NSB024 NURSING PRACTICE IN CONTEXT 4
ASSESSMENT 1 – Written Assignment
Length: 2,500 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
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? ? ? 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:
? His right leg is cool to touch;
? Pain Score is 7 on a scale of 1-10;
? Fracture site and pin sites are 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 6ltires 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, in pathophysiological terms, how Mr Jensen’s current problem may affect his other two co-morbid conditions (approximately 600 words).
2. You’ve undertaken your physical assessment of Mr Jensen, identify what your physical examination will have produced, for example, vital signs, musculoskeletal assessment, neurovascular assessment etc. (approximately 400 words);
3. Identify Mr Jensen’s actual PRIORITY problems. Justify each problem based on the data collected from Mr Jensen’s physical assessment with reference to the evidence-based literature (approximately 500 words).
4. For each problem identified, describe one (1) nursing goal for his care (approximately 200 words).
5. Choose two (2) of the identified goals, and justify, with a synthesis and an analysis of the evidence-based literature, nursing interventions to assist in achieving the identified goals. (approximately 800 words).