Recent Question/Assignment

Kathleen Johnson is 45 years old and works in a library part-time returning books to the shelves. Kathleen is very overweight (BMI 40kg/m2) and has Type 2 diabetes, which she tries to control with diet. Kathleen is the sole carer for her father, who has dementia. Kathleen admits to consuming up to four bottles of beer a night, several glasses of whisky as well as smoking a packet of cigarettes a day and drinking several cups of coffee, which she says is to help her cope with stress of managing her father, her diabetes and her appearance.
Kathleen was admitted to hospital for sleeve gastrectomy surgery for weight loss.
After 2 hours in the post-anaesthetic recovery room (PARU) and an uneventful recovery, Kathleen was transferred to the ward, where you have been allocated to her care.
On return to the ward Kathleen’s observations are as follows:
• Respirations 28 breaths per minute
• BP 190/100
• Pulse 130 beats per minute
• Temperature remains 35.1oC
• Pain score 7/10
• Indwelling urinary catheter (IDC) 5mls in the last hour
• Nasogastric tube 50mls of gastric fluid
It is planned for Kathleen to be discharged after two days on the ward.
Questions to be addressed:
In relation to Kathleen Johnson:
Q1. Discuss the aetiology and pathophysiology of the patient’s presenting condition
Q2. Critically discuss the underlying pathophysiology of the patient’s post-operative deterioration. Prioritize, outline and justify the appropriate nursing management of the patient during this time
Q3. Identify three (3) members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement.
Specific guidance case study Kathleen Johnson
Provide an introduction to the case study – what are you going to discuss. Write the introduction last you know what you have discussed.
? Discuss the aetiology & pathophysiology of obesity – where does the problem arise what is obesity?
? What are the effects of untreated obesity?
? What is the cause?
? How does surgery manage obesity?
(Review A&P books, Brown et al, pathophysiology books and literature via Google Scholar or UpToDate)
Kathleen is 2hrs post-op and she has some abnormal vital signs
? Discuss aetiology and pathophysiology of Kathleen’s vital signs post-op. E.g. what are normal vital signs (reference required) How do her vital signs link to her presenting condition e.g. alcohol, obesity & hypertension, smoking.
? What could be the causes of all her symptoms if taken together.
? What is the impact of pain on Kathleen’s vital signs
? What is the normal hourly urine output (reference required) and what reasons could Kathleen have for low output
(Review A&P books, Brown et al, pathophysiology books and literature via Google Scholar or UpToDate)
Priorities of care
? What are Kathleen’s specific care needs 2hrs post-op in relation to removal of part of her stomach
? What do you need to do about her abnormal vital signs
? What is safe care 2hrs post-operatively for Kathleen?
(Review Brown et al 2015 or other academic sources)
? Review Kathleen’s history. Which MDT professionals would assist Kathleen’s long term recovery
(You can use the professional websites for the roles of the MDT referrals and how they would help Susan or other academic sources)
Provide a conclusion to your case study which sums up the main findings i.e. what you learned about obesity and your care not ‘I discussed that and I discussed that’.
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