Nursing | Case Studies | Assignment

Nursing
Student’s name:
Institutional:

Case Study
Question 1
Edward (Ted) Williams, an 82-year-old male, is now 4-day post-operative having undergone
a bowel resection and formation of a temporary colostomy. He underwent surgery after being
diagnosed with a malignant mass in his colon according to his coloscopy and biopsy tests.
Ted lives alone since his wife died three years ago due to a bout of pneumonia. He moved to
a retirement village one year ago and has a partner Gwen, aged 78, living in the same
retirement village. Ted has two children, a son and a daughter. The son, Christopher, lives
overseas with his wife and son while his daughter, Janice, lives with her family (husband and
three children) in the city. Applying the RLT Model for assessment of the patient, it is
evident that he suffers from psychological and social deficits which must be addressed during
his nursing care. He has to adapt to acquiring skills to live with his altered body and go
through a psychological transition. He may require assistance for cleaning and emptying of
his stoma from a healthcare professional. Studies show self-deprecating experiences inpatient
with a stoma due to feeling of mutilation, fear of social rejection, reduced self-esteem and a
sense of incapacitation (Song at al., 2020). Ted is also experiencing diet restriction due to
surgery. He was Nil By Mouth 48 hours post-surgery and a full fluid diet and the light meal
was commenced yesterday. Therefore, according to Roper-Logan-Tierney's model, Teds
achieves the activities of daily living such as a safe environment, sleeping, breathing and
communication. However, he is yet to effectively meet others like elimination, working and
playing, washing and dressing, and eating and drinking

Question 2
Ted has a past medical history type II diabetes mellitus, heart failure, obesity and gout. His
weight and height are 115kgs and 175cms, respectively, with a BMI of 37.6m2. Breakfast
was served today he vomited twice and feels nauseated. This was managed by 4mg
ondansetron for nausea. Vomiting is one of the common problems after a colostomy due to
poor digestion and absorption of the nutrients from his intestine (Silva et al., 2018). At 10 am
His vital signs are; T 38.1°C, BP 135/85 mmHg, HR 98 b/min, RR 26 and SpO2 94% on 3L
NP. Ted is also experiencing right-sided inspiratory coarse crackles and has a moist
productive cough. These are an indication that the patient might be suffering from aspiration
and chronic bronchitis (Studer et al., 2016). Coarse crackles are also one of the primary
symptoms of aspiration after abdominal surgery (Cheng, 2010). He reported an abdominal
pain of 4-5/10 scale which increased to 7/10 on palpation; however, he is under patient-
controlled analgesia (PCA) morphine for effective pain relief. His abdomen is also distended.
The stoma was pink, moist, and warm and slightly raised from the skin and visible through
the colostomy bag. The abdominal laparotomy performed has clear occlusive dressing with a
minimal ooze present. He has a redivac drain with 30 ml of haemoserous fluid and urine
output via the urinary catheter in situ with an output of approximately 60-70 ml per hour,
which is within the normal range (Yue et al., 2015). Ted current medication includes
Metformin 500mg Mane, Captopril 12.3mg mane, Allopurinol 100mg Daily and paracetamol
1 g QID.
Ted’s temperature of 38.1 degree Celsius is higher and may indicate infection. Fever is one of
the four cardinal signs of infection. Paracetamol, being an antipyretic and analgesic, is,
therefore, being administered to reduce fever and pain. Ted heart rate is more than the
average (75 b/mins) in adults which may be due to heart failure. His respiratory rate is also a
bit higher. He is also obese (BMI) of 37.6. Captopril is being administered in order to manage