Medical and Surgical

Running head: MEDICAL AND SURGICAL 1
Medical and Surgical
Student’s Name
Institutional Affiliation

MEDICAL AND SURGICAL 2
Introduction
The chosen scenario is case study one, the morning shift. Here, Danial is being shifted
from the Emergency Department to the Respiratory Medical Unit as he was presented with a
one-week history of productive cough and SOB more than normal. The essay identifies five
health issues from the case study that are within their scope of practice and selects three of them
and ranks them in the order of priority. It also provides a rationale for the order of ranking.
Moreover, it explains the nurses’ responsibilities in addressing the top three priority health
problems utilizing assessment, care coordination along with care provision. Within the
discussion, the links with the regulatory frameworks of nursing and health department policies
such as NSW health policy, Registered Nurses Standards for Practice and National Safety and
Quality Health Service Standards are discussed.
Part One
Health issues happen when the normal metabolism of the body fails or is altered as a
result of bacteria, pollutant or other forms which may result in health problems regarded as a
disease. The essential approach for nurses at the beginning of a handover for prompt assessment
and therapy is the Airway, Breathing, Circulation, Disability, Exposure, Fluids along with
Glucose (A-G) assessment (Rihari-Thomas, DiGiacomo, Phillips, Newton & Davidson, 2017).
Mr. Danial has a lot of possible health issues and the airway related health issue is COPD,
breathing or respiratory related health problem is pneumonia, and the circulatory related health
problem is hypercholesterolemia or high cholesterol. Moreover, Danial has a fluid related health
issue of dehydration and an exposure related health issue of paleness since upon admission he is
described as a pale man.
Part Two

MEDICAL AND SURGICAL 3
Some fundamental health problems have to be prioritized which include COPD,
pneumonia as a result of defective oxygenation, malnourishment or dehydration, potential
alcohol with drawl, high cholesterol along with depression since he expresses feeling lonely for
the past few months. As a new graduate nurse within a medical-surgical unit with my team, to
plan my handover I will prioritize the area of assistance and offer a pleasant environment for
Danial to eradicate the possible risk factors that might result in more discomfort to Danial.
However, the highest priority health issues include COPD, pneumonia along with
hypercholesterolemia which requires urgent assistance. According to Danial’s condition, COPD
is the highest priority followed by pneumonia and then hypercholesterolemia to break down the
complicated medical conditions and provide therapy as per the A-G algorithm.
Danial’s spirometry test was predicted to be FEV1 50%. However, when a FEV1 value is
less than 80 % this indicates that an obstructive lung disease like COPD is present hence needs to
be handled rapidly. On the other hand, his breathing issues as a result of pneumonia become
more responsive at the tissues around the lungs, nasal passages, and bronchial tubes become
dehydrated which makes the passage wet. His low SPO2 of 88% RA-93 % 2L O2 via NP show
that the state of the airway might be jeopardized (Litvack et al., 2016). The results from blood
gases of pH 7.32, PaCO2 55mmHg, PaO2 70mmHg indicate uncompensated respiratory acidosis
with Hypoxemia (Abrams, Bacchetta & Brodie, 2016). As a result of the breathing issue, Denials
has been recommended to take prednisolone.
Furthermore, Danial was diagnosed five years with high cholesterol which if not quickly
treated nay result to a heart disease. Sleep is a lifestyle factor which impacts the levels of
cholesterol in the body (Lemke, Apostolopoulos, Hege, Wideman & Sönmez, 2017). Too little
sleep affects the cholesterol levels negatively which is evident in Danial’s case since it is said