Acute Health Problems: Nursing Interventions and Patient Care Plan

This case study focuses on Nadia, a 76-year-old patient admitted with a bowel obstruction, detailing her initial assessment, potential health issues, and the roles of various healthcare team members. It covers pre-operative care education, including pain management and physical restrictions, and explains how to communicate these issues to Nadia's family. The pathophysiology of Nadia's acute health issues, such as bowel obstruction, Crohn's disease, hypernatremia, and edema, are defined and described. The case study also uses ISBAR and A-H formats to document information handover and record-keeping. Furthermore, it examines post-operative care following emergency bowel surgery, addressing anesthetic reviews, pain management, and nutritional support through nasogastric feeding. Desklib offers a range of solved assignments and past papers for students.

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ELEMENT ONE: Identify impact of acute health problems on a person, family or carer
Case Study One:1/7/2018
1100: Nadia Canssino is a 76-year-old NESB lady admitted to your ward from Accident and
Emergency. Nadia is able to understand a small amount of English and lives with her daughter.
Nadia presented with a Bowel Obstruction which may require surgery in 2 days if it does not

resolve on its own. Nadia’s observations on admission to your ward are Temperature 36.7, Pulse
98, BP 156/89, Respiration 22, Oxygen Saturation 96% on Room Air, Weight is 43kgs. Nadia is
complaining of abdominal pain on arrival to the ward and requests pain relief.
1300: Nadia is to remain NBM with IV fluids over 6 hours for hydration. Intravenous Catheter
(IVC) is in-situ to the left arm, the site is NAD. A nasogastric tube is in-situ for free drainage and
4th hourly aspiration. IDC in-situ and is draining adequate amounts of urine every hour. Nadia
remains NBM Nadia’s IDC and Nasogastric hourly output is as below:
IDC N/G
1300 25mls 100mls
1400 20mls
1500 30mls
1600 32mls
1700 20mls 250mls
1800 40mls
1900 5mls
2000 10mls 100mls
1645: Nadia complains of a painful red and swollen left arm and the IVC is removed at 1700.
The Doctor attempts to insert another IVC for Nadia however after 4 attempts the doctor decides

that Nadia will need a PICC line inserted but is unable to organize it until tomorrow. Therefore,
Nadia has no IVC access until tomorrow.
2000: Nadia complains of feeling unwell, she looks pale and clammy. Observations T 38.6, P
120, BP 100/55, Respiration 25, Oxygen level 92% room air. A critical review is called for
Nadia.
2030: Temp 38.5, P 130, BP 92/50, Respiration 26, O2 Sats 89% 4 litres nasal prongs. Nadia is
continuing to deteriorate, and you need call for emergency response for her (as per organization
procedures) as her level of consciousness is decreasing.
Use CASE STUDY ONE provided to answer the following questions: -
Question 1.1.1
Define and describe the aim and characteristics of acute care
Acute care is one among the branches of secondary health care which mainly deals with
patients requiring active and short-term treatment as a result of severe injuries, urgent medical
conditions or recovering from surgery. The main aim of acute care is to ensure that the patients
in acute conditions receive critical care in order to survive the acute conditions. This branch is
uniquely characterized by patients diagnosed with short but serious conditions resulting from
accidents and emergency. The patients are also physiologically unstable, critically ill and highly
vulnerable to complications.
Identify and explain briefly 1 (one) acute health problem relating to Nadia.
The Bowel Obstruction suffered by Nadia can be categorized as an acute health problem.
From the explanation in the case study, the disease has been presented to require a quick

response in terms of surgery (2 days) if it does not resolve by its own and that short duration is a
characteristic feature of acute health problems.
What should be included in the preliminary health assessment?
 Inspection- Nadia will be examined and inspected at the various parts of her body for
normal shape, colour and consistency. This will help in alerting the healthcare providers
on the problems she might be having
 Palpation- the examiners will use their hands to tap on Nadia’s body. This will help in
listening to her heart, neck, abdomen or the lungs in order to identify problems she might
be having
 Auscultation- this is a physical examination technique which will be used to listen unto
Nadia’s lungs, heart, abdomen or neck to identify any problems which she might be
undergoing
 Neurologic examination- this will entail assessing Nadia’s cranial nerves, motor function
and sensory function.
List three (3) the actual and potential health issues for Nadia
 Crohn's disease
 hypernatremia
 Edema
List 2 (two) other health team members are involved in the care of Nadia and describe their roles
 Neural Surgeons- responsible in diagnosing and carrying surgery on Nadia
 Intensive care unit- responding to Nadia’s condition when under emergency

Question 1.2.1
List and describe 2 (two) factors you would include in the pre-operative care education of Nadia.
Your answer must include the potential physical and psychological impacts of acute health
problems on daily living activities
 Pain management- after the surgery, Nadia is expected to undergo a lot of pain before
recovery. She, therefore, needs to be prepared psychologically for that and how to
manage the condition.
 Physical restrictions- there are some of the duties which Nadia used to perform on her
own like cleaning utensils but the condition after surgery won’t allow her to perform
them. She, therefore, needs to be informed about the consequences of being involved on
those activities on her health.
For the two factors listed above how would you explain these issues to Nadia’s family?
First of all, I would explain to the family members on the reason behind Nadia’s pain and
how it’s an unavoidable circumstance to her. For instance, the issue of surgery I would inform
them that undergoing painful conditions by surgery patients is normal and that the pain won’t
last forever. I would also enlighten them on how to help her contain such moments. As far as
being restricted from vigorous physical activities is concerned, I would explain to them about the
consequences of her being involved in some of the physical activities like farming, cleaning or
carrying heavy luggage she used to be undertaking before.
Question 1.3.1

Define Pathophysiology: Pathophysiology is the study of disorders in physiological processes
which are associated with diseases or injuries.
List four (4) of Nadia’s acute health issues
 Bowel Obstruction
 Crohn's disease
 hypernatremia
 Edema
Briefly define and describe the Pathophysiology of the four (4) acute health issues you identified
for Nadia
 Bowel Obstruction- Faecal impaction as a result of large, hard mass of stool getting stuck
in Nadia’s digestive tract and which can't be eliminated in the normal way
 Crohn's disease - an inflammatory bowel disease which will cause inflammation of
Nadia’s digestive tract
 hypernatremia – an electrolyte problem if the hydration being administered to Nadia fails
and the serum sodium concentration value exceeds 145 mmol/L
 Edema- a swelling on Nadia’s body which will be caused by excessive fluid trapped in
her tissues if the hydration process fails
ELEMENT TWO: Contribute to planning care for a person with acute health problems
Question 2.1.1

Using the ISBAR format describe the information you would hand over to the registered nurse?
ISBAR
I Introduction- I will identify Nadia to the Nurse (her name and her local
location) then give the nurse the reason as to why i called
S Situation – I will give Nadia’s age and gender
Then her status as per the time of calling which can be
A) Stable or
B) Unstable
B Background –give Nadia’s relevant details like her problems and her
clinical history
A Assessment –I will put it all together at this point by explaining Nadia’s
current condition, risks, and needs
R
Recommendation – I will give recommendation on her transfer/ review
treatment
Using the ISBAR format describe the information you would hand over to another member of
the healthcare team. (Your handover must have key differences to the previous question)
ISBAR
I Introduction- I will identify Nadia (her name and location) then give the
reason as to why I called

S Situation – I will give Nadia’s age and gender
B Background –give Nadia’s relevant details like problems
A Assessment –Explaining Nadia’s current condition, risks, and needs
R
Request – I will give my request on how I think Nadia can be assisted.
Question 2.2.1
Using the A-H format document what you would enter into her record at 2030.
 her heart rate
 her blood pressure
 her breathing and respiration
 her pain management and nausea
ELEMENT THREE: Perform nursing interventions to support the health care of a person
with acute health problems.
Case Study TWO