NUR302-Patients Care & Alex and Kim Case Study – Medical Science Assignment Help

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Clinical Scenario

Kim works on a general medical, and cardiology ward and is three months into her graduate year as a Registered Nurse. She is working a late shift on a Friday, (1330 – 2130). The ward is working understaffed today as one of the RNs rostered has been identified as a COVID close contact and can’t work. Kim has been allocated eight patients with Alex, an experienced EN who is in the third year of her RN degree. Kim has worked with Alex before and feels a little bit intimidated by her. There is a PCA rostered on today (Fei-Li) who is floating across Rooms 1-8.

Bronwyn is the team leader today, and Kim has worked with her often during her first month on the ward. Bronwyn has been generous with her time explaining some of the more difficult acronyms and handover jargon to Kim. Kim is aware that there is a graduate nurse educator and cardiology Clinical Nurse Consultant available in the hospital until 5pm.

Alex and Kim are taking over the care of the patients in four single rooms, and one four bed bay. After handover, Alex informs Kim that she will care for the four bed bay, and Kim can take the single rooms. She also advises that as she is nearly registered herself, she does not require any assistance or supervision.

Kim and Alex will provide all care for the patients in rooms 1-5.

Room 1 – Roy Ocean; 61 year old with end stage heart failure. He had been on the heart transplant list with Prince Charles hospital but was de-listed because he continued to smoke. Roy was admitted with fatigue and shortness of breath 7 days ago. He received his last dose of Levosimendan IV yesterday but is still receiving IV frusemide via a PICC line. The frusemide will run out at 5pm.

Room 2- Maxine Beach; 32 year old woman; with long standing Pulmonary hypertension she has a permacath in situ for her continuous IV infusion of Flolan (epoprostenol), but the site has become infected and she will be having the catheter replaced tomorrow afternoon. Her syringe driver will need a refill at 5pm. Normally Maxine would refill the syringe herself but she is requesting assistance today as she is feeling very fatigued- Kim has never reconstituted Flolan before but knows that stopping the infusion abruptly could be fatal for Maxine.

Room 3 – Rajiv Singh; is a 46 year old man who is returning from the catheter lab after a coronary angiogram at 4pm – He will need 15 minutely groin and limb observations for 1 hour and then ½ hourly observations for 2 more hours

Room 4 –Glenda Tukey, a 78 year old woman admitted from the emergency department for management of left leg cellulitis , and congestive heart failure. She has insulin dependant type 2 diabetes and her blood sugars have been unstable. She has had a IV cannula inserted in her left hand and has been prescribed IV antibiotics and frusemide. Her first dose of 40 mg of IV frusemide was given in the emergency department and the second dose is due at 3pm She is a large lady at 126 kg and 178 cm tall. She uses a stick to ambulate but pitting oedema to her knees and peripheral neuropathy from her diabetes means she is unsteady on her feet and needs assistance. She is buzzing as she is desperate to go to the toilet.

Room 5 – 4 bed bay:

5.1 Athena Swann –A 65-year-old woman admitted for recurrent chest pain from her GPs office. The pain was intermittent and retrosternal, occurred on physical exertion and was relieved by rest. She had a history of prediabetes and chronic hypertension controlled with a ?-blocker. She had subsequently undergone coronary angiography and angioplasty for a stenosis in her LAD coronary artery. She has a Fem-Stop pressure device on her Left femoral access site required 15 minutely groin and limb observations for another hour moving to half hourly at 4pm. The morning staff had marked where they felt her foot pulses but neither the left dorsal nor posterior tibial pulses are palpable when Kim Checks- Athena is complaining of pain at the groin site.

5.2 Madison Goose – 19 year old female with asthma, admitted following an acute attack last night. She hasn’t been taking her preventative medications as her social life has been taking precedence over her health. She was absent from the ward at time of handover, and the morning shift RN has passed on that she is very unhappy about still being in hospital as she had plans for Friday night. No-one is exactly sure where she is.

5.3 Liam Duck – 24 year old tall thin male, admitted today for management of a spontaneous pneumothorax. Has just had an intercostal catheter (ICC) inserted and underwater seal drainage connected. He is on 1/24 UWSD observations and is due to go to Medical Imaging for a check chest X-ray to confirm whether his lung has re -inflated. Kim sees Alex about to clamp and disconnect the ICC before being transferred to Medical Imaging at 3pm.

5.4 Peter Finch; newly diagnosed non-small cell lung cancer. He has been admitted for management of his symptomatic malignant pleural effusion and has a chest drain in place which is causing him considerable discomfort. He has not been seen by the oncology team yet today, and is waiting for a transfer to the oncology ward. He presses the buzzer and wants to know why he can’t just have surgery to manage the problem. His wife is with him, and while upset, they seem quite calm.

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