NRSG258 Principles of Nursing Surgical

Case Study – Edward (Ted) Williams

Edward (Ted) Williams is an 82year old male who is day 4 post-operative following a bowel resection and formation of a temporary colostomy. Ted had previously had a coloscopy and biopsy that confirmed a malignant mass. He has a past medical history of; heart failure, type II diabetes melilites, obesity and gout. (BMI 37.6m2; Height 175cm; weight 115kgs)

Ted is a widower and lives alone. His wife died 3 years ago following a bout of pneumonia. One year ago, Ted moved into a retirement village located in a regional area two and a half hours from the city. The retirement village is near where he lived with his wife and children until they left home. Ted has 2 grown up children, a son Christopher who lives overseas with his wife and son, and a daughter Janice who lives with her husband and 3 children in the city. While Ted lives alone, he has a partner Gwen 78, who also lives in the same retirement village as Ted.

Current medication: Metformin 500mg Mane Captopril 12.5mg mane Frusemide 40mg mane Allopurinol 100mg Daily Paracetamol 1g QID

Ted is now day 4 post op. He was Nil By Mouth (NBM) for the first 48 hours after surgery. Yesterday he commenced on a full fluid diet and has upgraded to a light diet yesterday evening. Today, Ted was given his regular metformin and ate breakfast. Since then Ted has vomited twice and feels nauseous. He has been given ondansetron 4mg for nausea.

Teds vital signs at 10am are as follows: T 38.1; HR 98 reg; BP 135/85; RR 26; SpO2 94% on 3L NP. He has right sided inspiratory coarse crackles and he has a moist productive cough. He has PCA morphine in situ for effective pain regulation. Ted has some abdominal pain that he says is at a scale of 4-5/10, he says the pain worsens on palpation to 7/10 and you note that his abdomen is distended. The colostomy bag is intact and the stoma can be sighted through the bag. The stoma is warm, pink, moist and slightly raised above the skin. There has been no output since his surgery. He has sluggish bowel sounds and has not passed flatus. The abdominal laparotomy has a clear occlusive dressing (opsite) and there is minimal ooze present. He has a redivac drain with 30mls of haemoserous fluid, and a urinary catheter in situ and is passing approx. 60-70mls of urine/hr.

1: Use stage one of the clinical reasoning cycle (CRC) ‘Consider the patient situation’ to identify the biopsychosocial, spiritual and cultural impacts of Ted’s surgery for him and his family

2: The information for stage two of the CRC collect cues and information has been provided for you in the case study. Use this information to provide responses to CRC stages three ‘Process the information’ and stage four ‘Identify Problems.’ Please link to pathophysiology and provide evidence from the literature to support your thinking. (600words)

3: Using stage five of the CRC Establish goals outline and justify (5) nursing care interventions/strategies the registered nurse would implement to provide care for Ted. Justify your thinking with links to current peer reviewed evidence and literature

4: Select two classes of drugs that would be used to manage Ted’s post operative condition. Please provide a rationale for why that drug class would be suitable for Ted. Provide a detailed description of the pharmaco-dynamics of each of the selected class of drug as well as the potential side effects and the nursing implications for administration