Assignment Brief

This assignment requires you to consider the following case scenario; 

Case Study – Tom Lewis

Perioperative

Tom Lewis is a 72 year old gentleman who recently presented to his GP reporting a six-month history of abdominal discomfort, indigestion, fatigue and constipation.  A colonoscopy confirmed the location of cancer in the sigmoid colon. All blood tests were normal and further imaging indicated the cancer has not spread beyond the sigmoid colon. 

Tom has a history of a left total hip replacement (2007), myocardial infarction (MI) (2010), hypertension, high cholesterol and lower back pain. Tom is independent with his activities of daily living (ADL's). 

Tom's hypertension and high cholesterol are managed with oral medication though admits if he is feeling well, he sometimes omits his medications. Tom has a 40 year history of smoking 2-3 cigarettes a day. 

Tom's wife passed away twelve months ago.  He lives alone but is in regular contact with his two daughters who live nearby. He plays lawn bowls weekly.

Postoperative

Tom returned from theatre at 2000 following an elective open left sigmoid colectomy. Tom's was recovered in Postoperative Acute Care Unit (PACU) unit before being transferred to the general surgical ward.  

Tom has a midline – incision with an occlusive dressing.  The dressing is not to be removed until reviewed by the colorectal surgeon.

Observations: 

On returning to PACU Tom's observations were: BP 90/54, HR 88, RR 12, oxygen saturations 96%, temperature 36, Sedation score = 1 Urine output- 30-40mls/hour

Medical therapy:

• Indwelling catheter (IDC) on hourly urine measures
• Vacuum wound drain (Bellovac) in-situ 
• 2L oxygen (O2) via the nasal prongs 

Medications:

• Regular IVI paracetamol (once patient is tolerating fluids IVI can be converted to oral)
• Aspirin 100mg daily (ceased 5 days prior to surgery)
• Perindopril 5mg daily
• Lipitor 20mg daily
• PRN ondansetron and metoclopramide
• Patient Controlled Analgesia (PCA) Morphine 1mg bolus with a five minute lockout
• Intravenous infusion: Normal Saline (NaCl) 100mls/hour

The assignment has three parts –

Part 1 is written as a care plan – see attached template (page 7)

Parts 2 and 3 must be written in the format of an academic assignment and in third person.

Part 1: Utilising the case scenario and academic literature to devise a plan of care (may use 10 font and two A4 pages)

This section will concentrate on the first 24 hours of post surgical care.

1. Analyse the case and formulate an appropriate prioritised plan of care for Tom within the defined 24 hour period.
2. In the plan of care include, relevant assessment, potential problem/issue identification and interventions/nursing actions (including monitoring). 
3. The scope of your prioritised interventions may include both physical and psychosocial aspects of care.
4. The care plan must involve justification of your proposed prioritised interventions and supported with rationales derived from suitable literature.

Part 2: Analysing the case to identify potential clinical issues (800-1000 words)

1. Discuss smoking, and the co-morbidity of cardiac heart disease, (previous MI, hypertension and High Cholesterol) in the context of having a general anaesthetic within the 24 hour postoperative period. 
2. Outline the possible clinical complications related to the smoking and cardiac heart disease that could arise in this 24 hour period. 
3. Discuss what the nurse would observe for, assess and intervene to identify and prevent clinical deterioration. Explain your reasons / rationale, with reference to the literature, for the actions identified. 
4. Analysis of the case must involve justification of your proposed prioritised interventions and supported by suitable literature and nursing evidence for practice.

Part 3: Discharge planning (500-700 words). 

1. Plan and prioritise a discharge plan for Tom.  
2. In the discharge plan, consider the ongoing management of a sigmoid resection and colorectal cancer including, social and emotional support, lifestyle modifications and medication advice. 

Assignment Structure

To assist you in planning and structuring your essay the following guidelines are recommended. The structure is inclusive of the topics to be covered in the essay and the recommended word limit for each of these.   Please read your Assignment Rubric and the 'Guidelines for Writing and Submission and Support' document which are published separately.

Introduction

The presented analysis of Tom Lewis's case study is effectively undertaken in three parts with the objective of delineating the clinical complications experienced by the patient and recommending appropriate nursing interventions for the systematic improvement in the wellness outcomes.

The part – 1 of this analytical paper effectively analyses the case scenario and recommends an evidence-based plan of care. However, the part – 2 evaluates the potential clinical issues related to the case study. The part – 3 presents a systematic discharge planning while recommending the requirement of follow-up sessions, lifestyle modifications and emotional support for the treated patient. The assignment includes nursing care examples in the context of recommending mitigative measures related to the presented patient complications. 

(Some parts of the solution has been blurred due to privacy protection policy)