Case Studies on Nursing PDF

Running Head: Case Study
NURSING CASE STUDY
Name of the Student
Name of the University
Authors Note

1NURSING CASE STUDY
Response to Question 1
Ted was admitted to the hospital for bowel resection surgery and the surgery took
place 4 days ago. He is now admitted in the post-operative management. He is suffering from
various issues such as respiratory distress, high blood pressure and pain. Ted did not show
any bowel movement after the surgery. Body temperature of the patient was high. As Ted
was an elderly patient, he might show the drug withdrawal or post-operative withdrawal
symptoms. The patient vomited after having break-fast and regular metformin. Vomiting and
nausea might be occurred due to the transition of the diet from liquid to light . The person has
hypertension, high blood glucose and is an obese patient . Therefore the complications might
increase in him in higher rate.
Socio-demographic condition of Ted William is very critical also. As he lives alone
in a retirement village and his wife died 3 years ago. He has a son and a daughter but they
lived separately. His son lives in another country where as his daughter lives with her
husband and 33 children in the city. Therefore, emotional and psychological distress might
be observed in him. He has a partner , named Gwen in the village. Therefore he might have
regular and frequent communication Gwen , which is very important for an elderly patient.
Although the retirement village is quite far from the city.
Response to Question 2
Process information
The patient has temporary colostomy after the surgery and has shown no bowel
movements. He is feeling sever pain in the surgical site with the scale of-4-5/10.
Additionally, the person had worse pain during palpation and the pain scale is 7/10 which is
severe pain. His body temperature is elevated than the normal range. He has right sided
inspiratory coarse and crackle sound. The person was producing unknown mucous and the

2NURSING CASE STUDY
colorations of the cough must be checked. The heart rate was 98 bpm which is under the
normal range. Moreover, his respiratory rate is 26 bpm in 94% O2 saturation and respiratory
rate is quite higher than normal rate (Papazian et al., 2019). The oxygen saturation rate is less
than the normal physiological range which must be 98%-100%. The person has pre medical
history of congestive heart failure and the heart rate of the person has given. Therefore,
nurses should check the heart rate regularly. Blood pressure of the patient is 135/85 which is
higher than normal rate of blood pressure. The patient has diabetes mellitus and has to take
regular metformin.
Identify problems
Respiratory rate of the patient is higher than the normal range and during inspection a
coarse crackle sound can be observed. Therefore the person might have fluid accumulation in
his lungs. Ted is suffering for respiratory distress or dyspnea (Baston et al.,2019). The
oxygen saturation rate and cough production should be taken under consideration.
The post-operative pain is another major problem in the abdomen of the patient. The
patient’s abdomen appeared to be distended. Moreover, the pain intensity gets increased
during performing palpation in the abdomen (Goodman, 2019). The pain is 7 out of 10 on the
pain scale.
Fever might be caused by infection in the operative site and the accumulation of
cough and fluid in lungs. Post-operative stress due to severe pain and respiratory distress are
the causes of fever. Infection might be another cause of fever in the patient.
Absence of bowel movement is another significant issue in the case scenario. There is
no signs of bowel movement and flatus passing. Therefore, the patient’s abdominal status
must be checked by the examinations whether accumulation of gas or some symptoms of

3NURSING CASE STUDY
inflammation present or not (Chong, Schultz & Donnelly, 2019). As the patient has diabetes
abdominal distension can be occur. However, the nurses and doctors must examine whether
the Crohn's disease and ulcerative colitis present or not. The causes of distended abdomen
might be transient constipation and dysphasia.
Response to Question 3
Nurses should try to reduce the crackling sounds and should aim to increase the respiration
quality (better oxygen flow and normalize respiratory rate). They should prevent arise any
kind of infection in the patient.
The respiratory assessment should be completed by placing the patient in Fowler’s
position. As this position will help to promote breathing in the patient (Ringdal & Gullick,
2019). Complete respiratory assessment should be performed by the nurses. Suctioning and
possible fluid accumulation restriction should be P/F ration should be checked by the nurses.
Nurse will help him in breathing exercise and diaphragmatic exercises to regularize the
breathing patterns.
Nurses should try to lessen the respiratory distress and dyspnea. As a result the respiratory
rate will automatically improve.
Nurses might give him oxygen supplement with the suggestion of physician. They
would help the patient by teaching him coughing patterns and breathing techniques. This will
help him to control the cough production in the patient. Sputum of the patient should be sent
for testing to understand the underlying causes. The suctioning process will be suggested to
patient if breathing patterns failed. Nebulizer management should bee suggested to the
patient with registered nurses.
Pain should be decreased in the post-operative condition. Ted’s pain should be reduced to the
scale of 0-3 out of 10.

4NURSING CASE STUDY
Pain management includes pharmacological and non-pharmacological interventions
as per the physician’s suggestion. Nurse can help the patient in non pharmacological
interventions such as repositioning and performing the pain assessment procedure. The
assessment will help to understand quality, severity, onset and duration of pain. PCA
morphine has been administered in Ted , reassessment of patient after administering
morphine is also important. Sleep and relaxation process should be recommended by nurse.
Nurses should prevent onset of infection in Ted’s surgical site.
Infection management requires regular dressing and supervision of wound infection.
As Ted has occlusive dressing, chance of tissue disposition and injury might be occurred in
the wound site. Wound site should be assessed regularly to prevent gangrene and hair growth
in wound site. Catheter, colostomy bag and transfusion tube with IVC setting should be
checked so that Ted might be prevented from infection.
The nurses should focus on regularizing the bowel movement to avoid further gastrointestinal
issues.
Rectal pain, fatigue, abdominal distension should be checked by the nurse and proper
nutritional habit must be maintained in managing Ted’s condition (Cunningham & Moore,
2019). Bowel sound should be assessed and noted down by the nurse. Regular abdominal
assessment should be done in this case scenario as Ted is showing disturbed bowel movement
after the operation.
Response to Question 4
Non-steroidal anti-inflammatory drugs can be given to the patient as overdose of
Morphine might be occurred in the case scenario. PCA morphine intake might arise side
effects in the patient (Ghlichloo & Gerriets, 2019). NSAIDS are highly susceptible in binding
with plasma protein and could easily be eliminated though urine. The half-life of these drugs

5NURSING CASE STUDY
are variable. These drugs prohibit prostanoid synthesis with obstructing cyclooxygenase
enzyme activities. As a result analgesic and anti-inflammatory effect can be observed in the
patient. Long-term use of the drugs can occur in side effects such as allergy, stomach pain,
high blood pressure and headache.
Furosemide might be suggested to the patient as it will help in reducing the adverse
effect of ARDS in patient’s body. Continuous dosage will help the patient to get rid of the
effect of respiratory distress. Furosemides will help to inhibit active transportation in the
ascending limbs. These drugs help to reduce reabsorption of NaCl in nephrons and isotonic
urine is produced (Khan & Siddiqui, H. 2019). The effect of medicine will help to reduce
vasoconstriction and chest pain. The overdose of the drug can cause renal failure and
dehydration.

6NURSING CASE STUDY
References
Baston, C. M., Coe, N. B., Guerin, C., Mancebo, J., & Halpern, S. (2019). The Cost-
Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe
Acute Respiratory Distress Syndrome. Critical care medicine, 47(3), e198-e205.
https://doi.org/10.1097/CCM.0000000000003617
Chong, V., Schultz, T. J., & Donnelly, F. (2019). Clinical protocols for adults with acute
abdominal pain in Australian emergency departments. Journal of evaluation in
clinical practice, 25(3), 412-419. https://doi.org/10.1111/jep.13103
Cunningham, S., & Moore, T. (2019). Nursing skills in nutrition, hydration and elimination.
Routledge. https://books.google.co.in/books?
hl=en&lr=&id=bcbADwAAQBAJ&oi=fnd&pg=PT9&dq=bowel+mov
Ghlichloo, I., & Gerriets, V. (2019). Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
https://www.ncbi.nlm.nih.gov/books/NBK547742/
Goodman, M. (2019). Improving Postoperative Pain Management (Doctoral dissertation,
Grand Canyon University). https://search.proquest.com/openview/c9c9d53b75086
Khan, T. M., & Siddiqui, A. H. (2019). Furosemide. In StatPearls [Internet]. StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499921/
Papazian, L., Aubron, C., Brochard, L., Chiche, J. D., Combes, A., Dreyfuss, D., ... &
Mercat, A. (2019). Formal guidelines: management of acute respiratory distress
syndrome. Annals of intensive care, 9(1), 69. https://doi.org/10.1186/s13613-019-
0540-9

7NURSING CASE STUDY
Ringdal, M., & Gullick, J. (2019). Respiratory assessment and monitoring. ACCCN's Critical
Care Nursing-E-Book, 418-455. https://books.google.co.in/books?
hl=en&lr=&id=J6aeDwAAQBA
.