NRSG370 Assessment Task 2: Case Study – Medical/Surgical #1
Melody King, 36, Peritonitis following ruptured appendix
Ms. Melody King presented to the Emergency department with 2-3 days of severe Right 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
Melody’s observations were as follows:
- BP 95/45mmHg
- HR 120
- Temp 38.3°Celcius
- 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.
You are the RN caring for Melody post-operatively on the surgical ward.
NRSG370 Assessment Task 2: Case Study – Medical/Surgical #2
Jack Buun, 69, femoral neck fracture post a fall
Jack Buun presented to the emergency department (ED) via ambulance after a fall in his backyard, which lead him to twist and fall directly on the lateral aspect of his right hip. On examination the paramedics reported his right leg to be shortened and externally rotated, and Jack was unable to get up and in a significant amount of pain. His wife Ethel found him and called the Ambulance. Jack has a past history of hypertension that is well controlled.
Jack required emergency surgery under general anaesthetic for his femoral neck fracture, and underwent a hemiarthroplasty. You are called to the post anaesthetic recovery unit (PACU) to receive handover and are happy that he meets the discharge criteria of the hospital. You are told that Jack received the following intravenous medications for pain during and after his surgery:
- 20mg Morphine
- 100mg Tramadol
- 40mg Paracoxib
- 1g Paracetamol
Jack also received 0.625mg of droperidol in the PACU for nausea. On arrival to the orthopaedic ward you conduct further assessment as follows:
- Vital Signs: BP 145/80, HR 120, SpO2 96% on 2L via nasal prongs, Temp 37.1° Celsius, RR 10;
- Drowsy but rousable to voice commands;
- Pinpoint pupils;
- Neurovascular observations (Right Lower Limb): Cool, pale, touch present, movement present, capillary refill sluggish, dorsalis pedis present but thready;
- Pain 3/10.
You are the RN caring for Jack on the surgical ward.
