Assessment Task 1 – Case Study

Consider the patient situation

Kristy Parkes is a 16-year-old female who lives with her parents and younger brother in St Ives, Sydney. Kristy is a keen and competent horse-rider, competing in various events including show jumping with her horse Jasper. While competing at the Sydney Show Jumping Club yearly event, in the 90cm round (where the jumps are a 90cm in height) Kristy fell from her horse, landing on her right side and appeared to onlookers to hit her head. She was wearing a helmet in compliance with the event rules and regulations, however, did not appear to be moving immediately after the fall, and people watching close by let the first responders know that her eyes were closed for ‘about ten seconds’ after her fall. Kristy was taken by the road ambulance already at the event to Royal North Shore Hospital (RNS) with her dad, Derek, who was watching her compete.

On arrival to RNS ED, X-rays were taken revealing a fractured right clavicle, and CT scans showed right side cerebral contusions. Kristy is intermittently confused. She remembers falling at the show but does not remember any of the events afterward including the ambulance ride to the hospital. She is intermittently disoriented to place and time, but consistently orientated to who she is and her date of birth. Her spine and neck have been radiologically cleared and she has no neck pain. Kristy has no other medical history. She has been administered intravenous (IV) morphine for her pain and is waiting for surgery which is scheduled for tomorrow to repair her fractured clavicle. Kristy’s mum, Meredith will be arriving at the hospital shortly with her younger brother, Sam.

Question 1:Using the Roper-Logan-Tierney (RLT) model of nursing discuss the biological, psychosocial, spiritual, and cultural factors Kristy and her family may be experiencing following her accident and injury.(500 words)
Question 2:Explain the legal concepts of consent, the doctrine of necessity and enduring guardianship/NOK. Discuss how these legal considerations may or may not apply to Kristy’s situation. (200 words)
Question 3:Kristy now has a valid consent for her surgery tomorrow. In preparing Kristy for surgery, outline three (3) preoperative nursing actions that are required and explain why they are required as part of her care. (300 words)

Case Study continues…

It is now the following day. Kristy has been transferred from theatre recovery to the ward post operatively following a 3-hour surgery to repair her fractured right clavicle. The recovery nurse hands over to you that Kristy’s surgery went well. There was a small amount of blood loss of approximately 300mls intraoperatively. She received 500mls of fluids intraoperatively and has been commenced on IV normal saline (NaCl 0.9%) fluids in recovery, of which the first bag is currently running. She had fentanyl, propofol and midazolam during the procedure and a dose of IV fentanyl was also administered in recovery for her pain.

Upon arrival to the ward, you conduct an assessment of Kristy and find the following:

? Kristy is a little drowsy but easy to rouse, she is orientated to person, however confused to time

and place

? Kristy is moaning that she “feels sick”
? Her vital signs are as follows:

opain score is 7/10oBP 105/74mmHgoPR 95bpm, regularoRR 15bpm

oSpO2 97% on 4L O2 via nasal prongs (NP)

oT 35.8°C
?BGL is 6.5mmol/L. Her limb assessment reveals the following:

obilaterally cool feet, slightly pale skin colour, and cap refill to both feet is 3 seconds. She can move both feet and can slightly bend her knees on the bed.

oBilaterally cool hands, slightly pale skin colour, cap refill on both hands is 3 seconds. She denies any numbness, tingling, or pins and needles in both upper limbs/hands.

?Kristy has a honeycomb long OpsiteTM dressing to her right clavicle. The dressing is clean, dry, and intact, and her arm is in a ‘cuff and collar’ sling. Kristy is to remain on bed rest until the physiotherapist reviews her later this afternoon.

Question 4:Identify three (3) abnormal cues in Kristy’s post-operative nursing assessment.
For each of these cues, discuss the pathophysiological or pharmacological factors that has resulted in these abnormal findings. (800 words)