Assessment item 3 Case Analysis – Scenario

Question:

Background:

Assessment item 3 Case Analysis – Scenario

Mr David (Dave) Porter, is an 83-year-old widowed man who lives alone on his farm. He has a son who is married (no names have been provided by Mr Porter) and they are a four hour drive away from Mr Porter.

Mr Porter was head butted by a horned ram yesterday, whilst in the sheep yards, preparing them for the shearers. A shearer called an ambulance and Mr Porter was transferred to a large rural hospital and arrived in ED at 1800 hours. An x-ray at 1900 hours in the Emergency Department (ED) confirmed a closed transverse fracture to the shaft of the right femur. Staff in ED prepared him for surgery and awaited advice from the Orthopaedic Surgeon.

Mr Porter is allergic to Morphine, reporting a history of a severe rash on two separate occasions when previously given this medication. He has a history of:

• Hypertension;
• Osteoarthritis;
• Gastro-oesophageal reflux disease;
• Atrial fibrillation; and
• Congestive cardiac

Mr Porter’s usual medications include:

• Apixaban 5mg PO BD;
• Metoprolol 25mg PO BD;
• Digoxin 62.5mcg PO daily;
• Frusemide 40mg PO BD (mane/midi); and
• Nexium 40mg PO

Pre-operative (baseline) observations:

• BP: 170/65 mmHg;
• HR: 98 bpm (irregular);
• RR: 20/minute;
• SpO2: 96% on room air
• Peripheral pulses present R=L;
• Cap refill <3secs R=L;
• GCS 15/15; and
• Temp: 0°C.

Mr Porter was administered all of his regular morning medications, except Apixaban 5mg, prior to theatre at 0630 hours this morning. At 0800 hours, Mr Porter was taken to the Operating Theatre (OT) from Emergency for an open reduction and internal fixation of the fracture. Following this operation, he was transferred to the Post-Anaesthetic Care Unit (PACU) at 1200 hours. Post- operative orders include:

• VTE prophylaxis;
• Triflow / deep breathing exercises;
• Bellovac wound drainage, hourly checks until review by Orthopaedic team;
• Leave dressing intact until Ortho Team review;
• Bedrest until Physio review;
• Analgesia as charted;

• IV fluids as charted;
• Prophylactic antibiotics for 48 hours post OT as charted;
• IDC q1h measures;
• Blood transfusion as per orders;
• Light diet and fluids orally as

You are working as a Registered Nurse in the Orthopaedic Surgical Ward and you have been allocated Mr Porter for your shift. You receive a call from Mr Porter’s son at 1200 hours, he states his name is John. John has asked you to call him when his father arrives on the ward to be given an update on Mr Porter’s condition. There is no indication on record of who his Mr Porter’s next of kin.

The PACU Registered Nurse (RN) accompanying Mr Porter arrives on the Orthopaedic Ward and is handing over to you at 1400 hours. All of the observations last taken in the PACU until were within the normal ranges for that unit. The nurse mentions Mr Porter had all of his regular medications prior to theatre at 0630 hours, the Apixaban was withheld, and in the PACU post operatively, he was administered:

• Cefazolin 2g IV BD;
• Heparin 5000 units SC BD; and
• PRN orders include Fentanyl 50mcg IV every 3/24.

There are two peripheral intravenous cannula inserted (one in each forearm). Mr Porter has received in OT:

• 2 litres of Sodium Chloride 9%;
• 1 unit of Packed Red Blood Cells (PRBC); and
• Currently has 1 litre of Hartmann’s solution running over 4 hours that was commenced at 1300 hours.

The PACU RN also states in the clinical handover that Mr Porter complained of pain about ten minutes ago but the staff in the PACU determined not to give him analgesia due to his observations being within normal limits and “he didn’t look like he was in too much pain”. She also mentioned that Mr Porter’s haemoglobin result was 72 Hb g/L just before he was transferred and he has been ordered another unit of PRBC that is ready at the Blood Bank to be collected and commenced as the blood from the Bellovac is not able to be used.

This patient is now under your care.

Observations taken by you after arrival to Orthopaedic Ward at 1415 hours:

• BP: 103/50 mmHg;
• HR: 81 bpm (irregular);
• RR: 22/minute;
• SpO2: 94% with Nasal Prongs 3L/min;
• Temp: 1°C;
• Pain Score – 7/10;
• GCS – 13/15.

When you speak to Mr Porter he wakes to your voice and answers simple questions appropriately yet is slightly confused saying that he was “just about to close the yard gate”, he obeys your commands, and returns to sleep when you stop speaking to him.

Address the questions outlined in the Subject Outline.

Assessment item 3 – Case Analysis

back to top

Value: 50%

Due Date: 25-Sep-2020

Return Date: 20-Oct-2020

Length: 2000 words

Submission method options: EASTS (online)

Task

back to top

In this task, the student needs review the provided scenario in the Subject I2 Site. The patient for this case analysis assessment is Mr David Porter. All of the details needed to complete this assessment can be found on the Subject I2 site under the Assessments tab.

To complete this case analysis each question listed below must be completed and applied to Mr Porter’s case. Throughout this case analysis, your responses need to be supported by current (less than weven (7) years), peer-reviewed, scholarly sources. The emphasis of this subject is the connection between theory and practice so the student needs to ensure that theory and evidence underpin all areas of their response.

Introduction (suggested 200 words)

• Comment on the importance of connection between theory and nursing practice;
• Outline the key aspects of the patient, Mr Porter;
• Outline the content of your paper.

Body (suggested 1600 words)

Question 1: Apply the A2K Assessment Framework (Primary and Secondary Survey) to Mr Porter’s case and differentiate between the normal and abnormal clinical findings. Propose at least two (2) nursing assessments that are indicated based on the abnormal findings and explain why these assessments are necessary.

Question 2: Identify one (1) nursing intervention (medication OR Intravenous fluid OR blood product) that has been prescribed for the patient and explain:

• why the intervention is specifically indicated;
• the safety considerations (including the ‘5 Rights’) needed when a nurse is administering this intervention;
• why a nurse should administer the intervention OR why a nurse might choose to withhold the intervention and seek clarification.

Question 3: Identify and relate one (1) Standard of Practice (NMBA, 2016) AND one (1) fundamental responsibility from the ICN Code of Ethics for nurses (ICN, 2012) to the nursing care of the patient in the scenario.

Conclusion (recommended 200 words)

• Summarise the key points covered in the paper;
• Comment on the impact that the assessment has had on your learning about the connection between theory and nursing practice;
• Do not include new information in this section

Throughout this case analysis, your responses need to be supported with a minimum of 12 current (less than 5 years), peer-reviewed, scholarly sources.

Rationale

back to top

Subject learning outcomes

This assessment task will assess the following learning outcome/s:

• be able to demonstrate a broad foundational knowledge of the legal, ethical and professional knowledge required for safe and accountable practice (aligns with Nursing and Midwifery Board of Australia National Competency Standards for the Registered Nurse: 1.1, 1.2, 2.2, 2.5, 2.6, 9.3, 9.5).
• be able to conduct and document a comprehensive health assessment and physical assessment (NMBA 1.2, 2.2, 2.5, 2.6, 5.1, 5.2, 5.3, 7.4, 8.1).
• be able to apply theoretical knowledge, critical thinking and clinical decision making skills to provide safe, person-centred nursing care in a workplace learning experience (NMBA 1.2, 2.2, 2.3, 2.5, 2.6, 6.1, 6.2, 6.3, 6.4, 7.1, 7.2, 7.4, 7.7, 7.8, 8.1, 8.2, 9.3, 9.4, 9.5, 10.3).
• be able to access health information and research, and critically evaluate its application to address complex problems in the clinical setting (NMBA 2.6, 4.1, 5.1, 5.3, 9.3).
• be able to apply theoretical knowledge to the safely administer and monitor the effects of medications, intravenous fluids and blood products (NMBA 1.2, 2.5, 7.2, 7.4, 9.3, 9.5).

The emphasis of this subject is the connection between theory and practice so you need to ensure that theory and evidence underpin all areas of your response.

Graduate learning outcomes

This task also contributes to the assessment of the following CSU Graduate Learning Outcome/s:

• Academic Literacy and Numeracy (Skill) – CSU Graduates demonstrate the literacy and numeracy skills necessary to understand and interpret information and communicate effectively according to the context.
• Information and Research Literacies (Skill) – CSU Graduates demonstrate the skills required to locate, access and critically evaluate existing information and data.
• Professional Practice (Skill) – CSU Graduates demonstrate discipline-specific technical capabilities and self-appraisal required for a beginning practitioner or professional.

Marking criteria and standards

back to top

Presentation

back to top

Scholarly papers, reports, or other similar assessment items must be ‘word processed’ and not handwritten. Requirements include:

• Leave 2 cm margins and double line space your work;
• Use 12pt font, throughout the entire assessment;
• Number all pages;
• Insert student name and number in header or footer of every page of every assessment; and
• Include a title page that includes the subject name and code, title of the assessment task, due date, lecturer’s name, student’s name and student’s number.

Requirements

back to top

Referencing

Correct and consistent referencing is an important component of producing professional and credible academic work. Marks will be awarded for high quality referencing.

Please refer to the following text for information on how to reference your paper:

American Psychological Association (APA). (2020). Publication Manual of the American Psychological Association (7th ed.). Washington DC: APA.

Students may also access CSU’s Academic Referencing Tool (ART) which provides detailed referencing examples for the referencing style – APA 7th. This resource can be accessed at https://www.csu.edu.au/current-students/learning-resources/build-your-skills/academic-skills-help/referencing

Resources to assist with case analysis

Other Resources that may be helpful when considering this assessment –

• Emergency Care Institute – care of fractured femur https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal/musculoskeletal-orthopaedic-guide/femoral-shaft-and-distal-femur
• Elderly Trauma Pain Guidelines – https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0017/304325/2013_Elderly_Trauma_Pain_Guidelines_SVH.pdf
• Lower Limb Fracture management from Western NSW LHD – this ppt has information for all lower limb fractures, including femoral fractures. Lower Limb Fractures Management from Western NSW Health LHD.pdf
• NSW Health Documentation and Management policy directive at this link https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_069.pdf