based on agreed priorities, goals, plans and outcomes
and revises practice accordingly Registered Nurse standards for practice
Retrieved from:

https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Case Study

Mr
Ben Brown, a 68-year-old part-time landscape gardener presented to his GP
(General Practitioner) four weeks ago with a 3-month history of abdominal
pain and diarrhoea. A colonoscopy and CT (Computed Tomography) scan revealed
extensive diverticular disease of the large bowel and a large tumour located
in the ascending colon.  Ben has been
scheduled for an open right hemicolectomy.

Please refer to the following pre-
and post-operative assessment data to answer the assignment questions.

Pre-operative clinical data

Objective Data

Past Medical History

Social History

·       
Weight 122 kgs

·       
Height reported 175 cm

·       
BP 155/100

·       
HR 88

·       
RR 18

·       
Temp 36.4C

·       
Urinalysis – normal

Current
Medication

·       
Simvastatin 40mg nocte

·       
Captopril 100 mg mane

·       
Aspirin 100 mg mane

·       
Ventolin prn

·       
Hypercholesterolemia

·       
Hypertension

·       
Asthma

·       
Obstructive sleep apnoea (OSA) confirmed with sleep study January
2011

·       
Uses CPAP (Continuous
Positive Airway Pressure) machine at night

·       
Myocardial
infarction (MI) 2007 with left coronary artery stenting

·       
Married with 3 grown children

·       
Part-time landscape gardener

·       
Consumes 6 units of alcohol per day

·       
Independent with daily cares

·       
Smokes 10 cigarettes/day

Family
history

·       
Father RIP bowel cancer

·       
Mother 84 years of age: myocardial infarction 

Postoperative clinical data

Ben
returned from theatre at 1900 following an open right hemicolectomy for a
poorly differentiated adenocarcinoma of the ascending colon. Lymph node
metastasis was discovered in four of the 28 dissected lymph nodes.

You
are the registered nurse looking after Ben on the early shift the day after
his surgery. You have received handover at 0700 and are planning his care for
the day.

Observations 0800

Medications

Post-operative orders

·       
BP (Blood Pressure)
90/55mmHg

·       
Pulse: 110 and regular Respiratory rate: 12/min shallow SpO2 95% 2
litres via nasal prongs, Temperature 37.8°C Axilla,

·       
Sedation score = 2

·       
Vacudrain in-situ 400 mL in bag

·       
Estimated blood loss (EBL) in OT 600mL

·       
Urine output via a Foley IDC: 10-15 mls/hour <1mL/kg/hour last
three hours

·       
Pain score 6 on a scale of 0-10

·       
Midline abdominal dressing (minimal ooze)

 

·       
Simvastatin 40mg nocte

·       
Captopril 100 mg/day

·       
Aspirin 100 mg mane

·       
Fentanyl PCA (Patient
Controlled Analgesia) 20mcg bolus: 5-minute lockout

·       
Regular paracetamol 1G QID (PO/IV)

·       
Tramadol 50-100mg QID prn (PO/IV)

·       
Oxygen 2L via nasal prongs

·       
Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl)
80mL/hour

·       
IV
Cefoxitin 2gms TDS

 

·       
Midline abdominal dressing
– leave intact

·       
Nasogastric tube (NGT)
4/24 hourly aspiration

·       
Mobilise day 1 with physiotherapist

·       
Sips of clear fluid only

·       
Remove IDC 1000, day 1

·       
DVT (Deep Vein Thrombosis)
prophylaxis –TED stockings

·       
Pain management

·       
Oncology review 1/52. Will
require
adjuvant
chemotherapy as an outpatient

·       
GP follow up 2/52

·       
OPD appointment 4/52 with
Dr McCormack

 

 

 

 

 

Task description in detail

This assignment requires you to
consider the case scenario of Ben Brown who has undergone an open right
hemicolectomy. Your answer will
concentrate on the first 24 hours of post-surgical care and
includes discharge planning

1.
Provide an INTRODUCTION (approximately 100 words)

An introduction will
provide clear scope about the direction of your assignment. This includes
providing some background to your essay (not restating the case) and defining
the issues that you will be addressing in your discussion.

Part A: Analyse the case
to identify potential clinical issues and relevant nursing care (1000 words)

This section will focus
on the first 24 hours of post-surgical care and involves prioritising nursing
care for Ben. Consider Ben’s co-morbidities including obstructive sleep
apnoea (OSA), previous MI, asthma, hypertension, and hypercholesterolemia in
the context of having a general anaesthetic (GA) and in identifying your clinical
issues.

1.     
Identify THREE (3) PRIORITY clinical issues
for Ben e.g., at risk of severe pain

2.      Identify NURSING
INTERVENTIONS
for each of the three clinical issues e.g.,
Encourage deep breathing exercises hourly

3.      Explain RATIONALES
for each nursing intervention. Rationales justify your interventions and are
referenced. Suggestion: Intervention: Encourage deep breathing exercises
including use of the spirometry, hourly; Rationale: Smith (2019) surmises
that this promotes normal lung expansion increases oxygen levels, and is
useful in preventing pneumonia and atelectasis

Part B: Discharge planning (600 words)

1.      Plan and prioritise discharge advice for Ben

2.      In the discharge plan, consider the appropriate post-operative
education for
Ben post-surgical care.   Provide a concise discharge plan that
includes education around medication, prevention of post-operative
complications, psychosocial issues, and lifestyle modification.

3.      Refrain from merely providing generic information. Be succinct
and appropriate in your advice but also critically evaluate the information
in the case and specifically relate this to your discharge plan.

 

Provide a CONCLUSION (approximately 100 words) Your
conclusion succinctly summarises the main points of your assignment, not an
opportunity to introduce added information.

 

Assignment Tips

ASSIGNMENT

DETAILS

Introduction

 

Provide an overview of the structure of
the assignment. Provide a brief overview of how you will approach each
section. Outline examples in your essay that will be used to respond to the
assignment question. Do not restate the case

Part A: Identifying clinical issues, proposing nursing interventions and
rationales

Clinical
issues 

Consider pathophysiology, Ben’s
co-morbidities, current medications, surgery, and response to general
anaesthesia


Consider
the relevant assessment data you have been given in the case and other
assessment data you will need to collect to care for
Ben


Choose
three (3) prioritised actual or potential clinical issues. Be mindful
of the 24-hour post-operative period


It is
expected that the information in this section will be referenced
(Academic sources 4-6 would be reasonable for this section)

Prioritised
interventions supported with researched rationales

Evidenced
based nursing interventions and rationales should relate to
pathophysiological processes and aim to improve clinical outcomes.


The
rationales support your interventions and justify why you have
prioritised clinical issues. Rationales need to be referenced.
(Academic sources 4-6 would be reasonable for this section

Part B – Discharge planning

 

Consider both physiological and
psychosocial aspects in discharge planning.
(3-5
academic sources are expected for this section)  

Conclusion

Provide
a critical review and summarise the main findings of the assignment.

Length

Markable word limit of 2000 words. This limit does not include the
reference list but does include all in-text citations and headings. There is
no minimum word limit for this assignment but if you write less than 1000
words, it may be difficult to meet the marking criteria.

Marks out
of:

Weighting:

A total of 70 marks = 40% (refer to Marking Rubric)

APA 7 formatting, no dot points, no bullets