NRSG258 Case Study Assignment
• The assignment is to be presented in a question/answer format not as an essay (ie no Introduction or Conclusion).
• Each answer has a word limit (1500 in total for the assignment); each answer must be supported with citations.
• A text format and Reference List must be in APA 6th style format, provided at the end of the assignment.
adhere withinin 10% of word limit
clear progressional of ideas, correct grammar, syntax, spelling and punctuation
>structure and overall presentation appropriate to format chosen organisation, presentation and referencing
NRSG258 Case Study Assignment
Case Study 1: Adam
Adam is a 45 year old man who works as a sub contractor for a large building company as a carpenter. During a rugby game on the weekend, he tore his rotator cuff. Adam has 4 children, 2 live with him and his current wife, the other 2 live with their mother across town. After consultation with the surgeon Adam is told that he will require a shoulder arthroscopy with rotator cuff repair followed by 3 months of rehabilitation before he can return to work.
Adam is the sole provider for his family and has child support payments to make for his other children. Adam likes to take care of things himself and doesn’t like to ask for help from family or friends. During preadmission it’s established that Adam is concerned about his family finances. He expresses doubt about how his family are going to cope with him not working and how he will be able to take care of his children.
Adam’s surgery goes to plan and is uneventful during the perioperative stage. On his arrival to PACU he is still unconscious; he is positioned supine with his arm in an immobilising sling with an abducting pillow. He is oxygenated through a Hudson mask on 6L and his breathing is shallow. He starts to rouse and moves his shoulder, there is a sharp cry of pain and Adam grits his teeth. The PACU pain management protocol allows the nurse to administer 5mg morphine IVI. This is administered with good result and Adam settles down and begins to drift off to sleep. On routine PACU observation it is noticed that Adam has unusually noisy breath sounds and is increasingly more difficult to rouse. Adam begins to shiver and his peripheries are cool to touch with a capillary refill of more than 3 seconds. His blood pressure is recorded as 110/55, HR 62, RR 12 and SaO2 99%.
Adam returns to the ward after 45 mins in the PACU. He is still drowsy but easy to rouse. He has a Normal Saline infusion running 12th hourly and he is ordered PRN pain relief medication, IVI morphine 5mg 4/24, PO paracetamol 1gm 6/24 and PO/IV metoclopramide 10mg 8/24. Adam begins complaining of tightness in his hand and pins and needles in his fingers. Peripheral circulation is assessed and capillary refill is less than 2 seconds with good sensation in all fingers. Adam’s pain has come back and he is now complaining of pain 7/10 however there is insufficient time since the last dose of morphine was administered.
Adam has been on the ward for 8 hours, he has yet to pass urine and according to the fluid balance, both intra-operatively and from the ward, he has had a total of 3L of Saline. He is now eating and drinking a full ward diet but denies any need to pass urine. He has not been out of bed since returning to the ward and is reluctant to move. The physiotherapist arrives to take Adam through the exercises that he will need to do the next day.
Answer the following 4 questions with the following requirement mentioned in each question:
Q1. Identify the psychosocial impact of surgical intervention including the psychosocial impact of elective and emergency admissions, separation, and loss of income and/or loss of control as related to the case study (400 words)
Linked to the case study identifies all psychosocial impact
Provide explanation of impacts on client and or family
Q2. Explain the recovery process of your chosen patient. Identify and provide rational for airway management as related to the case study (250 words)
Comprehensive understanding of recovery process
Provides comprehensive explanation surrounding airway management as related to case study
Q3. Identify the assessment and nursing intervention involved in addressing the patient’s pain as related to the case study? (250 words)
Identify a comprehensive guide of nursing measure/ interventions related to the case study provides evidence based practice (EBP) and rationale supporting their use
Q4. Develop a (case report) nursing care plan focusing on the post operative care in the first 24 hours. In order of priority, using evidence based literature, identify and discuss nursing care and rationales as related to the case study (600 words)
The case report was articulate, logical, balanced and convincing. A diverse range of perspective offered.
All important aspects are covered demonstration comprehensive knowledge of the key areas