Clinical scenario

Description: This assessment task allows students to demonstrate theoretical knowledge around pathophysiological changes in disease, pharmacological management of disease, planning nursing care and evaluating care. Students are required to answer the case scenario questions provided.
Students should attempt all questions in the case study:
…You are just starting your shift as a graduate nurse and you are about to review your first patient, William Tran is a 33 year old man who has been admitted to the surgical ward – high dependency area post the formation of a temporary ileostomy. During admission, it is documented that William has a past history of Crohn’s disease – ulcerative colitis and multiple hospitalisations for Crohns related illnesses including malabsorption and weight loss (55kg).
He is prescribed Prednisolone, Metronidazole, Balsalazide. He is also on a narcotic analgesia infusion (Morphine 60mg in 60 ml with Normal Saline 0.9%, equaling concentration of 1mg/ml) with a continuous infusion rate of 3ml/hr and a patient controlled analgesia demand dose of 2mg. Prior to transfer to the ward he was prescribed and administered a loading dose of intravenous morphine (5mg). His social history reveals he has been partnered for 10 years. Extended family live in Vietnam.
1.1 Describe the pathophysiology of acute pain. How does this differ from chronic pain? Include in your answer the pathophysiological effects of narcotic analgesia as a treatment option for acute pain. Demonstrate links to Tran’s case. (400words)
When you arrive at Tran’s bedside, you notice that he is difficult to rouse and non-verbal. His eyes are closed. You take an initial set of vital signs: Temp 35.8, Pulse irregular 110 bpm, BP 98/55, RR 6, SaO2 93% 6Lt oxygen via Hudson mask.
1.2 Discuss THREE types of nursing assessments in order of priority that would be appropriate for Tran’s deterioration (excluding vital signs) and provide a description of each of these in the context of Tran’s complaint with rationale as to why these would be your priority. (400 words)
1.3 Discuss THREE nursing interventions (may include one pharmacological) you would initiate and provide rationale as to how these would improve physiological outcomes of Tran’s problem. (400 words). Nursing interventions would include nursing activities or actions that the nurse could initiate in response to nursing assessment findings.

Page 3 of 4 CRICOS Provider No. 00103D NURBN3023 Context of Practice 5: Patient Deterioration and Management.
Note: please be aware of the difference between an assessment and an intervention.
1.4 Discuss the administration (including administration, benefits, risks and contraindications) of Morphine for Tran’s pain. Include in your explanation what education you should provide to Tran’s on commencement of the patient controlled analgesia (PCA). (400words)

1.5 Report the major side effects of intravenous morphine apply your findings to Tran’s case. Explain why this finding would need to be reported immediately to the Doctor. (200words)