Special conditions: upper gastrointestinal surgical specialty
Case Details
As a new graduate nurse on your last rotation, you are working on a busy 50 bed surgical ward (upper
gastrointestinal surgical specialty). You have arrived for an evening shift and receive handoverfrom
the stafffrom the previous
shift.
You have been allocated 6 patients to care for. Their details are as follows:
Bed 1: Linda is a 40 year old female that presented
with a 24 hour history of gradual upper
abdominal pain radiating to the right upper quadrant. She is now febrile 38.7.
Bed 2: Jayne is a
35 year old female with vague upper abdominal discomfort over several days and
noticed skin and eyes turning yellow and urine becoming
dark. She has a past history (PHx)
of intravenous drug user (IVDU).
Bed 3: Max is a 20 year old male with recurrent peptic ulcer disease
who presented with
haematemesis; he is currently on a Pantoprazole infusion via a syringe driver (concentration:
1mg per ml running at
5mls per hr).
Bed 4: Phillip is a 55 year old male with oesophageal cancerthat was surgically excised yesterday,
he has a tracheostomy
insitu that requires regular suctioning.
Bed 5: Colleen is a 50 year old female with severe alcoholic liver disease brought in by ambulance
(BIBA) following severe haematemesis and melaena – she required an ICU admission for
haemorrhage control and administration of blood
products. She was transferred from the ICU
to yourward earlier on in the day.
Bed 6: Tony is a 55 year male with history of severe
epigastric pain that is associated with nausea.
He has a past history of non-compliant Type 2 Diabetes. He is scheduled for an endoscopy
and is currently nil by mouth. He has a 5% Dextrose infusion running at 1oomls/hr and an
insulin infusion (Actrapid 50 units in 5omls)
running at 4 units per hourvia a syringe driver.
O1. Prioritise and discuss how you will initially assess your
care according to your patients’ conditions
and treatment (500 words).
02. While assessing your patients, you record a blood glucose
level (BGL) on patient 6. Your reading
on the BGL monitor returns a level of1.5 mmol/L. The patient responds to voice on the AVPU
scale,
he is cool and clammy to touch. What is the significance ofthis result? Referring to the
ward protocol attached (page 24), rationalise
your actions (500 words).
03. It is now 20oohrs. You find that much ofthe nursing care you are trying to provide to your patients
is
taking longerthan you expected and you haven’t had an opportunity to record your 18oohr
observations or administer your medications.
Discuss why it is important to seek assistance and
identify who may be the resource people that can assist you (250 words).
04. The alarm
sounds on the infusion pump with your patient in bed 3. You find that the Pantoprazole
infusion has completed and you are required to draw
up a new one. You then notice the patient
across the room in bed 4 has been coughing consistently and vigorously, and notice blood
stained
sputum from the tracheostomy. What would be your interventions in this case scenario
and what would be the priority for your actions? (250)
words
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