Assignment Task

 Task

You are required to read the case study below carefully and complete the assessment task highlighted above:

Case Study

Sean Murphy is a 70-year-old patient admitted to the surgical ward presenting with a 1-day history of moderate headache and severe right wrist pain post fall; and 4-day history of abdominal pain, diarrhoea, vomiting, dizziness, and fatigue. Sean is stated to have been on the bathroom floor for approximately eight hours post fall.

Following a Medical assessment at the Emergency Department, Mr Sean Murphy was diagnosed with a moderate head injury, Right (R) distal radial (wrist) fracture and severe dehydration.

On examination the nurse caring for Sean notes the following:

Level of Consciousness: Mr Sean Murphy is unable to recall the current year and has a

Glasgow Coma Score (GCS) of 14 (E4, V4, M6); PEARL.

Blood Pressure: 91/48 millimetres of mercury

Heart rate: 132 bpm (regular pulse)

Respiratory rate: 25 bpm (rapid shallow breathing)

Temperature: 35.2°C

Oxygen Saturation: 93% (Room air)

Capillary refill: greater than 3 seconds

Pain score: 7/10 headache; 9/10 right wrist pain.

Urine output: averaging less than 20 millilitres per hour.

Full body examination: The patient has bruising to his head; severe right wrist tenderness with swelling, bruises and deformity of the right hand, inability to move the right hand with reduced range of movement. The patient is noted to be severely dehydrated with signs and symptoms of hypovolaemia which includes generalised weakness, fatigue, dizziness, leg cramps, dry mucous membranes, increased thirst, cool, clammy, pale skin, and reduced skin turgor.

Blood glucose level: 4 millimoles/litre

Weight: 52 kilograms

Height: 175 cm

BMI: 17

Laboratory tests

Hyponatraemia - serum sodium level of 121mmols/litre

Hypokalaemia with a potassium level of 3.0mmols/litre.

Past medical history

Hypertension, ischaemic heart disease and had an acute myocardial infarction 2 years ago.

Medications

Frusemide 40 milligrams twice daily, orally; metoprolol 50 milligrams twice, daily, orally; aspirin 100 milligrams once daily, orally; and potassium chloride 600 milligrams once daily, orally.

Allergies

Nil known allergies.

Lifestyle habits

• Smokes 5-10 cigarettes/day (attempted to stop smoking with no success)
• Consumes 5-10 standard glasses of alcohol/day.
• Denies illicit drug use.

Familial History: Father - hypertension, ischaemic heart disease, Type 1 diabetes mellitus

Question

1. Define and explain the type, aetiology, and relevant physiology of the pain associated with Mr Sean Murphy`s injuries.

2. In the context of the patient`s hypovolaemia, hyponatraemia, and hypokalaemia, explain the underlying pathophysiology that results in each of the following abnormal assessment findings:

i. Tachycardia

ii. Hypotension

iii. Tachypnoea .

3. Using relevant links to the patient within the case study, explain two (2) evidencebased nursing interventions within the registered nurse`s scope of practice, and briefly explain how each could be applied to prevent and/or manage underlying pathophysiology of hypovolaemia 

4. Using relevant links to the patient within the case study, explain one (1) evidencebased collaborative (interprofessional) intervention that could be applied to prevent and/or manage the exacerbation of the patient`s hypovolaemia and briefly explain how this will address the underlying pathophysiology of hypovolaemia. 

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