NRSG258 Principles of Nursing: Mr. Ted’s Case | Assignment

Running head: PRINCIPLES OF NURSING 1
NRSG258; Principles of Nursing: Mr. Ted’s Case
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PRINCIPLES OF NURSING 2
Question 1
According to the RLT model of nursing, the activities of living carried out by Mr. Ted are
suggestive and could potentially affect the outcome of any surgical procedure performed on him.
This model specifies how bio psychosocial, cultural and spiritual factors can have impacts on
someone’s health (Cao, White & Ma, 2017). Below is an overview of how the RLT model of
nursing care was applied in the clinical assessment of Mr. Ted.
The first element of the RLT model is maintaining a safe environment. Mr. Ted was an
obese patient who had a urinary catheter in situ. After his surgical procedure to remove the mass
in his colon, he had a surgical wound that was infected. He also had a colostomy bag in place
and had no output since the procedure. Effective communication is also an RLT model (Cao,
White & Ma, 2017). He was communicating with the nurses. He gave them information of the
morning day of his surgery on how he was faring on. His breathing had also been affected by the
surgery. The respiratory rate had increased to 26 breaths per minute. The bold oxygen saturation
level was 90%.
Another element of the RLT model is eating and drinking (Du, Li, Qu, Li & Bao, 2019). This
was an obese patient who also had gout. He had his bowel prepared for the effectiveness of the
surgery. He remained nil by mouth for the first two days after the surgery. He started ordinary
diet on a full fluid diet and on their day post-operative; he was given his regular metformin and
breakfast. Proper nursing care had been considered in order to make him eliminate his urine and
fecal contents. It is reported that he voided 60 to 70 mls of urine per hour. A colostomy bag was
also in place. In terms of personal cleansing, it is not told whether Mr. Ted had the ability to
clean himself. His body temperature was 38.1 degrees Celsius. In terms of mobilization, he could

PRINCIPLES OF NURSING 3
move and turn in his bed. Working and playing are the RLT elements that had been affected by
his condition (Du, Li, Qu, Li & Bao, 2019). His wife had died three years ago from pneumonia.
Expressing sexuality; Mr. Ted’s wife had died and had a friend, Gwen, who was living nearby. It
is however not known whether his sleep had been affected.
Question 2
The two identified problems during the assessment of Mr. Ted were abdominal distention
& obstruction and post-operative pain with nausea & vomiting. These were in the post-operative
period on the fourth day. It should be remembered that he had a bowel resection procedure done
on him to remove the large mass in his descending colon. The evidence form the case study to
support the problem of intestinal obstruction is that he had started eating on the third day post-
surgery but had not voided anything into the colostomy bag connected to his stoma. Another
pathophysiology linked to this problem is that he exhibited a clinical symptom of vomiting (Du,
Li, Qu, Li & Bao, 2019). This is suggestive of an obstruction. He also complained of abdominal
pain that could be as a result of the obstruction. The intestinal contents could have exerted
pressure on nearby organs hence the pain, considering that he had had a bowel resection
(Shoqirat, Mahasneh, Dardas, Singh & Khresheh, 2019).
Mr. Ted did not eat anything first 48 hours post-surgery. On the 3rd day, he had a meal
made up of only fluids in the morning and a light meal in the evening. He was given his regular
metformin and breakfast on this 4th day. However, he feels nauseated and has vomited twice.
This raises a red flag for the care givers. The collected information also narrows down to the
possibility of having an infection due to the fever (Feng-Juan, Yu, Hua, Jin-Zhuo & Zhen-
Zhong, 2019).

PRINCIPLES OF NURSING 4
He had post-operative pain which he rated it at 4-5/10 and increased in its severity to 7/10
on palpation. He was given morphine as an analgesic to help counteract the pain. This was
somehow helpful. However, morphine leads to a reduced respiratory rate and also slows down
intestinal movements (Feng-Juan, Yu, Hua, Jin-Zhuo & Zhen-Zhong, 2019). These side effects
are potentially life threatening considering the fact that he had been given a general anesthesia
during his surgery that could as well be having the same side effects (Hesketh et al., 2017).
Therefore, the observed slowed bowel movements and his intestinal obstruction could be as a
result of the morphine given (Roshanov et al., 2017). He was also given ondansetron to relieve
his nausea and vomiting. This drug has similar side effects, and hence could have exaggerated
his condition (Feng-Juan, Yu, Hua, Jin-Zhuo & Zhen-Zhong, 2019).
He also had an abdominal laparotomy which had clear occlusive dressing with minimal
ooze. The stoma margins were slightly raised above the skin, warm, pink ad moist. There was
no output into the colostomy bag since the surgery had been performed. A urinary catheter was
in place, draining about 60 to 70 mls of urine per hour. This shows that his kidneys were
functioning normally (Manworren, Gordon & Montgomery, 2018).
The nurse took his vital signs in the morning and found out that his temperature was 38.1
degrees Celsius, a heart rate of 98 beats per minute, a blood pressure of 135/85, a respiratory rate
of 26 and an oxygen saturation level of 90%. The raised temperature could indicate that he had
fever that could have been caused by a possible infection (Manworren, Gordon & Montgomery,
2018). He had right sided inspiratory course crackles with a moist productive cough. All these
observations should have been carefully taken into consideration as they are normally the
indicators of health (Shoqirat, Mahasneh, Dardas, Singh & Khresheh, 2019).