Nur 331: Mr John Assessment Answer

Nursing Case Study

Mr John Hayes has been admitted to the emergency department after a car accident. His details are:

Age 68, T 36.5, P96, RR 28, BP 160/95, oxygen sats 92%, Pain score  9/10. He has pain over his left chest and decreased air entry to his left chest. His GCS is 15. He had no LOC and was able to extricate himself from the car. The airbags had inflated.

Johns’ weight is 130kgs. John is married to Beryl aged 65 years. They live in a high set house and struggle to get up and down the stairs into the house. They have 2 sons who live nearby and visit regularly.  Both John and Beryl have poor eyesight and wear glasses.

John has been xrayed and this has been assessed by the doctor.

Part A This case study requires you to:

Apply evidence based principles to correctly assess this patient. Detail the types of assessment you would do now for this patient in their current state. Use a systems framework to do this. eg CNS, CVS, Respiratory, Abdo, renal and social/ other.

Describe the urgent appropriate care for this patient, being aware of the prioritisation needed. You need to cover the care for the first 1-2 hours only.

Part B

He has been diagnosed with a left pneumothorax.

John is now day 5 days post injury and preparing to be discharged from hospital. Please outline the discharge advice for this patient and what educational considerations may be needed for this patient, considering the principles of equity, self-determination, rights and access to this case.

Case 2

Mr Paul Peters has been admitted to the emergency department following a fall at home and has suffered an injury to his left hip. His current condition is unstable and his ECG shows AF. His current observations are: T36.5, HR 120, RR 18, BP 90/60, and his oxygen sats are 92%. His left leg is externally rotated and shortened. His pain in his hip is 9/10. He weights 88kgs and he is aged 50. He still works as a factory worker at the Ginger factory. He admits to drinking 6 stubbies of beer a night. He smokes a packet of cigarettes a day and has done this for 30 years. He does little exercise, but his job involves being on his feet all day. On assessment of Paul’s knowledge of his condition, he admits that he only did Grade 7 of primary school, and really cannot read well.

Part A This case study requires you to:

Apply evidence based principles to correctly assess this patient. Detail the types of assessment you would do now for this patient in their current state. Use a systems framework to do this. eg CNS, CVS, Respiratory, Abdo, renal and social/ other.

Describe the urgent appropriate care for this patient, being aware of the prioritisation needed. You need to cover the care for the first 1-2 hours only.

Part B

The patient is now day 10 post ORIF to his left hip.  His arrhythmia has stabilised and is preparing to be discharged from hospital. Please outline the discharge advice for this patient and what educational considerations may be needed for this patient, considering the principles of equity, self-determination, rights and access to this case.