Mr George Jensen, a 65-year old male, was brought into Emergency Department with an open fracture of his right tibia and fibula after falling from his roof while clearing the gutters
He was taken to theatre as an emergency case where he had an open reduction and external fixation of his fractures. He has returned to your ward at 5.30am post-operatively. You have arrived on the morning shift to find:
ASSESSMENT DATA
- His right leg is cool to touch;
- Pain Score is 7 on a scale of 1-10;
- Fracture site and pin sites have serous ooze with notable swelling of his right leg;
- Blood glucose level of 17mmols/ltr;
- His post-operative vital signs are currently, HR 107BPM, BP 104/55mmHg, temp 37.9°C Axilla, SaO2 95%, FiO2 6 ltires via Hudson mask, Resp rate 24BPM;
- Hartmans solution running at 125mls/hr via triple lumen central line situated in the right internal jugular.
- Insulin and dextrose infusion running at 2mls/hr (2 units/hr);
- Urine output via a Foley IDC is >1ml/kg/hr and dilute.
Applying your knowledge and understanding of Type 2 Diabetes, fractures and hypertension, you are asked to write an academic essay applying the following principles throughout your discussion:
- Explain, the pathophysiology of Mr Jensen’s post-operative hypovolemia and how some of his post-operative assessment data might have contributed to this. In addition explain how the body might compensate for this physiologically (approximately 800 words).
- Identify Mr Jensen’s actual PRIORITY problems. Justify each problem based on the data collected from Mr Jensen’s assessment data (approximately 400 words).
- For each problem identified, describe one (1) nursing goal for his care (approximately 200 words).
- Choose two (2) of the identified goals, and justify, with a synthesis and an analysis of the evidence-based literature, nursing interventions with rationales to assist in achieving the identified goals. (approximately 800 words).
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