Special conditions

Case Details

As a new graduate nurse on your last rotation, you are working on a busy 50 bed surgical ward (upper
gastrointestinal surgical specialty). You have arrived for an evening shift and receive handoverfrom
the stafffrom the previous

shift.

You have been allocated 6 patients to care for. Their details are as follows:

Bed 1: Linda is a 40 year old female that presented

with a 24 hour history of gradual upper

abdominal pain radiating to the right upper quadrant. She is now febrile 38.7.

Bed 2: Jayne is a

35 year old female with vague upper abdominal discomfort over several days and

noticed skin and eyes turning yellow and urine becoming

dark. She has a past history (PHx)

of intravenous drug user (IVDU).

Bed 3: Max is a 20 year old male with recurrent peptic ulcer disease

who presented with

haematemesis; he is currently on a Pantoprazole infusion via a syringe driver (concentration:

1mg per ml running at

5mls per hr).

Bed 4: Phillip is a 55 year old male with oesophageal cancerthat was surgically excised yesterday,
he has a tracheostomy

insitu that requires regular suctioning.

Bed 5: Colleen is a 50 year old female with severe alcoholic liver disease brought in by ambulance
(BIBA) following severe haematemesis and melaena – she required an ICU admission for
haemorrhage control and administration of blood

products. She was transferred from the ICU

to yourward earlier on in the day.

Bed 6: Tony is a 55 year male with history of severe

epigastric pain that is associated with nausea.

He has a past history of non-compliant Type 2 Diabetes. He is scheduled for an endoscopy

and is currently nil by mouth. He has a 5% Dextrose infusion running at 1oomls/hr and an

insulin infusion (Actrapid 50 units in 5omls)

running at 4 units per hourvia a syringe driver.

O1. Prioritise and discuss how you will initially assess your

care according to your patients’ conditions

and treatment (500 words).

02. While assessing your patients, you record a blood glucose

level (BGL) on patient 6. Your reading

on the BGL monitor returns a level of1.5 mmol/L. The patient responds to voice on the AVPU
scale,

he is cool and clammy to touch. What is the significance ofthis result? Referring to the
ward protocol attached (page 24), rationalise

your actions (500 words).

03. It is now 20oohrs. You find that much ofthe nursing care you are trying to provide to your patients
is

taking longerthan you expected and you haven’t had an opportunity to record your 18oohr
observations or administer your medications.

Discuss why it is important to seek assistance and

identify who may be the resource people that can assist you (250 words).

04. The alarm

sounds on the infusion pump with your patient in bed 3. You find that the Pantoprazole
infusion has completed and you are required to draw

up a new one. You then notice the patient

across the room in bed 4 has been coughing consistently and vigorously, and notice blood
stained

sputum from the tracheostomy. What would be your interventions in this case scenario
and what would be the priority for your actions? (250)

words