NSB334-Integrated Nursing Practice

Case Study

The ambulance officer stated that Mr. Dwight has vomited foul smelling bile stained fluid once since leaving home and has ketotic breath. Mr. Dwight told the ambulance officers that he is a diabetic and hasn’t eaten or drunk anything much for a few days. Six months ago Mr. D was diagnosed with bowel cancer and had a Hartmann’s procedure with the formation of a colostomy. Postoperatively he developed 'heart trouble' and since then has been taking Lasix on a daily basis. His blood glucose level on arrival in the ED was 22mmol/L.

Questions directly related to Mr. Dwight’s Palliative Care Consultation

1.. What are strategies that assist with the early detection of bowel cancer? Name and describe two (2) in relation to bowel cancer screening. 

2.Mr. Dwight is to have a Hartmann’s procedure with the formation of a colostomy. With your knowledge of the anatomy and physiology of the procedure:

a.Name four (4) essential pre-operative topics of education you should provide to Mr Dwight.

b.Explain how you will approach this education- name two (2) specific educational strategies will you use?

c.How would you evaluate effectiveness of your education? 

3.Name four (4) observations of the skin surrounding the stoma that would alert you to problems in the post-operative phase.

4.a. Mr. Dwight presents with symptoms that indicate a bowel obstruction. Explain why this can occur in the context of bowel malignancy.

4.b.Identify three (3) signs/symptoms that indicate a bowel obstruction and explain why these may have occurred in the context of a large bowel malignancy linked to the pathophysiology.

5.Mr. Dwight might require a blood transfusion because of post-operative bleeding, intra-opertaibe blood loss or later, during his chemotherapy treatment. 

a.Name four (4) adverse effects you might see when administering blood products and justify why these may occur?

b.Review Standard 7 of the NSQHS. Using the NSQHC standard and relevant literature, and state (6) actions required of the registered nurse if an adverse or suspected adverse reaction to blood products occurs.

6.Review and recall your knowledge on nasogastric tubes.  

a.Provide a rationale for why Mr. Dwight required a nasogastric tube inserted?

b.The RN you are working with checked the position of the nasogastric (NG) tube by injecting 20mLs of air and auscultating the stomach using a stethescope. This is an outdated method that is no longer considered safe or definitive for checking the position of an NG tube. Utilising an evidence based approach and referring to the evidence and literature on this subject, what is considered a definitive check for the position of the NG that the RN can perform in the ward?   

7.Effective and accurate clinical assessment skills are imperative for the nurse working with Mr. Dwight at all times. Identify  two (2)  clinical problems that could occur for Mr. Dwight during his admission to the palliative care unit with regard to fluid and nutrition that are commonly seen in the palliative care setting.  

8.From your identified clinical problem, state one (1) goal for Mr. Dwight’s management using the SMART framework.   No reference required for this response.   This should be a sentence or two that contains all the elements of the SMART goal 

9.Based on your goal in Q13, state and describe (2) interventions (nursing, collaborative or pharmacological) which would assist to achieve Mr. Dwight's goal.

10.Provide and justify two (2) methods of how you would evaluate the outcomes for your interventions in Q 14.   

11.name four (4) members of a multi-disciplinary team (MDT) who may be involved in the care of a palliative care patient like Mr Dwight. 

12.What are benfits for the palliative care patient  to have a MDT involved in planning and delivery of care? Note: this question does not ask you to define specific team member’s roles but use the literature about MDT to consider the role of such a team and the benefits.