HLTEN512B: Diploma of Nursing- Harold Smith Case Study- Nursing Case Study Assignment
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Case Study
Harold Smith is a 70 year old gentleman who has been admitted to your ward with extensive burns to one side of his body. He fell whilst trying to assist with a grass fire in bush land behind his 10 acre block that backs onto the national park. His fall was not precipitated by any altered level of consciousness and he has no significant neurological signs.
Harold lives with his wife who is 68 years old and has early signs of Alzheimer’s (diagnosed three months ago), she is able to carry out her Activities of Daily Living but her short term memory is slightly deteriorating. Mrs Smith is attempting to write down in a note book her activities of daily living, so that she is aware of having eaten, toileted and drank recently.
Harold also has two children, a daughter who is 40 years old and has a 20yr old daughter and an 18yr old son. Their 38 year old son is married with three boys who are 15, 14 and 12. Both of Harold’s children live in the same town as Harold and his wife.
Harold is scheduled to undergo skin grafting of his anterior right lower leg and the medial aspect of his upper thigh and anterior abdomen. As these are the areas Harold has sustained full thickness burns to approximately 15% Total Body Surface Area. The other burns are superficial or partial thickness burns and are being treated with silver sulphadiazine cream and exudry dressings. The superficial burns cover another 20% Total Body Surface Area and involve the posterior thigh, genitals and chest. The partial thickness burns cover 5% Total Body Surface Area and involve the lateral right leg.
PART A
- Discuss the clinical manifestations (signs and symptoms) of Harold’s burns and the implications this will have on Harold’s’ treatment.
- How would you anticipate the burns treatment and injury to impact on Harold’s activities of living? How could you involve Harold’s family in meeting his self-care needs?
- As a member of the clinical team caring for Harold, what would you include in your assessment data? Give rationales for each.
- Harold has been ordered Gentamycin 80mg IV diluted into 100mLs of Normal Saline solution and 5mg of Diazepam as a pre-operative prophylactic dose. Identify the actions and side effects of these medications.
- Discuss the pre-operative education you would provide Harold and include a pre-operative check list.
- Explain the potential post-operative complications that could develop during this phase of treatment.
- Outline the post-operative nursing interventions, providing a rationale for your answer (under the supervision of the RN), to reduce or eliminate the potential of an adverse outcome.
- How will you evaluate the effectiveness of each of your interventions?
- Harold has been prescribed Packed Cells x 2 post-operatively; his Hb is 100g/L (normal range for a male is 135-175 g/L). On review of Harold’s Hb results, outline the reasons for the packed cells to be prescribed.
- Outline the required observations that the client will undergo whilst receiving a transfusion. Identify the appropriate PPE necessary on commencement of the transfusion and changing a bag of pack cells. Identify three potential complications associated with a Blood Transfusion.
Harold has sustained 40% burns to his body involving his anterior right lower leg, medial aspect of his upper thigh and anterior abdomen, his right posterior thigh, genitals and chest.
- On the Lund and Browder diagram below, shade in the affected areas on Harold’s body that have been burnt. Clearly show the different degrees of burns on the diagram, using various coloured pencils.
PART B
Harold returns from the operating theatre and requests pain relief, he is given a narcotic analgesic. As soon as the Registered Nurse leaves the room Harold becomes drowsy and unresponsive to verbal and painful stimuli.
- What are your responsibilities as an EN?
- What urgent assessments and observations would you make?
- Provide a rationale for each nursing intervention and assessment.
- List five first line emergency medications available on the emergency trolley.
- Identify and outline the role of the emergency response team members.
- Who would you report this data to?
PART C
Harold is later diagnosed as having suffered a reaction to the narcotic which he had never been administered before. Following his successful recovery, the medical officer ordered a different type of narcotic that maintains his comfort level.
Because of Harold’s reaction to the narcotic he has an extended stay in hospital.
- Develop a plan of care for Harold that the Enrolled Nurse would implement in collaboration with the Registered Nurse, during his extended stay in hospital. Explain your nursing interventions, rationale and discuss the effectiveness and how this would be evaluated.
- In collaboration with the Registered Nurse, develop a discharge plan, relevant to Harold’s care, including the multidisciplinary approach.
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