NURS3001 Nursing Case Study On Theoretical Positions

by Peter Hill January 31, 2017

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Case Study

Instructions Essay – NURS3001

Students are required to:

Make connections to the client scenario for Mrs Green (see excerpt below, for full case information see Caseworld)

. Reflect on the information presented, and through the process of clinical reasoning, problem solve and determine effective priorities for interventions that will appropriately support Mrs Green in the specific nursing issue/priority chosen as a focus for Assignment 2

. Document findings and develop a comprehensive plan of care (to be attached to the essay)

§  use clinical reasoning as the clinical decision making framework to analyse and present the essay and a plan of care for Mrs Green (see§ details of the clinical reasoning decision making framework in Modules 1, 2 and 6)  provide a rationale for the problem solving undertaken and the priorities of care determined for Mrs Green

§  Substantiate all arguments in the essay by drawing upon contemporary evidence from reputable scholarly texts and other peer reviewed literature using the Harvard referencing style as per SoNM guidelines.

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Instructions Essay – NURS3001 

As a Registered Nurse working in the Cardiac Care Ward, you have just met Mrs Green who is back from surgery. Mrs Elizabeth Green is a 78-year-old lady who lives alone in a single storey unit. Elizabeth has one son and daughter and 5 grandchildren.

She is a retired widow, living alone in her own ground floor unit. She utilises a Webster pack for medication, and employs a private cleaner once a week. She does not drive and prefers to use a taxi for transport.

Mrs Green has had a femoral angioplasty performed. A blockage is found in Mrs Green’s Left Anterior Descending artery, which is able to be successfully stented. Other cardiac vessels viewed have 10-20% occlusion. Mrs Green is diagnosed with an anterior MI with LAD occlusion. Mrs Green is transferred from the Angio Suite Recovery area to the Cardiac Care Ward at 1250. Handover from Angio Suite Recovery Nursing Staff states that Mrs Green has had an unremarkable recovery post procedure. GTN has been ceased prior to returning back to the ward. The pump with the GTN is turned off, but remains connected to the IV cannula.

1250 On arrival to the ward her observations are:

BP 145/90 HR 85 beats per minute RR 24 respirations per minute Temperature 35.8C SpO2 98% on 6L O2 via CIG BGL: 5mmol Pain: No reported chest pain RIGHT foot is warm, pink with normal movement and sensation, pulse present LEFT foot is pale, cool, with normal movement and sensation, pulse present. Puncture site soft, bleeding on dressing noted to be a size of a “10 cent size”

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1300 Observations:

BP 155/90 HR 85 beats per minute RR 26 respirations per minute Temperature 35.8C SpO2 99% on 6L O2 BGL: 5mmol Pain: No reported chest pain RIGHT foot is warm, pink with normal movement and sensation, pulse present Puncture site soft, “5 cent size” of bleeding on dressing. No pain reported Assignment 2 I Cardiac Care Ward-1400

Cardiologist Review The cardiologist reviews Mrs Green at 1400, approximately 1hour post procedure due to Mrs Green’s Left foot being pale and cool. Eliza attends the Cardiologists round and review of Mrs Green. She highlights to the Cardiologist that the Left Foot remains pale and cool and that Dorsal and Pedal pulses are present. The Cardiologist performs a Doppler ultrasound on the Left foot, and determines that there is adequate blood flow, but requests that half hourly neurovascular observations to continue for another 2 hours to monitor for any changes.

At 1400 Mrs Green’s observations are: BP 140/80 HR 88 SaO2 99% on 6L via CIG Pain: No reported chest pain LEFT foot pale, cool, normal movement and sensation, pulse present RIGHT foot is warm, pink with normal movement and sensation, pulse present Puncture site soft, no bleeding.

Cardiac Care Ward-1430

At 1430, Mrs Green asks John who has just come on for the late shift, if he could disconnect her GTN infusion as it is restricting her arm movement. John has not received handover as of yet and is relieving on the ward. Nevertheless John agrees to disconnect the GTN infusion as it appears to be turned off. Whilst disconnecting the infusion, Mrs Green states that “…the cannula is very sore and could he do something about it?” John advises Mrs Green that he will flush her cannula. When the cannula is flushed Mrs Green shouts out to John that this is very painful, however he persists and slowly the discomfort around Mrs Greens IV cannula site eases. 1450 Mary the late shift RN introduces herself to Mrs Green. Mrs Green advises Mary that she is feeling very light headed. Mary assesses Mrs Green. The solution of this nursing case study has been prepared by assignment help experts after a thorough study of all aspects of the given case study.

1450 Observations:  BP 100/50 HR 80 beats per minute RR 18 breaths per minute SaO2 99% on 4L O2 via nasal specs Pain: No reported chest pain LEFT foot pink, warm, normal movement and sensation, pulse present RIGHT foot is warm, pink with normal movement and sensation, pulse present Puncture site soft, no bleeding.

1500 Observations: BP 110/66 HR 88 beats per minute RR 20 breaths per minute SaO2 99% on 4L O2 via nasal specs Pain: No reported chest pain LEFT foot pink, warm, normal movement and sensation, pulse present RIGHT foot is warm, pink with normal movement and sensation, pulse resent Puncture site soft, no bleeding.

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