NRSG258 Acute Care Nursing 1 Semester 1 2016/Case Study A: Louise (Graves disease Thyroidectomy) Louise is a 32 year old woman who works as a Registered Nurse in the Emergency Department of a large public hospital. Louise is the sole provider for her two young children who are in primary school. She has been separated from her husband for six months and he has moved interstate. Louise has recently been diagnosed with Graves disease. Her endocrinologist referred her to an surgeon who recommended a total thyroidectomy. On admission to hospital Louise told the ward nurse that she had lost a lot of weight recently and had been feeling very tired. Louise stated that she currently smokes but she is trying to quit. She appeared anxious and was constantly fiddling with her mobile phone handbag and clothes. Louise said that she is very worried about having time off work and that she is concerned that her parents will not be able to cope with looking after her two children while she is in hospital. Louise returned to the Post Anaesthesia Recovery Unit (PARU) having undergone a total thyroidectomy. She received a general anaesthetic and the surgery was uneventful. There was no visible ooze on the small dressing covering the incision site which has been sutured using a subcuticular stitch to hold the wound edges together and a Redivac drain in situ with 50mls of blood in it. Initially Louise was noted to be drowsy but when she started to rouse spontaneously her voice was hoarse and she complained that she was cold and that her neck felt tight and painful. Louise was positioned in a high Fowlers position and was receiving oxygen via a Hudson mask at 6L/min. Her vital signs were as follows: BP 110/56 HR 105bpm Temp 35.5oC RR 12 Sp02 95%. Louise returned to the ward after 60 minutes in PARU. She remained drowsy but was easy to rouse. Louise had an intravenous infusion of 1000mls 0.9% Sodium Chloride running at 125ml/hr and was ordered IV/Oral Paracetamol 1g 8/24 Tramadol Oral 50mg 6 hourly PRN and IV Ondansetron 4mg 8/24 PRN. Louise was given a discharge prescription for oral thyroxine 150mcg daily and oral tramadol 100mg q8h PRN. The next day Louise was assessed as ready for discharge. Her Redivac drain was removed but her subcuticular suture was to remain in place for 7 days. Her voice remained hoarse and she told the nurse that her neck felt weird and that she just couldnt bear to look at it. Louise said that her car is parked outside and asked if she can drive straight to her parents house to pick up her children. NRSG258 Acute Care Nursing 1 Semester 1 2016 QUESTIONS Please refer to the rubric on page 11-12 of the Unit Outline for full marking criteria. Question 1 (10%) In relation to your chosen patient discuss the pathophysiology of their presenting condition and using evidence based literature explore current surgical treatment options for your patient Question 2 (15%) Critically discuss the assessment of ventilation circulation and consciousness prior to the patients discharge from PARU. Discussion must relate to the effects of anaesthesia and surgery on these three physiological functions and be directly related to your chosen patient. Question 3 (10%) Develop a discharge plan to support your chosen patient on discharge home. Include any education you deem relevant any referrals to allied health professional/s required and discuss your rationale. Page 1 of 4 ASSIGNMENT GUIDANCE NRSG258 ASSESSMENT 1: CASE STUDY Dear students here are some guidelines to assist you in writing Assessment 1: Case Study. If after reading through these you still have questions please post on the relevant forum. If you are still unsure then please contact your campus specific lecturer to arrange to discuss your assignment. We ask that you bring these guidelines to any meeting and highlight the areas about which you are still unsure. In this case study you do not need an introduction or conclusion for this case study of 1500 WORDS 10% due by midnight 8th April Turnitin. Just answer the questions. Turnitin is located in your campus specific block. Although we suggest you do your background reading in the current textbooks for basic information the case study also requires you to find current literature/research/articles to support your discussion throughout the case study. Do NOT use Better Health Channel WedMed dictionaries encyclopaedias etc. These are NOT suitable academic sources. If you use these you will not meet the criteria for this question and you will lose marks. You must follow the APA referencing format as directed by ACU in your case study and in your reference list. The Library website has examples of how to do this referencing and you can find the correct format at the end of your lectures and tutorials as well as in the free Student Study Guide. This essay should have approximately 10 relevant sources. Textbooks if cited should be a range of medical-surgical pathophysiology anatomy & physiology and pharmacology for specific information e.g. organ function or drugs. Do not copy information from books or articles or information from previous students assignments. This is plagiarism and you will be heavily penalised. Turnitin will highlight copied information to markers. Please give a title to your essay e.g. Case Study Louise and ensure your name and student number are on each page as a footer. Although you do not need a conclusion or introduction and are answering each question you must write in sentences not point form as this does not show critical thinking. Do not use abbreviations e.g. i.e. etc. in your essay. Write e.g. in full if you need to explain something further. Do not use etc. in an essay. This suggests to the marker that you do not know what else should go into your case study. You must explain any terms you use not just copy them out of a Page 2 of 4 book/article/research. The markers need to know that you understand your chosen patients condition and management for safe care. ASSIGNMENT WRITING TIPS Question 1 (10%) In relation to your chosen patient discuss the pathophysiology of their presenting condition and using evidence based literature explore current surgical treatment options for your patient (10%). (Suggested length for your answer approximately 350 words). First give a very brief overview
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