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  1. The patient has been fasting from 2400. Sue states she was not sure whether to take her morning medications. State the reason why some of her medications may be given and some withheld on the day of surgery. 
    1. Ms Warral requires blood taken for a Urea & electrolytes (U & E) before surgery.Discuss the rationale for this investigation & type of consent required. 
  2. Discuss how you will perform a venepuncture on Ms Warral using the vacutainer system, including any infection control precautions you would take. Include rationale for actions. (procedure may be written in list form. 
  3. Discuss three (3) factors that make Ms Warral at risk of perioperative deep vein thrombosis. 
    1. Mrs Warral is to have anti-embolic stockings fitted to assist in the prevention of deep vein thrombosis

    Explain how to put anti-embolic stockings on a client 

  4. Ms Warral is to use the incentive spirometer following surgery to prevent pulmonary complications.
  5. Discuss your explanation of how to use the incentive spirometer to your patient. 

Putting on Anti-embolic Stockings

  1. The patient has been fasting since Sue states she was not sure whether to take her morning medications. State the reason why some of her prescriptions may be given, and some withheld on the day of surgery. (50-100 words)

On the day of surgery, a patient is advised to alter some medication has it ensure she undergoes anesthesia safely and it may delay the recovery after surgery. It is also necessary some medication taken to help increase blood pressure which had been suppressed by anaesthesia and medicine for the patient.

  1. Warral requires blood taken for a Urea & electrolytes (U & E) before surgery.

Discuss the rationale for this investigation & type of consent required. (50-100 words)

Urea and electrolytes show important information about the health of Ms. Warral such as the volume of the blood and the PH level by regulating acid and base level in the blood

  1. Discuss how you will perform a venepuncture on Warral using the vacutainer system, including any infection control precautions you would take. Include rationale for actions. (procedure may be written in list form. 100 – 150 words)

Before taking the venipuncture result, I have found out if she had ever had blood drawn before. If not, I will explain to her the discomfort and prevent the anxiety of the patient (Loveitt). This procedure is known as informed consent.  In case she is concern about the test, I will have to explain to her that the doctor has ordered further laboratory test to monitor the procedure.

 To prevent infection during this procedure, a high level of hygiene should be kept. I will have to wear gloves, wash her hand with alcohol to prevent disease, and after the test needles and tubes should be disposed of (Pang et al., 2018) if she had ever had blood drawn before if not I will explain to her the discomfort  and prevent the anxiety of the patient this procedure is known as informed consent ifDiscuss three (3) factors that make Warral at risk of perioperative deep vein thrombosis. (50-100 words)

Age factor

Patient with older age are at risk of hypertension, postoperative dehydration and immobility are a risk factor of DVT. Notably, this patient is usually associated with vascular sclerosis and higher blood viscosity

Immobility

Due to her work has a receptionist in a local school lack of movement may lead her to a high risk of DVT. Additionally, due to her surgery which is likely to prolong her bed rest, it may increase DVT.

Previous Risk Of The Same Illness

The previous occurrence of DVT from the health record of Ms. Warral it indicates she had been diagnosed before with DVT which puts a high standard of getting the risk of DVT again.

  1. Warral is to have anti-embolic stockings fitted to assist in the prevention of deep vein thrombosis

Explain how to put anti-embolic stockings on a client (50-100 words)

Stocking prevents the patient from the risk of blood clotting.  Before applying to stock, Ms warrant leg should be measured using the fitting chart. One should insert the hand inside stocking as far as the heel. In this light, on have to keep the hands inside the stocking and turn the stocking inside out. Finally, one should pull the hose up and fit around the ankle and calf (Kato et al., 2016)

  1. You complete the pre-operative ECG, as ordered.
  • Looking at Lead 2 Please discuss PQRST and the method for calculating rate and determining rhythm.State the type of rhythm shown in the ECG below. The kind of rhythm is normal sinus rhythm.
  1. Warral is to use the incentive spirometer following surgery to prevent pulmonary complications.
  2. Discuss your explanation of how to use the incentive spirometer to your patient. (50-150 words)

Rationale for Urea and Electrolytes Investigation

Incentive spirometer helps patient lungs clear and helps the recovery process.  Ms. Warral should sit on the edge of bed  help her hold incentive spirometer in an upright position. Place the mouth piece on her mouth and make sure she seals her lips tightly around it (Higgins, Helm, Gould, & Kindel, 2018). Additionally, make sure she breathes slowly, and as deeply as possible I would notice the yellow indicator should reach the blue outlined area help her hold her breathe as possible and make sure she exhale slowly and allow the piston to fall to the bottom of the column.  The process should be repeated after she can get of bed safely and take frequent walk.

  1. You are also asked to monitor Warral’s oxygen levels (Spo2) how would you do this

I would use pulse oximeter which contains a microprocessor and displays oxygen saturation will display the monitor updates its calculation regularly to give oxygen saturation and pulse rate (Gautham, Arulvelan, & Manikandan, 2016)

Ms. Warral returns from theatre following abdominal hysterectomy & bilateral salpingo-oopherectomy. She has insitu, a fentanyl PCA, oxygen 2l/min via nasal prongs, IV fluids, IDC – SD, bellovac drain & vac dressing.

During the evening, you notice Ms Warrals’ bellovac drain has filled to 400ml. You observe her wound & find a large collection of blood has formed under the vac dressing. In response to your questions she has become increasingly drowsy & having trouble speaking.

Review the attached ADDS chart, make an assessment based on her vital signs & discuss the actions you would initiate. Use the DRSABCD acronym as headings to explain your answer. 

D

Checck if she has any danger

R

Ask her to breathe  in deep

S

Call for help if needed

A

Check for any foreign object

B

Look if the wound has spread

C

Ask her if she is pain

D

Apply some nursing as soon as possible

 

Ms. Warral stabilizes following the intervention of the Medical Emergency Team. Her surgeon orders her 1gm cephalexin IV QID.

  1. Review Warrals’ history & discuss your actions in response to this drug order. (50 – 100 words)

Because Ms. Warral has been smoking in the past which has to led her to the growth of asthma, she has to avoid smoking (Gautham, Arulvelan, & Manikandan, 2016).

  1. The medical staff order the removal of the Bellovac drain & her IDC. What infection control precautions are required for these procedures? (50 words)

First, you will have to perform hand hygiene by wearing gloves then you will have to confirm the medical order correlate with the amount of drainage in the past 24 hours you will have to explain the procedure to her

  1. Discuss how you will perform a female urinary catheterization on Warral, including any infection control precautions you would take. (procedure may be written in list form. 100 – 150 words)

First, you will have to perform hand hygiene if its possible she will have to wash her genitals with soap and water after that I will have to explain to her the procedure and identify if she has any allergies, her privacy should be highly considered (Epstein, 2016). Ms. Warran will remove her underpants and put her legs in a recumbent position. She will then place the blue disposable sheet  under patients buttocks perform hand hygiene open catheter pack and separate trays by holding the nonsterile side of the plastic sheet then you will have to open sterile gloves.

After 5 days in hospital Ms Warral is discharged home into community care with an indwelling urinary catheter.

Access the document Working with People with Chronic & Complex Health Care Needs. (NSW gov)

Discuss two (2) resources that Warral may be able to access to assist in the supply of urinary equipment. (50 – 100 words)

She can use catheters which is a hollow tube  which drains directly from the bladder into a drainage bag

She will also have to apply pads which are available at most retails and pharmacies

  1. Explain the definition of a successful Trial of void according to the ACI TOV Clinical Guideline (Community) accessed through Working with People with Chronic & Complex Health Care Needs. (NSW gov) (50 – 100 words)

Identifying DVT Risk Factors

TOV is the ability to pass urine  after  three  consecutive  void with complete  bladder emptying with no or minimal post void residual then it will be considered successfu

  1. Warral may require a bladder washout at some stage shortly if she is to go home with a urinary catheter.

Under what conditions would a bladder washout be required

Bladder wash is necessary if Ms. Warral is found to have a lot of sediments in her urine, if she is not sure her catheter is draining  correctly . In case there has blocked  and there is no replacement or if she has been adviced to do bladder washout treatment

Identify two nursing interventions you may do in regards to a bladder washout.

Assessed Ms. Warral if she has abdominal pain or spasms sensation of bladder fullness or catheter bypassing.

Assessed her knowledge regarding the purpose of performing catheter irrigation

  1. Before Warrals discharge, you refer to her nursing history of osteoarthritis (OA) in her knee, What questions might you ask her to help determine the severity of her OA and how may OA impact her activities of daily living? (50-100 words)

I would ask her about her personal and family history then perform a full physical examination and conduct diagnostic test I will also have to find out where she is experiencing pain and stiffness                                                           

  1. Ms Warral is concerned over her children and what is going to happen to them as they have had to spend a lot of time at their father’s house, she is also feeling quite anxious about their care and has stated that she is feeling entirely “down” following her surgery and isn’t sure how she will cope at home once discharged. She has also stated that she been arguing on the phone with her ex-husband in regards to her children’s care and she doesn’t know how to deal with this.

Outline 4 nursing interventions you can do to assist with the emotional, psychosocial wellbeing and conflict resolution support of Ms. Warral, keeping in mind her cultural heritage

 The need to make sense of the illness she will have to understand why she has been singled out and what it means for her future and her family future (Bridges, Gibbs, & Hoehmann, 2017). they ill have to understand and cope with the situation

Need for a spiritual belief to be acknowledged, respected and supported

A need to transcend the illness ad self

The need and purpose and meaning in the midst of illness

Questions 17-28 are multiple choice questions with case studies

  1. An 84-year-old male patient has been admitted to day surgery for removal of a 5cm carcinoma from his back

What is the most dangerous type of skin cancer, often characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised?

?   Basal cell carcinoma

?   Malignant melanoma

?   Squamous cell melanoma

?   Verruca cell

  1. Nurse Mary is caring for an elderly bedridden adult. To prevent pressure ulcers, which intervention should the nurse include in the plan of care?

?   Turn and reposition the client at least once every 8 hours

?   Slide the client, rather than lifting, when turning

?   Provide a turning schedule of 2hrly to the nursing care plan

?   Vigorously massage lotion into bony prominences

  1. Mr Jack has been admitted to your ward for eye surgery. You are completing the patient’s history as part of the admission process and you see that Mr jack has clouding of the lens of his eyes, what would this condition most likely be given that Mr Jack is 78 yrs old

?   Strabismus

?   Hyperopia

?   Myopia

?   Cataracts

  1. Mr Stevenson arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye, what is the initial nursing action?

?   Perform visual acuity tests

?   Apply an eye patch

Performing Bladder Washout

?   Irrigate the eye with sterile saline

?   Remove the piece of wood using a sterile eye clamp

  1. Molly Jones is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear?

?   Tinnitus

?  Serous otitis media

?   Burning of the ear

?   Pruritus

  1. Which instruction about insulin administration should the nurse give to a client?

?   “Discard the intermediate-acting insulin if it appears cloudy.”

?   “Always follow the same order when drawing the different insulins into the syringe.”

?   “Store unopened vials of insulin in the freezer at temperatures well below freezing.”

?   “Shake the vials before withdrawing the insulin.”

  1. A male client is admitted to your ward with suspected pulmonary tuberculosis, he is placed in a single isolation room. Choose the answer that best outlines the additional precautions required when caring for this client.

?   Gown and gloves plus a mask only if there is a risk of the patient coughing when you are attending to his vital signs

?   Standard PPE, mask and a shared room is fine as long as the patient doesn’t go near the other patients

?   Standard PPE, any sort of mask, normal room ventilation is fine as droplets can’t be spread

?   Standard PPE plus a well-fitting mask specific for tuberculosis, dedicated patient equipment, special room ventilation reequipments

  1. You are caring for Mr Smith a 56 yr old gentleman who was admitted to hospital with a blocked suprapubic catheter and bladder infection requiring antibiotics. Which of the 4 answers below outline nursing interventions that may apply to the care of a suprapubic Catheter? 

?   Checking for kinks or bends in the catheter tubing

?   Ensure that the catheter bag is taped to Mr Smith’s Chest

?   Hand washing

?   Keeping the catheter bag below bladder level

?   Documenting the color of the urine

?   Remove the catheter if it becomes blocked again

  1. Mr Corn is a 68-year-old male with a past medical history of cancerous polyps in the bladder. For the past 5 years, he has undergone regular cystoscopy and bladder scrapings. He has now undergone a surgical procedure (cystectomy) to form an urostomy / ileal conduit. Once Mr Corn has recovered you are required to educate Mr Corn on how to empty his urostomy.

Which of the following educational points would you be able to inform Mr. Corn about when emptying his urostomy bag (there is more than one point to choose)

?   No need to wash hands as it is not a sterile procedure done by a nurse

?   Empty the Urostomy bag every 2 – 4 hrs or when 1/3rd full 

?   Wait until the urostomy pouch is completely full before emptying

?   Empty the urine from the urostomy bag into the toilet

?   Remove the urostomy bag before emptying

?   Wash hands with soap and water before and after emptying

  1. Mrs Robertson has recently had bowel surgery to her large intestine for carcinoma of the bowel and now has a colostomy. While Mrs Robertson is recovering, you are required to change the colostomy bag on day five, what is an important factor to consider when placing a new colostomy flange over the stoma

?   Measure the stoma diameter using a wooden ruler and cut out stoma hole in the colostomy bag 5mm larger than the stoma size. 

?   Measure the stoma diameter using a measuring guide and cut out stoma hole in the flange 2mm larger than the stoma size.

?   Measure the stoma diameter using a measuring guide and cut out stoma hole in the   flange 10mm larger than the stoma size

?   Take a guess at the stoma size and cut out stoma hole in the flange 5mm larger than the stoma size to ensure that you cover the stoma and 5mm of surrounding skin

  1. Choose 3 answers that best reflect nursing interventions for nasogastric tube feeding

Emotional and Cultural Heritage Support

?   Enteral feeding tubes must be flushed prior to, and after medication administration (as per facility policy)

?   When preparing to administer feeds there is no need to confirm the position of the enteral tube as it should be in the correct position

?   When preparing to administer feeds nursing staff must confirm the position of the enteral tube.

?   A enteral feeding pump must be used for bolus feeds only

?   the head of the bed should be elevated 30-45 degrees during feeding (or upright if able) and for at least 30 minutes after the feed to reduce the risk of aspiration

  1. Choose 3 answers that best reflect nursing interventions for percutaneous tube feeding

?   Due to the fact that the position of the tube has been confirmed by x-ray you only need to confirm its position every 72hrs

?   By providing education to the patient on their percutaneous feeding tube the risk of complications is reduced

?   Careful examination of the skin around the insertion site is required each shift (or as per facility policy) to ensure that the area is free from infection and irritation  

?   If the percutaneous tube becomes blocked it should be removed immediately

?   Always check tube placement before administering feedings and medications 

  1. Match 2 conditions from the list below with the disorder

e.g. Osteoarthritis (condition) + Musculoskeletal (Disorder)

List of conditions: Diverticular disease, rheumatoid arthritis, Melanoma,  Meniere's disease, Pneumonia, Colorectal cancer,  Bone fractures,  Ovarian Cancer, Chronic Kidney, Disease asthma Alzheimer's disease, Diabetes mellitus, Kidney Stones, Cellulitis, Glaucoma, Adrenal insufficiency, Otitis, Multiple Sclerosis, Enlarged Prostate, Gland Macular Degeneration

Condition 1

Condition 2

Disorder

Bone fractures

Rheumatoid arthritis

musculoskeletal disorders

Melanoma

Chronic kidney

skin disorders

Asthma Alzheimer disease

Pneumonia

respiratory system disorders

Diverticular disease

Colorectal cancer

gastrointestinal disorders

Menieres disease

Otitis

ear disorders

Alzheimers disease

Multiple sclerosis

nervous system disorder

Diabetes mellitus

Adrenal insufficiency

endocrine disorders

Ovarian cancer

Enlarge prostate

reproductive system disorders

Kidney stones

Enlarge prostate

urinary system disorders

Gland macular degeneration

Glaucoma

eye disorders

Mr Jack Brown is a patient in your care and due to a small bowel obstruction, he is to have a nasogastric tube inserted.

30a.   Please outline the process of insertion

First you will to explain to him the benefit and the risk to him  and posile show the equipment to him

Make sure he in upright for optimal neck/stomach alignment

Examine nostril for obstruction so has to determine the best side

Measure tubling from nose to earlobe

Mark the measured length with marker

Make atlist 2-4inches of the tube is lubricated cause the procedure is usually discomfort to patient

Pass the tube via nare posteriorly

Instruct him to swallow  and advance the tube as he swallow

If resistance is met try to rotate the tube gently

Advanced the tube until mark is reached

Attached syrige to free ends of the tubes

Secure the tube with tape

Document the reason for the tube insertation

Multiple Choice Questions

Six days later once Mr Jack Brown has recovered the Dr orders for the nasogastric tube to be removed.

30b.   Outline how this procedure is done

Verify verbal/written order for removal from medial team you will have to discuss the procedure to him

Hand hygiene  and prepare the equipment required

Make sure he is placed in upright in bed or chair

Aspirate the gastric content before removal

Remove securing adhesive strip or naso fix dressing

Instruct him to take deep breath and hold it will help in closing glottis and reduce potential risk of aspiration whilst

When removing the tube pinch to prevent the content draining to the throat of him

Observe nasal  mucosa for sign of trauma or ulceration and ensuring he is comfortable after removal

Document the procedure on fluid balance chart and in clinical record.

31a.   Outline 5 characteristics of critical thinking

Should have wide range of issue

Always remain updated on issues

Have self confidence

Ready to take oppturtinity on any resource available

Take opinions from others and always listening

Appreciate oppinions of the others

31b.   Outline the differences between critical thinking, creative thinking and problem-solving

Critical thinking is biased cause one os limited to specific ideas and strongly anlysing it unlike creative thinkibg which one is rweady to welcome new ideas and thinking beyond problem solving is the idea of coming with a solution to issue that has occurred by becoming creative and critical (Allman,Wilson, & O'Donnell, 2016))

  1. The core standards that are available to support individuals, families and carers with disabilities outline resources available.

Please use this weblink to access the core standards required

Outline 3 resources available to each of the following 

People with disabilities

Disability include the government commitment to identifying and breaking down the bariers.

Disability complaints  the guidelines ensure that the complaints are treated  in fair and just manner.

Support people with disability by supporting the family and offering  job opportunity.

Older people

Create home for older people

Offer guidening and councelling

Provide wheelchair and equipment needed by older people

Offering job

Giving non profit loan to the disable people to start business

Sponsor their education so that they can persue their career

References

Allman, K., Wilson, I., & O'Donnell, A. (Eds.). (2016). Oxford handbook of anaesthesia. Oxford university press.

Bridges, F., Gibbs, J., & Hoehmann, C. (2017). Laparoscopic sleeve gastrectomy complicated by portomesenteric vein thrombosis: a case series. Obesity surgery, 27(4), 1112-1114.

Copanitsanou, P. (2018). Mobility, Remobilisation, Exercise and Prevention of the Complications of Stasis. In Fragility Fracture Nursing (pp. 67-83). Springer, Cham.

Epstein, N. E. (2016). 24–48 hour preoperative “surveillance” lower extremity venous Doppler's: Aren’t they worthwhile prior to spine surgery?. Surgical neurology international, 7(Suppl 42), S1075.

Gautham, N. S., Arulvelan, A., & Manikandan, S. (2016). Anesthetic management of a patient with polycythemia vera for neurosurgery. Journal of anesthesia, 30(5), 907-910.

Higgins, R. M., Helm, M., Gould, J. C., & Kindel, T. L. (2018). Preoperative immobility significantly impacts the risk of postoperative complications in bariatric surgery patients. Surgery for Obesity and Related Diseases.

Kato, F., Takeuchi, H., Matsuda, S., Kawakubo, H., Omori, T., & Kitagawa, Y. (2016). Incidence of and risk factors for venous thromboembolism during surgical treatment for esophageal cancer: a single-institution study. Surgery today, 46(4), 445-452.

Li, Q., Yu, Z., Chen, X., Wang, J., & Jiang, G. (2016). Risk factors for deep venous thrombosis of lower limbs in postoperative neurosurgical patients. Pakistan journal of medical sciences, 32(5), 1107.

Loveitt, A. Additional Review Questions. Passing the Certified Bariatric Nurses Exam, 157.

Pang, H., Wang, L., Liu, J., Wang, S., Yang, Y., Yang, T., & Wang, C. (2018). The prevalence and risk factors of venous thromboembolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. The clinical respiratory journal.

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