course material

1. Apply a clinical decision making framework in the assessment and
prioritisation of health problems in individuals undergoing surgery
Topic: Case StudyOrder DescriptionAssessment 1: Case StudyThe assignment is to be
presented in a question/answer format not as anessay (i.e. no introduction or conclusion).
Each answer has a word limit; each answer must besupported with citations. Students must
provide in-text referencing and a Reference List must beprovided at the end of the
assignment.Due date: Friday 28th March, 5pm (Week 5)Weighting: 40%Length and/or
format: 1500 wordsLearning outcomes assessed:2. Apply a clinical decision making
framework in the assessment and prioritisation of healthproblems in individuals
undergoing surgery;5. Determine appropriate nursing therapies and describe medical and
allied health interventionsfor selected episodic health alterations and illnesses6. Plan
evidence-based, safe, person-centred care for individuals undergoing surgery
includingeducation and discharge planning; (ACU Graduate Attribute: 5,6)? Reference List
(adhering to APA style)Case StudyBeth is a 35 year old woman who has recently married
her long term partner. Both Beth and her husband have professional careers, and are well
established in their private lives. They have been discussing the thought of having children
and are planning the ?right time? in the next 1-2 years. Recently, whilst in the shower Beth
noticed a lump in her left breast. Following this she visited her GP and got a referral for an
ultrasound and mammogram, and on review she was referred to a surgeon. A biopsy and
lymph node removal indicated that further surgical intervention was required.Beth is now
being admitted to undergo a left breast mastectomy and a DIEP reconstructive flap. During
her nursing admission you note that Beth has a past history of asthma, exacerbated by
stress and environmental factors, but that she is generally fit and well.After approximately 6
hours in the OR Beth arrives in the recovery room where the anaesthetist hands over that
her general anaesthetic was uneventful and she remained stable throughout the operation.
The anaesthetist mentions that just before transfer to recovery she was given ?a little more?
morphine to assist with pain relief when she wakes up. In addition it is handed over that the
breast tissue has been sent to pathology for further examination, the flap needs strict
routine observations, the pressure dressing is to remain intact until surgical review the next
day and there is a low suction Jackson-Pratt drain insitu.The recovery nurse begins her
recovery assessment of the patient and notes Beth?s vital signs. BP 100/70, HR 85, SpO2
92%, Temp 35.0 and her RR 8. On closer respiratory inspection Beth?s breathing is quite

2. shallow and has a distinctive ?noise? on expiration, with a slight tracheal tug noticed. All
other recovery observations are stable at this time. As Beth starts to rouse the respiratory
?noise? and tracheal tug becomes quite evident, as does Beth?s anxiety and stress levels.
Her vitals are now BP 130/90, HR 100, SpO2 96%, Temp 35.0 and RR is now 28.After a long
stay in PACU, Beth is now comfortable and ready for discharge to the ward. The charts are
complete with an IV fluid order for Hartmann?s 2/24hrly, with numerous bags to follow.
Antiemetic and Analgesic orders including Kytril 6-8/24 and Ondansteron 6/24, a PCA
order of morphine commenced in PACU at 1mg/ml with a 5 minute lockout, and a PRN
order for O/IV Paracetamol 1g. Beth has an IDC insitu with 1/24 readings. The surgeon?s
orders are strict regarding the care and observation of Beth?s surgical site and flap
reconstruction. The low suction drain is to remain insitu for 24-48hrs in which it will be
reviewed prior to removal.The next morning after handover you review Beth and her
overnight progress post surgery and documents. You note that Beth has voided
approximately 30-50mls per hour according to her FBC.As Beth has had a reconstruction
you know that this constitutes minimal urine output and may require surgical review. You
also note that according to her PCA observations chart she has had many ?demands? of the
PCA but her pain control does not seem adequate. Beth draws your attention to her surgical
site and you note that the colour of the flap is normal and seems to be perfusing well. A
routine Hb is due to be taken this am.Question 1Whilst the patient is in PACU, identify and
discuss airway management (and rationales) as related to the case study (400
words)Question 2In order of priority, using evidence based literature, identify and discuss
the nursing interventions (and rationales) required to care for the chosen patient in the first
24 hours upon returning to the ward.Nursing intervention/care presented needs to be
accurate, relevant and specific to the chosen case study. (800 words)Question 3As part of
your role as a primary nurse for your patient, you are required to initiate discharge
planning. Identify the allied health professional/s you would refer your case study patient
to and discuss the rationale behind your referral, what treatment may this health
professional/s provide. (300 word)TEXTS AND REFERENCES: Required text(s)Farrell, M., &
Dempsey, J. (2011). Smeltzer and Bare?s textbook of medical-surgical nursing (3rd
Australian and New Zealand ed.). Sydney: Wolters Kluwer Health/ Lippincott Williams &
Wilkins.McCance, K., Heuther, S., Brashers, V., & Rote, N. (Ed.). (2010). Pathophysiology: The
biologic basis for disease in adults and children (6th ed.). St. Louis: Mosby
Elsevier.McKenna, L. & Lim, A. G. (2012). Pharmacology for nursing and midwifery. (1st
Australian and New Zealand Edition). Broadway: Lippincott Williams & WilkinsRequired
texts (From BN 1st year):Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T., Dwyer,
T., et al. (2012). Kozier and Erb?s fundamentals of nursing. (2nd Australian ed.) French?s
Forest, NSW: Pearson Australia.Tollefson, J. (2010). Clinical psychomotor skills: Assessment
tools for nursing students (4th ed.). South Melbourne: Cengage LearningRecommended
references: Nursing and Midwifery Board of Australia. (2006). National competency
standards for the registered nurse. Retrieved from
http://www.nursingmidwiferyboard.gov.au/Codes- Guidelines-Statements/Codes-
Guidelines.aspxNursing and Midwifery Board of Australia. (2013). Codes and guidelines.
Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-

3. Statements/Codes- Guidelines.aspxForrester, K., & Griffiths, D. (2010). Essentials of law for
health professionals (3rd ed.). Sydney: Mosby Elsevier.King, J., Hawley, R., & Weller, B.F.
(Eds.) (2008). Australian nurses? dictionary (4th ed.). Sydney: Balliere Tindall.Perrin, R.
(2012) Pocket guide to APA Style (4th ed.) Boston Massachusetts: Wadsworth/