Mrs Stella Thomas Case Study - Inguinal Hernia - Nursing Assignment Help

Assignment Task:

Case Study One.
Mrs. Stella Thomas is a 64-year-old woman admitted to your ward for repair of an inguinal hernia. She is scheduled for surgery some time during your morning shift. She has been fasting from 6am after a light breakfast and has had her morning medications with a sip of water. She weighs 75kg and is 160cm tall. She has a past history of Type 2 Diabetes Mellitus (diet controlled), hypertension and smoking. 

Medications
Irbesartan 150mg oral daily(Used to treat high blood pressure – hypertension and diabetic nephropathy which is also knows as kidney disease. Kidneys have been damaged from having diabetes. High BGL due to diabetes can damage the part of the kidneys that filters the blood). 

Atorvastatin 40mg nocte(Used along with a proper diet to help lower ‘bad’ cholesterol and fats)

She has IV fluids 1L 0.9% Sodium Chloride 10/24 rate, and 6hourly BGLs.

At 0900 hours her vital signs are: 
HR 89 (regular)
BP 149/74 mmHg
RR 18
Temperature 36.7C 
SpO2 97% on RA
BGL 6.9mmol/L

At 0930 hours you go to answer Mrs. Thomas toilet buzzer. As you enter the room you see her sitting on the toilet looking extremely anxious and has her hand clutching her left side of chest. She looks up at you and says, “I don’t feel good, I have terrible pain here” (She is pointing to the left side of her chest). 

You are the Registered Nurse caring for Stella Thomas.

In order for nurses to provide safe, quality person-centred nursing care, their practice must comprise ofa comprehensive assessment, the development of a nursing plan, implementation of the care and evaluation of outcomes(NMBA, 2016).

Instructions:

Your case study will include a number of findings that will assist you in addressing the below criteria.

1. Identify and describe the subjective and objective assessment findings outlined in the case study that are applicable to the patient’s acute condition (approx 300 word)

Subjective – Upon attending to my patient she was looking extremely anxious whilst sitting on the toilet. Mrs Thomas stated that she does not feel good and that she has terrible pain. 

Objective – Mrs Thomas was guarding the left side of her chest with her hand whilst explaining to the nurse the severity of pain that she was in.  

Whilst attending to Mrs Thomas, nurse walks into the toilet pressing the emergency buzzer as she is requiring urgent help.  Nurse asked Mrs Thomas if she was in pain and what her pain was as the nurse could see that she was anxious and not feeling good.  

Mrs Thomas was transferred back to her bed with help from other nursing staff, where Nurse attended to the patient’s vital signs, blood glucose level (BGL) which included a Glasgow Coma Scale (GCS). Nurse also performed an Electrocardiography (ECG). 

The nurse can initiate anguinine to help with the chest pain. 

Is the patient SOB? 

Is the pain radiating down the left side/arm

The patient could be having pre operation anxiety attack or she could be having an angina attack. 

2. Document the relevant focused assessment findings centred on the patient’s acute condition (approx 400 word)
Whilst caring for Mrs Thomas the nurse would perform an assessment, which includes an A-G, Pain assessment – PQRST..
All of Mrs Thomas’ observations are within normal ranges 

Airway–Patent, maintaining own airway, speaking full sentences, In respiratory distress. 
Breathing – Respiratory rate is 18, Oxygen Saturation (Sp02) levels 97% on Room Air. These rates are all within the normal ranges. 
Circulation – Heart Rate is 89 and regular, Blood Pressure (BP) is 149/74mmHg. All observations are in the normal ranges. 
Disability - GCS? PQRST?
Exposure – Temperature 36.7 degrees 
Fluids – IVC insitu and patent. 1Litre of 0.9% Sodium Chloride running over 10 hours in a 24 hour period.  A Fluid Balance Chart (FBC) should completed, this records input and output to ensure that the patient is not retaining any fluids.  
FBC should have all intake and output so IV intake, oral and output whether that be urine or vomit or diarrhoea. 
Glucose – Blood Glucose Level (BGL) is 6.9mmol/L at 09:00hrs.  This is to be taken every 6 hours.

Mrs Thomas is experiencing left sided chest pain and states that she does not feel

3. Based on the assessment findings, formulate appropriate nursing interventions and analyse how you will prioritise their implementation using evidence-based nursing literature to support your care decisions (approx 600 word)
As a nurse completing an assessment of my patient and formulating a nursing care plan 

What would you do as a nurse?
APIE assessment 
Assessment – Objective and Subjective data 
Planning – what am I going to do to help this patient? How can we get them better. How are we going to help them overcome the diagnosis. Must be measureable. 
Pathophysiology or med surg book
Interventions – this is what we are going to do to get the patient to meet their goals (planning)
Evaluation – how is the patient meeting the goals..

Assessment: 
Subjective – Patient says she does not feel good, I have terrible pain. 
Objective - Patient sitting on the toilet and is hand clutching the left side of her chest.  All her vital signs are within the normal ranges.
Planning – After 8 hours of nursing intervention the patient will: 
• Remain free from pain 
• Maintain stable vital signs 
• Maintain relaxed body posture 

Intervention 
• Assess for vital signs and symptoms of pain such as facial grimacing, rubbing of neck or jaw, reluctance to move, increased blood pressure, and tachycardia. 
o Note onset, duration, location, and pattern of pain. 
• Use a pain rating scale to assess the patient’s perception of the pain’s severity 
• Administer sublingual nitro-glycerine as ordered 
• Instruct the patient to notify a nurse immediately when experiencing pain.  Have the patient stop current activity, and place her on bed rest in a semi to high fowlers position. 

Evaluation – after 8 hours of nursing intervention the patient was free from pain, maintains stable vital signs and relaxed body posture. 

4. Choose two (2) constructs (e.g. Knowing self, shared decision making, engaging authentically) from the Person-Centred Practice Framework (McCormack & McCance, 2017) and consider how these constructs enhance person-centred care delivery to your patient (approx 500 word)

5. Briefly describe how you would evaluate the care provided to your case study patient (approx 200 words) 

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