Assessment 1: Case Study – Mrs Kristy Parkes
50%
1800 words
Reference: APA 7- 15 reference
Using clinical reasoning cycle and Roper Logan Tierney (RLT) model
to reflects on the case study and answer the questions.
Case study:
Consider the Patient
Kristy Parkes is a 35-year-old woman who owns and runs a large cattle farm with her husband in outback central Queensland. Together she and her husband have a 3-year-old son, Sam. Yesterday Kristy was thrown from her horse whilst mustering cattle. She landed on her right side and hit her head. She was not wearing a helmet. Her husband witnessed the event and rang for help and Kristy was air lifted to Brisbane Hospital, 2 hours away by the care flight rescue team.
On arrival to hospital her X-rays showed she has fractured her pelvis in 2 places on the right side, and her head CT scan shows some right sided cerebral contusions. Kristy is intermittently confused. She remembers her horse bucking and her falling off but does not remember the events after her fall. She remains sometimes confused to place and time. 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 but stable pelvis. Her husband has had to remain at home to care for their son and to continue to manage the family property.
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)
Post-op Phase Update
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 pelvis. The recovery nurse hands over to you that Kristy’s surgery went well. There was a small amount of blood loss of approximately 400mls 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: pain score is 7/10; BP 105/74mmHg; PR 95bpm, regular; RR 15bpm; SpO2 97% on 4L O2 via nasal prongs (NP); T 35.8°C
• BGL is 6.5mmol/L. Her lower limb assessment reveals the following: bilaterally cool feet, slightly pale skin colour, and cap refill to both feet are 3 seconds. She is able to move both feet and can slightly bend her knees on the bed. She denies any numbness or pins and needles to both lower limbs/feet.
• Kristy has a honeycomb long Opsite dressing to her right hip. The dressing is clean, dry and intact. Kristy is to remain on strict bed rest until the physiotherapist reviews her tomorrow.
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)