Reference no: EM133221188

Case senario 

Anne-Marie: Hi, good morning. It's great to meet you. My name is Anne-Marie. We're gonna be working together today. I've actually already received the handover off the night nurse, so let me get you up to speed. Urm.... We'll start with Mr George. He's a 69-year-old gentleman. He has an Italian background and he has limited English. He lives at home with his wife. So his situation is, Mr George was brought in to the Emergency Department three days ago. Unfortunately he had a fall in his daughter's back garden and he fractured his left neck of femur. So the same day he had, errr, some theatre for that. He had an open reduction and internal fixation. So currently Stephen actually has a dressing on his left hip, and we need to actually redress that at some point in today's shift, errrr, when we get a chance. So previously he's not had any walking aids. He walked independently. But he now has a pick-up frame after the physiotherapist has come to review him. Mr George's children actually voiced that they had some concerns about him and his wife coping at home, so we might explore that a little bit later. Ermmm, he's refusing to discuss it at the minute, unfortunately. So let's pull it out a bit more. Background wise, he's got a past medical history of atrial fibrillation, asthma, hypertension, hypercholestraemia, and heart failure. He's also allergic to penicillin, 'scuse me, need a coffee this morning! He's allergic to penicillin and he, errrr, has an anaphylaxis to that. He's also had some increasing episodes of confusion over the last two months. He's also, as well, had a little bit of functional urinary incontinence the last couple of weeks. With some occasional periods of aggression. So on assessment, the night duty nurse mentioned that Mr George hasn't actually really slept very much, and he's been quite restless and shouting out. The physiotherapist has also, erm, authorised his mobility over short periods. So they mentioned, he can go to the toilet and back, but he needs some supervision, from the nurse ideally, and a pick-up frame when he is mobilising. However, Mr George has actually been refusing to mobilise and ambulate, and the staff have actually been using a sling lifter for all his transfers. He's got some obs and medication charts that we can have a look at together in a couple of minutes. 

Anne-Marie: Erm, it's also worth mentioning, erm, the night duty nurse said Mr George's pain has been a big issue last night, erm, he's required two doses of immediate-release oxycodone overnight. So he had one dose at 2230 because he was complaining of 8 out of 10 hip pain. And this morning the nurse did give him another dose, I think it was about 6-30 - we can check the chart for some more hip pain. Erm Mr George, actually, wasn't able to rate his pain when the nurse did check this morning, but he was clearly uncomfortable. So I think what we probably need to do now is go and evaluate the effectiveness of that, er, 6-30 dose of analgaesia, because the nurse hasn't had a chance to get back to him. The physiotherapist has also tried to get us to encourage some mobility as well, just over short distances, as he's tolerating it. Erm, I think, as well, what we need to do is have a look at his medication He's had quite a lot of oxycodone, so we might need to get that PRN dose reviewed. 

Background

You need to prepare a report outlining your response to the handover.

During this stage the nurse begins to collect relevant information by asking questions and performing a brief primary assessment.

• What are the components of a comprehensive primary assessment that are clinically appropriate for Mr George?
• Identify any areas of concern in the primary assessment you would like to highlight for Mr George. Your answers may be in dot point form for this section only.

Focussed Assessment

Based on the findings of the primary assessment,  the nurse begins to collect  information by asking relevant questions and performing a focussed assessment.

• Choose three (3) priority systems to assess and provide rationale for why you have prioritised these three (3) systems. Look for clues in the case information/handover/notes to ensure your choice is relevant to the case.
• Identify any other relevant information/assessment connected to your three (3) systems (focussed assessments) you would like to know more about to ensure a thorough focussed assessment has occurred.

Identifying Nursing Problems

In this stage, the nurse synthesises all the information that has been collected and identifies the most urgent patient problems.

• Discuss the physical assessment findings that may alert you to physiological deterioration and explain why the findings are concerning.
• Identify and prioritise two (2) actual patient problems and provide rationale for your prioritising of each patient problem.
• Identify and prioritise two (2) potential problems of concern for this patient, and provide a rationale for each of your choices. These problems must be of significance and relevance to the patient in this case.

Planning and Implementing Care

Based on Mr George's nursing problems, the nurse selects the most appropriate course of action and prioritises interventions.

Discuss four (4) key evidence-based nursing interventions, including brief rationales for each intervention.

• Interventions may relate to Mr George's presentation at 0730 or be based on the 'bigger picture' of her needs during admission.
• Interventions must be prioritised.
• Interventions need to be nursing interventions, not medical.
• Interventions must not be generic (i.e. vital signs, medication rounds are relevant to all patients; you should focus on interventions specific to Mr George's needs.)

Evaluation

This stage requires the nurse to evaluate each of the four (4) proposed interventions and determine whether the patient's condition has improved. This is how you will determine if the interventions you proposed have been successful.

• What physical assessment findings would indicate that the four (4) nursing interventions you have suggested, have been effective or not? For each intervention you have identified, state at least one (1) way you can evaluate if the intervention has worked or not.
• You may include your evaluation as part of your planning and implementing section.