Essay 1600 wordsCase study instructions: Utilise the Clinical Reasoning Cycle (Levett-Jones, 2013) (a clinical decision making framework) to plan and evaluate person-centred care: · Considering the person’s situation, collect, process and present related health information; · Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care; · Establish goals for priority of nursing care as related to the nursing problem/issues identified; · Discuss the nursing care of the person, link it to assessment data and history; · Evaluate your nursing care strategies to justify the nursing care provided; · Reflect on the person’s outcomes. NRSG370 Assessment Task 2: Case Study –Jack Buun, 69, femoral neck fracture post a fall Jack Buun presented to the emergency department (ED) via ambulance after a fall in his backyard, which lead him to twist and fall directly on the lateral aspect of his right hip. On examination the paramedics reported his right leg to be shortened and externally rotated, and Jack was unable to get up and in a significant amount of pain. His wife Ethel found him and called the Ambulance. Jack has a past history of hypertension that is well controlled. Jack required emergency surgery under general anaesthetic for his femoral neck fracture, and underwent a hemiarthroplasty. You are called to the post anaesthetic recovery unit (PACU) to receive handover, and are happy that he meets the discharge criteria of the hospital. You are told that Jack received the following intravenous medications for pain during and after his surgery: · 20mg Morphine · 100mg Tramadol · 40mg Paracoxib · 1g Paracetamol Jack also received 0.625mg of droperidol in the PACU for nausea. On arrival to the orthopaedic ward you conduct further assessment as follows: You have to Identify and prioritise at least three (3) following nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care. Link with the case · Vital Signs: BP 145/80, HR 120, SpO2 96% on 2L via nasal prongs, Temp 37.1° Celsius, RR 10; · Drowsy but rousable to voice commands; · Pinpoint pupils; · Neurovascular observations (Right Lower Limb): Cool, pale, touch present, movement present, capillary refill sluggish, dorsalis pedis present but thready; · Pain 3/10.You are the RN caring for Jack on the surgical ward. References: 16 references needed Weighting: 1600 words Format of paper· Introduction (be concise provide a brief description of what the paper will discuss – you may wish to identify your 3 prioritised problems here for clarity) · Introduce relevant patient data/information (step 1 & 2 of CRC) · Process relevant information (organise your paragraphs as needed in this section. From this analysing your 3 problems should emerge) (step 3 of CRC) · Clear articulation of your 3 prioritised issues/problems (identify and justify) following your analysis. (Step 4 of CRC) · 1 paragraph discussing goals (step 5 of CRC) · The next section is take action (discussion of nursing care) , this can be presented as 1 paragraph per intervention, including your justification, explanation and links to the data, problems. (step 6 of CRC) · 1 paragraph for evaluation of nursing care strategies (effectiveness of actions and desired outcome, has the situation improved?) (step 7 of CRC) · 1 paragraph for reflection (contemplate what you have learnt from the process and what you/or could have been done differently next time) Join these two together. First priorities I would say are post op observations and consideration of narcotic side effects because he has pin point pupils and is bradypnoeac Second I would say notify the doctor/vascular team that his vascular obs are off Third I am not sure maybe like standard precautions post neck fracture like keeping the bed flat/on a small angle and hip replacement precautions
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Essay 1600 words Case study instructions: Utilise the Clinical Reasoning Cycle (Levett-Jones, 2013).