Melody King, 36, Peritonitis following ruptured appendix
Ms. Melody King presented to the Emergency department with 2-3 days of severe Left Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix.
She has a past medical history of asthma and depression, with her current prescribed and compliant medications list which includes:
Ventolin
Seretide
Sertraline
Melodys observations were as follows:
BP 95/45mmHg
HR 120
Temp 38.3Celcius
RR 22/min and shallow
SpO2 95% on room air
She complained of increasing nausea and centralised abdominal pain 7-8 on a scale of 0 to10. Physical assessment showed a distended abdomen and generalised abdominal guarding. To investigate her condition further, pathology results reveal a raised white blood cell (WBC) count and CRP.
NRSG370 Assessment Task 2: Case Study High Dependency
Mrs. Connie Brownstone
Mrs. Connie Brownstone is a 79 year old women admitted to the Emergency Department (ED). Connie was brought into the ED by her daughter with a one-day history of fluctuating shortness of breath/dyspnoea unrelieved by medication.
Triage Nurse Assessment:
Vital signs: RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4 Celsius, BP 168/70;
Physical assessment: Dyspnoea, very anxious, audible expiratory wheeze;
Past history: Asthma, allergies to pollen and dust mite, ICU admission 5 years ago (endotracheal intubation and ventilation for 2 days status asthmaticus).
Medications: (1) Ventolin, and (2) Ipratropium bromide.
Due to her respiratory distress, Connie was triaged as a category 2, as per the Australasian Triage Scale, and brought directly from the waiting room into a HDU monitored cubicle where
you are the ED nurse allocated to her care (Department of Health and Aging, 2009). Oxygen of 6L/min was applied via the Hudson Mask.
Cubicle Nurse Assessment:
Vital signs: RR 35, SpO2 89% (6L oxygen), HR 125bpm, RR 35, Temp 39.4 Celsius, BP 172/75;
Physical assessment: Pt. seated and leaning forward, use of use of accessory muscles evident (sternocleidomastoid, scalene, and intercostal muscles), bilateral expiratory wheeze on auscultation, height 145cm;
Peak Flow 210 L/min (last normal reading 320 L/min)
Secondary survey revealed no other abnormalities.
Investigations/Results:
FBE Within normal limits
Urea & Electrolytes Within normal limits
C-Reactive Protein Within normal limits
Blood Cultures Pending
Troponin Within normal limits
Chest XRAY Hyperexpanded lungs, no consolidation or effusion
Arterial Blood Gas (ABG) pH 7.48, PaO2 60, PaCO2 30, HCO3 24 (Respiratory Alkalosis)
Normal ABG Ranges pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26
(Vincent, 2011)
References
Vincent, J. L., Abraham, E., Kochanek, P., Moore, F. A., & Fink, M. (2017). Textbook of Critical Care (7th ed.). St. Louis, Missouri: Elsevier.
NRSG370 Assessment Task 2: Case Study Perioperative
Candace Evans
Candace Evans is a 42 year woman admitted to the operating theatre at 38 weeks gestation for an elective lower uterine caesarean section (LUCS) under spinal anaesthesia. The patient has been diagnosed with Placenta Previa.
Pre-Operative Nursing Assessment:
Current History: Second pregnancy, 38 weeks gestation;
Past History: Gestational diabetes with her first pregnancy 5 years ago, which resolved following the birth with no recurrence in this pregnancy, depression, anxiety, post-natal depression.
You are working in the post anaesthetic recovery room (PACU) on a morning shift and will receive Candace following her LUCS. Candace arrives in the PACU, following the uneventful
birth of a male infant via LUSC with APGARS of 8 at 1minute and 10 at 5 minutes following birth. Intraoperative blood loss was estimated at 150ml.
PACU Assessment:
Dermatome level T3;
Pain 0/10;
Lower uterine dressing dry and intact;
In-dwelling catheter with 100ml of rose coloured urine;
Intravenous therapy of Oxytocin in CSL running at 250mL/hour;
Vital Signs: HR 88, BP 104/76, SpO2 97% on RA, Temp 36.9 Celsius.
You pull the curtains to inspect for vaginal blood loss and find the patients vaginal pad to be soaked with frank blood and some clots. The midwife, new baby boy and patients partner wait patiently on the other side of the curtain.
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