NRSG258 2021 Assessment 1- Case Study Incident: 72 yr old female Mrs Geraldine Berry sustained left fractured neck of femur (#NOF) and laceration to her head 5cm while walking her dog. Tripped on an uneven pathway. PMH: Hypertension and depression Current Medications: Coversyl 5mg Doxepin 25mg daily Atorvastatin 40mg daily SHx: Lives with elderly husband. Is the primary carer for elderly husband who has had a stroke previously and is mildly impaired. Attends church every Sunday and is responsible for arranging flowers for every Sunday service. She has started volunteering at the St Vincent De Paul’s Meals on Wheels distribution centre two days a week. She lost two children 5 years ago in a car accident. Geraldine is concerned who will look after her husband and their dog Nala. Geraldine and her husband have no children or relatives nearby. Current presentation Day 3 post op left total hip replacement, increasing pain in hip unable to weight bear, pain score currently 7/10. Geraldine has been prescribed oral tramadol tds, Ibroprofen prn, paracetamol prn, IV Amoxicillin 1000mg tds and Clexane 40mg SC BD. Suture line on hip appears red and swollen. Observations – 10am Day 3 Pulse Rate – 120 Respiratory rate – 22 Blood pressure – 120/80 Pain score – 7/10 Sa02 – 96% Temperature – 39.1 BGL – 6.8 mmol/l Glasgow Coma Score 15 Heat, pain and redness at suture site Refusing to mobilise due to pain NRSG258 Version 1 Feb 2021 Questions 1. Using the CRC and the information presented about Geraldine, identify the abnormal cues, and discuss why these are considered abnormal (200 words) (LO4). 2. Using relevant literature, discuss the pathophysiology related to the two post- operative issues of concern from the abnormal cues you have identified in question one (500 words) (LO1, LO4). 3. Using the template provided below, complete all the sections which include (200 words) (LO4, LO5): a. b. Identify the nursing goal for each identified issue/problem (2). List at least two nursing interventions for each issue/problem. Problem Goal Interventions 1. 2. 4. Using relevant literature, provide a rationale for the listed interventions and discuss how the interventions will be evaluated (500 words) ( LO1, LO3, LO4, LO5). 5. Identify 2 medications that were prescribed for the patient’s pre-operative condition. (Coversyl 5mg, Doxepin 25mg daily, Atorvastatin 40mg daily) used in this case study. Provide the mechanism of action, side effects correct dosage and contraindications for each medication. Explain how this might affect Geraldine in the post-operative period (400 words) (LO1, LO3, LO4, LO5). 6. Using the Roper-Logan Tierney Model, identify one (1) potential cultural/biopsychosocial issue/problem and discuss how this will affect the patient post-operatively or on discharge (200 words) (LO3, LO2).