History of Abdominal Pain and Diarrhoea - Nursing Assignment Help

Assignment Task

Task
Case Study Mrs Wendy Green a 64-year-old Teacher presented to her GP three weeks ago with a 3-month history of abdominal pain and diarrhoea. A colonoscopy and CT scan revealed a tumour in the ascending colon. Wendy was scheduled for an open right hemi-colectomy.
Please refer to the following pre- and post-operative assessment data to answer the assignment questions.
Pre-operative clinical data
Objective Data Past Medical History Social History
Weight reported 92kgs
Height reported 168 cm
BP 155/100
HR 88
RR 18
Temp 38.8C
Urinalysis - normal
Current Medication
Simvastatin 40mg nocte
Captopril 100 mg mane
Aspirin 100 mg mane
Ventolin prn Hypercholesterolemia
Hypertension
Asthma
Obstructive sleep apnoea (OSA) confirmed with sleep study January 2011
Uses CPAP machine at night
Myocardial infarction (MI) 2007 with left coronary artery stenting Married with 2 grown children
Teacher
Consumes 6 units of alcohol per day
Independent with daily cares
Smokes 10 cigarettes/day
Family history
Father RIP bowel cancer
Mother 84 years of age: history of cardiac disease
Postoperative clinical data
Wendy returned from theatre at 2000 following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis in four of the 28 dissected lymph nodes. You are the registered nurse looking after Wendy on the day shift following her surgery.
Observations 0800 Medications Post-operative orders
BP 90/55mmHg
Pulse: 110 and regular Respiratory rate: 12/min shallow SaO2 95% 2 litres via nasal prongs, Temperature 37.8°C Axilla,
Sedation score = 1-2
Vacudrain in-situ 400 ml in bag
Estimated blood loss (EBL) in OT 600ml
Urine output via a Foley IDC: 10-15 mls/hour <1ml/kg/hour last three hours
Pain score 6 on a scale of 0-10
Midline abdominal dressing (minimal ooze)
Simvastatin 40mg nocte
Captopril 100 mg/day
Aspirin 100 mg mane
Fentanyl PCA 20mcg bolus: 5 minute lockout
Regular paracetamol 1G QID (PO/IV)
Tramadol 50-100mg QID prn (PO/IV)
Oxygen 2L via nasal prongs
Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 80ml/hour
IV Cefoxitin 2gms TDS
Midline abdominal dressing
Mobilise day 1 with physiotherapist
Sips of fluid only
Remove IDC 0800, day 1
DVT prophylaxis –TED stockings
Pain management
GP follow up 2/52
OPD appointment 6/52 with Dr Bryant
Wendy will have 20 doses of adjuvant chemotherapy as an outpatient over the next three months.
Task description This assignment requires you to consider the case scenario of Wendy Green who has undergone a laparotomy.
Your answer will concentrate on the first 24 hours of post-surgical care.
Subheadings are required for each question
1. Provide an INTRODUCTION (approximately 100 words)
An introduction will provide clear scope about the direction of your assignment. This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.
Part A: Analyse the case to identify potential clinical issues and relevant nursing care (1100 words)
This section will focus on the first 24 hours of post-surgical care and involves prioritising nursing care for Wendy. Consider Wendy’s co-morbidities including obstructive sleep apnoea (OSA), previous MI, asthma, hypertension, and hypercholesterolemia in the context of having a general anaesthetic (GA) and in identifying your clinical issues.
Identify THREE (3) PRIORITY clinical issues for Wendy e.g. at risk of severe pain
Identify NURSING INTERVENTIONS for each of the three clinical issues e.g. Encourage deep breathing exercises hourly
Provide RATIONALES for each nursing intervention. Rationales justify your interventions and are referenced. Suggestion: Intervention: Encourage deep breathing exercises including use of the spirometry, hourly; Rationale: Smith (2019) surmises that this promotes normal lung expansion increases oxygen levels, and is useful in preventing pneumonia and atelectasis
Part B: Discharge planning (700 words)
Plan and prioritise discharge advice for Wendy.
In the discharge plan, consider the appropriate post-operative education for Wendy including the surgical procedure. Concisely provide a discharge plan and education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification.
Refrain from merely providing generic information. Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan.
Provide a CONCLUSION (approximately 100 words)
Your conclusion succinctly summarises the main points of your assignment but this section is not an opportunity to introduce new information.


Part A: Identifying clinical issues, proposing nursing interventions and rationales
Clinical issues Choose three (3) prioritised actual or potential clinical issues. Be mindful of the 24-hour post-operative period
Consider pathophysiology Wendy’s co-morbidities, current medications, surgery, and response to general anaesthesia
Consider the relevant assessment data you have been given in the case and other assessment data you will need to collect to care for Wendy
It is expected that the information in this section will be referenced (Academic sources 5-6 would be reasonable for this section
Prioritised interventions supported with researched rationales Evidenced based nursing interventions and rationales should relate to pathophysiological processes and aim to improve clinical outcomes.
The rationales support your interventions and justify why you have prioritised clinical issues. Rationales need to be referenced. (Academic sources 5-6 would be reasonable for this section
Part C - Discharge planning (700 words)
Consider both physiological and psychosocial aspects in discharge planning. (3-5 academic sources are expected for this section)
Conclusion (100 words) Provide a critical review and summarise the main findings of the assignment.

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