Mr. Fraser Case Study: Nursing Assessment and Interventions

This case study discusses the nursing assessment and interventions for Mr. Fraser, a postoperative patient who developed signs of hypovolemia. It explores the cues, health problems, nursing diagnosis, and interventions to improve his health status.

Mr. Fraser case study
Question 1
For any postoperative patient or any inpatient in the ward undertaking treatment, there is a
need to do some assessment which helps in monitoring the patient's progress. These pieces of the
information that the nurses gather during the assessment phase are called cues (Forbes & Watt,
2015). The nurses interpret these cues to make inferences or judgment about the health status and
progress of the patient. Mr. Fraser’s cues were within the normal range when he was stabilized in
the recovery room for the first two post-operative hours following a Laparotomy and right
hemicolectomy and then transferred to the surgical ward. In his room at the surgical ward, his
cues changed and the patient presented with signs of hypovolemia at 2200 hours which require
immediate implementation of some nursing interventions to improve his status
One of the clusters of cues which relate to one priority patient problem is oxygen saturation
and is related to impaired gas exchange. Abnormal cues include increased pulse rate up to 112
beats per minute while the normal heart rate range for an adult is 60-100 beats per minute
(Shaffer, McCraty & Zerr, 2014), respiratory rate of 22 instead of 12-20 breaths per minute,
systolic pressure of 90 mm Hg instead of 100-140 mm Hg, 92% oxygen saturation instead of
97%-100%. Severe pain of 8/10 instead of mild pain of less than 3/10. A temperature of 35.8
degrees Celsius instead of 36.5-37.5 degrees Celsius. A random blood glucose level of 14.2.
Normal random glucose level is less than 11.1 mmol/L (Ta, 2014), and urine output 15ml/hour
instead of 30-60 ml/hour.
Question 2

Knowledge of nursing cues and the observations obtained during the assessment of Mr.
Faser can easily be used to describe current health problems Mr. Faser requiring immediate care.
He has developed signs of hypovolemia including, dehydration evidenced by dry lips and dry
tongues, tachycardia and decreased urine output volume (Bishop & Elghenzai, 2014). When
patients undergo surgery, they lose a considerable amount of fluids in the form of blood.
Hypovolemic shock can, therefore, occur which is an emergency situation characterized by
excess fluid and blood loss during the surgery and some related risk factors including sweating
and urine loss. When this occurs, it results in the heart being unable to pump the essential blood
volume needed by the body. The body, therefore, compensates this by increasing the heart rate
and an increased respiratory rate. Hypovolemia can be presented by hypotension and
tachycardia. This is the case with Mr. Faser, he has an increased heart rate up to 112 beats per
minute, with an increased respiratory rate of up to 22 breaths per minute, and the patient is
hypotensive with a systolic pressure of 90 mm Hg. The client also presents with signs of
hydration including urine output of 15 ml/ hour and dry lips and dry tongue
Question 3
The ABCDE framework in patient assessment plus the clinical reasoning cycle bring basis
where we the patients’ actual and potential health problems can be prioritized with ease and in
this case, the actual nursing diagnosis is impaired gas exchange related to the ventilation-
perfusion imbalance as evidenced by abnormal breathing pattern and tachycardia (Ackley et al
2019). The abnormal breathing pattern is defined by increased respiratory rate and shallow
breaths.
Question 4

The impaired gas exchange simply means excess or deficit in oxygenation and/or carbon
dioxide elimination at the alveolar-capillary membrane (NANDA. International, 2014). The main
goals for this nursing diagnosis are; that Mr. Flaser will maintain optimal gas exchange in the
next 30 minutes of nursing intervention. Its outcome should be unlabored respirations at the
normal rates of 12-20 breaths per minute, oximetry results within the normal range of 97%-
100%. And baseline heart rate within the normal range of 60-100 beats per minute and usual
mental status with a Glasgow coma scale of 15/15. That the patient will maintain a clear lung
field, the outcome is remaining free of signs of respiratory distress.
Question 5
For the health status of Mr. Flare to improve, the nursing priorities identified must be
managed and this can be done by implementation of the nursing interventions. The essay will,
therefore, identify four nursing actions to achieve the stated goals. First nursing intervention,
positioning the patient in a semi-Fowler’s position with the head of the bed elevated at an angle
of 45 degrees when supine. Rationale, semi-Fowler’s position is an upright position which
allows increased thoracic capacity, the diaphragm can descend fully, and the lung expansion is
increased this prevents the abdominal contents from crowding (Cortes-Puentes et al 2018). The
second intervention, I will turn the patient every two hours while monitoring mixed venous
oxygen saturation closely. This prevents complications of immobility. Third nursing
intervention, I will maintain oxygen administration as ordered attempting to maintain the oxygen
saturation at its highest level possible 90% or above. This supplemental oxygen is required to
maintain the PaO2 at an acceptable level. Fourth nursing intervention, I will assist in splinting
the chest this is done by holding a pillow firmly on the chest during coughing and deep breathing
(Engelke & Woten, 2017). The incision can cause pain during coughing since coughing also uses

the abdominal muscles apart from accessory muscles. Abdominal muscles may have been cut
during surgery leading to pain during coughing and deep breaths.
Conclusion.
Excess blood loss during surgery can lead to hypovolemic shock which can be manifested
by signs of dehydration such as dry mouth and dry tongue. The body may compensate this by
alteration of some normal physiologic functioning of some organs such as the heart and lungs.
The heart rate increases and the respiratory rate as well. when this happens, nursing priorities
should be developed rapidly and the nursing interventions implemented to improve the patient's
status. exacerbation of hypovolemia can lead to shock and damage of organs

References.
Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M.
(2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning
Care. Mosby.
Bishop, C., & Elghenzai, S. (2014). Is This Elderly Patient Dehydrated? Diagnostic Accuracy of
Hydration Assessment Using Physical Signs, Urine, and Saliva Markers.
Cortes-Puentes, G. A., Gard, K. E., Adams, A. B., Dries, D. J., Quintel, M., Oeckler, R. A., ... &
Marini, J. J. (2018). Positional effects on the distributions of ventilation and end-
expiratory gas volume in the asymmetric chest—a quantitative lung computed
tomographic analysis. Intensive care medicine experimental, 6(1), 9
Engelke, Z., & Woten, M. (2017). Preoperative teaching: preparing patients for abdominal
surgery.
Forbes, H., & Watt, E. (2015). Jarvis's physical examination and health assessment. Elsevier
Health Sciences.
NANDA. International. (2014). Nursing Diagnoses 2012-14: Definitions and Classification.
Wiley.
Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: an
integrative review of the heart's anatomy and heart rate variability. Frontiers in
psychology, 5, 1040.

Ta, S. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37, S81.