Explain, the pathophysiology of Mr Jensen?s post-operative hypovolemia and how some of his post-operative assessment data might have contributed to this. In addition explain how the body might compensate for this physiologically (approximately 800 words).
NSB024 NURSING PRACTICE IN CONTEXT 4
ASSESSMENT 1 ? Written Assignment Length: 2,200 words (? 10%) Weighting: 50% Learning Outcomes Assessed: 1, 2, 3 & 5
Case Scenario
Mr George Jensen, a 65-year old male, was brought into Emergency Department with an open fracture of his right tibia and fibula after falling from his roof while clearing the gutters. The following data were obtained on his admission:
Objective Data Past Medical Admission History Social History ? Weight 122 kgs ? Height 190 cms ? BMI 33 ? Diminished peripheral pulses ? eGFR 78mls/min/1.73m ? Hb 11.3gms/dl ? BP 155/100 ? HR 110 ? Diagnosed with type 2 diabetes mellitus 2 years ago ? on oral hypoglycaemics ? Hypertension Current Medications: ? Glibenclamide, 5mgs, Mane ? Captopril, 50mgs, BD ? Simvastatin 40mgs, Nocte, ? Rantidine 150mgs, BD ? Aspirin 75mgs, Mane ? Has 3 children and an ex-wife who live out of state; ? Has been working as a real estate agent 20hrs/wk. ? Consumes 15units of alcohol/day ? Smokes 20 roll-up cigarettes per day for last 10 years.
He was taken to theatre as an emergency case where he had an open reduction and external fixation of his fractures. He has returned to your ward at 5.30am post-operatively. You have arrived on the morning shift to find:
ASSESSMENT DATA ? His right leg is cool to touch; ? Pain Score is 7 on a scale of 1-10; ? Fracture site and pin sites have serous ooze with notable swelling of his right leg; ? Blood glucose level of 17mmols/ltr; ? His post-operative vital signs are currently, HR 107BPM, BP 104/55mmHg, temp 37.9?C Axilla, SaO2 95%, FiO2 6 ltires via Hudson mask, Resp rate 24BPM; ? Hartmans solution running at 125mls/hr via triple lumen central line situated in the right internal jugular. ? Insulin and dextrose infusion running at 2mls/hr (2 units/hr); ? Urine output via a Foley IDC is >1ml/kg/hr and dilute.
Applying your knowledge and understanding of Type 2 Diabetes, fractures and hypertension, you are asked to write an academic essay applying the following principles throughout your discussion:
1. Explain, the pathophysiology of Mr Jensen?s post-operative hypovolemia and how some of his post-operative assessment data might have contributed to this. In addition explain how the body might compensate for this physiologically (approximately 800 words). 2. Identify Mr Jensen?s actual PRIORITY problems. Justify each problem based on the data collected from Mr Jensen?s assessment data (approximately 400 words). 3. For each problem identified, describe one (1) nursing goal for his care (approximately 200 words). 4. Choose two (2) of the identified goals, and justify, with a synthesis and an analysis of the evidence-based literature, nursing interventions with rationales to assist in achieving the identified goals. (approximately 800 words).
ASSIGNMENT TIPS
The most important thing you must consider for this assignment is that it is sequential. This means you cannot answer the questions out of sequence, the assignment won’t make sense to the marker if you attempt to do this. For example to answer Q3 you should have answered Q2 first and so on.
Q1: Is asking you to consider how the stress of the operation might affect his blood pressure.
Q2: Is asking you to consider the most important problems – remember ABCDE.
Q3: Is asking you to identify patient centred nursing goals for the problems you have identified from Q2 – I would strongly urge you to review the PowerPoint on Goal Setting as to how to write a concise patient centred nursing goal.
Q4: Is asking you to only pick 2 of those nursing goals (any 2 the choice is yours) and using the literature provide an evidenced- based rationale as to why these interventions are appropriate in this case.
? Minimum 20 references; ? Can use books as references but maximum of 5 and must be no later than 5 years old; ? Can use reputable medical/nursing based websites ? 5 maximum; ? Can reference journal articles up to 10 years old; ? The assignment is a case study so can use question and answer format ? no need for introduction and conclusion; ? APA referencing as per QUT referencing policy.
NSB024, Nursing Practice in Context 4, Semester 2, 2016
NSB024 SCENARIO WRITTEN ASSIGNMENT CRA (Criterion Reference Assessment) SEMESTER 2, 2016
Student Name & Number:
Assessment Criteria
Pass Fail 7 6 5 4 3 2 1
Critical Thinking & Knowledge (60%)
Assignment content: synthesis reflects high level interpretation and critical evaluation of the question;
Assignment content: synthesis reflects good interpretation and critical evaluation of the question;
Assignment content: synthesis reflects sound interpretation and some critical evaluation of the question;
Assignment content: synthesis reflects basic interpretation and some or no critical evaluation of the question ? content not overly discerning;
Assignment content: limited synthesis reflects poor interpretation and no critical evaluation of the question ? content not discerning;
Excellent understanding of the central issues of the question ? all key issues addressed;
Good understanding of the central issues of the question ? almost all key issues addressed;
Sound understanding of the question?s central issues ? most key issues addressed;
Fair understanding of the question?s central issues ? some key issues addressed;
Poor understanding of the question?s central issues ? key issues not addressed;
Incorporates all unit concepts within topic;
Incorporates most all unit concepts within topic;
Incorporates almost unit concepts within topic;
Incorporates some unit concepts within topic
Limited unit concepts within topic;
Challenging, analytical and comprehensive justification.
Comprehensive and analytical justification.
Good justification, some analysis present.
Fair descriptive justification.
Poor justification.
Excellent application of pathophysiological and physiological concepts
Comprehensive application of pathophysiological and physiological
Good application of pathophysiological and physiological concepts
Fair application of pathophysiological and physiological concepts
Poor application of pathophysiological and physiological concepts
Content & Literature (30%)
Clear, consistent links between question and its central issues;
Consistent links between question and its central issues.
Frequent links between question and its central issues.
Some links between question and its central issues.
Limited links between question and its central issues.
Excellent content and flow of concepts/ issues resulting in clear description and justifications;
Very good content and flow of concepts / issues resulting in clear description and justifications;
Good content and flow of concepts / issues resulting in sound description and justifications.
Sound content and flow of concepts / issues resulting in adequate description and justifications.
Poor content and flow of concepts / issues resulting in poor description and justification.
NSB024, Nursing Practice in Context 4, Semester 2, 2016
Appropriate application and interpretation of recent valid (10yrs) and varied academic sources.
Appropriate application and interpretation of recent valid (10yrs) and varied academic sources.
Sound application and interpretation of principally recent valid (10yrs) academic sources.
Sound application and interpretation of mainly recent valid (10yrs) academic sources, i.e; use of mainly websites and books.
No literature cited or use of few valid academic sources.
Presentation (10%)
? Minimum 20 references; ? Can use books as references but maximum of 5 and must be no later than 5 years old; ? Can use reputable medical/nursing based websites ? 5 maximum; ? Can reference journal articles up to 10 years old;
Clear identification of the question being answered;
Clear identification of the question being answered;
Clear identification of the question being answered;
Clear identification of the question being answered.
Unclear identification of the question being
Excellent use of appropriate professional non- discriminatory language; evidence of safe reasoning
Used appropriate professional non- discriminatory language; evidence of safe reasoning
Used some appropriate professional non- discriminatory language; evidence of safe reasoning
At times mostly used appropriate professional non- discriminatory language; evidence of safe reasoning
Not appropriate professional non- discriminatory language; evidence of unsafe reasoning
Correctly cited all sources both within the text and reference list with no errors;
Correctly cited all sources both within the text and reference list with few errors;
Correctly cited most sources both within the text and reference list with some errors;
Correctly cited some sources both within the text and reference list with a number of errors;
Poor citation of sources both within the text and reference list;
Consistently and correctly used QUT APA referencing style;
Correctly used QUT APA referencing style;
Used QUT APA referencing style with minimal errors;
Used QUT APA referencing style with occasional errors;
Referencing style inconsistently applied and inaccurate;
Expressed ideas clearly, concisely and fluently with correct spelling and grammar;
Expressed ideas reasonably clearly, concisely and fluently with minimal spelling and grammatical errors;
Expressed most ideas clearly with minimal spelling and grammatical errors;
Expressed most ideas clearly with occasional spelling and grammatical error;
Poor communication of ideas with frequent spelling and grammatical error;
Did not use direct quotes;
Rarely used direct quotes;
Sometimes used direct quotes;
Sometimes used direct quotes;
Overuse of direct quotes;
Kept to word limit. Kept to word limit. Word limit over the 10% allowance.
Struggled with word limit.
Not within required word limit.
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