Reference no: EM133295562

Case senario

I: Jason is 17 year old male

Situation: Presented to the accident and emergency department after a motor vehicle accident (MVA). An X-ray confirmed a fractured right (R) tibia and broken ribs. He also has concussion from a head injury sustained in the MVA.

Background: Jason has no significant medical or surgical history. He has an allergy to Morphine.

Social History (SHx):

Lives at home with mother, step-father and siblings.
Recently completed high school, waiting to hear if he has a place in university
Recently obtained his driver's licence
Has a girlfriend Lucy
Spends a lot of time playing computer games, is not very physically active.
Assessment: Jason is 88kg and 172cm in height. Current vital signs Resp 28, O2 Sats 97% on room air (RA), BP 130/85, HR 110, Temp 37, and pain 6/10.

Recommendations: Jason is scheduled to have surgery to repair his fractured tibia, an open reduction and internal fixation (ORIF). He needs to be prepared for surgery planned this afternoon.

Q1 Jason has been on prolonged bed rest due to his surgery and injuries from the MVA.

Discuss the possible complications associated with prolonged bed rest. (Discuss some possible complications of staying in bed for a long time. Provide examples of conditions that may occur when staying in bed.)
What information would you provide to Jason and his family to prevent these complications? (What could Jason and his family do to help avoid these possible complications?)
How would you ensure Jason is stable on his feet when he is able to begin mobilising? What member of the MDT would assist you with this? (What are the safety considerations when Jason starts to mobilise? How could you ensure he does not fall or hurt himself? What member of the MDT could help Jason to start mobilising?)

Q2: Jason's breathing difficulties from his fractured ribs have impaired his chest movements and he is now de-oxygenating despite having O2 administered at 10L/min via a Hudson mask. An X-ray shows that he has a pneumothorax. The doctor inserts an intercostal chest tube attached to an UWSD (under water seal drain)

Outline the care requirements for an UWSD, consider in your answer:

What are the monitoring requirements for an UWSD? (Describe the assessments you would need to complete on a client with an UWSD. Consider in your response, assessment of both the client and the drain.)
What are the possible signs of deterioration for a client with an UWSD? (Consider what signs and symptoms you might see in a client with an UWSD that may indicate they are deteriorating?)
The scope of practice for an EN caring for a client with an UWSD? (Consider what nursing care can you provide, as an EN, for a client with an UWSD?)
What education would you provide to Jason and his relatives relating to the UWSD? (What information could you give Jason and his family about caring for an UWSD. How can they help? What might reassure them?)

Q3 When you enter Jason's room to attend to his routine observations, you find that he is unresponsive.

What is your response to this situation? (What is your immediate response to finding an unconscious client?)
Outline 2 members of the MET and discuss the roles and responsibilities of each? (Outline 2 health professionals that may be part of the MET and what they would do in an emergency situation.)

Q4 It has been determined after the emergency response that Jason has had an acute brain haemorrhage. He is unconscious and requires a tracheostomy and a nasogastric tube to be inserted for NG feeds.

Outline your care of a tracheostomy tube. In your response consider:

care of the tracheostomy including suctioning and dressing changes (outline how to care for a tracheostomy; specifically dressing changes and suctioning.)
your scope of practice as an EN caring for a client with a tracheostomy (Think about what determines EN scope of practice in Victoria? How do you know you are safe to care for a tracheostomy; who could you ask or refer concerns to?)

Q5 A nasogastric tube (NGT) is commonly inserted to provide nutritional support to individuals.

Describe the care required prior to using the NGT? (What you need to do prior to commencing a NG feed. How do you know the NGT is in the correct position?)
What actions do you take if you think the tube is blocked? (What would you do if you think the NGT is blocked? Who would you discuss this with)
Describe your steps when giving a NGT feed. (Outline the steps you would take to administer a NG feed to your client.)

Q6 List three (3) nursing interventions that an enrolled nurse can do to care for the unconscious patient. (What care might you provide to an unconscious client and their family? Consider holistic physical and psychosocial support? Outline three (3) tasks/ cares/ interventions you could do as an EN.)

Q7 Discuss why it is important to check and know how to use all emergency equipment. (To answer this question, consider:
If you were in an emergency situation, why do you think it would be important to know how to use the equipment? Why is important to make sure the equipment is working correctly?)