Dane Barr is a 56 year old gentleman who lives with his wife Pamela and his son who is 26 years old. Dane is a musician and plays the trumpet in a band, he is also a keen traveller on motorcycle. Dane is normally fit and healthy, managing asthma with Relvar Ellipta inhaler once a day. Dane had a fall from the step ladder whilst changing a light bulb, He felt a crack on his hip and felt severe pain .He was unable to stand up. His wife and son helped him into the car and took him to the local hospital.
Dane’s signs, symptoms and observations in Accident and Emergency were:
Anxious.
Unable to weight bear on his right foot
Pain in the right hip.
Respiration Rate 33 respirations per minute.
Pulse 110 beats per minute.
Oxygen saturation 95% on air
Blood pressure 120/53 mmHg.
Temperature 36.6 oC.
Dane’s investigations in Accident and Emergency were:
X-Ray showed Right Neck of Femur Fracture
ECG Heart rate 110 beats per minute
Sinus tachycardia rhythm.
He was referred to the orthopaedic team and the Emergency unit team prescribed for Dane to have intravenous fluids and 10 mg of morphine with 10 mg of metochlopramide. The patient was cannulated and started on 1 litre of saline to be infused over 5 hours, he was catheterised for fluid balance monitoring.
The Orthopaedic team reviewed Dane and consented him for surgery for a Right hemiarthroplasty. Dane Barr underwent the procedure under general anaesthesia and post-surgery was transferred to an orthopaedic ward.
In the ward he had a PCA pump with morphine 1mg on demand with a lockdown of 10 minutes and a background infusion of 1mg per hour,to help him control the pain. He was started on
Tazocin 4.5 g IV QDS
Inhixa 20 mg OD
The next day after surgery, Dane noticed that his abdomen was swollen and painful, he had vomited 4 times coffee ground colour fluid. He had not passed any urine on that day. He was referred to the surgeons who asked for a CT abdomen, which showed an ileus but no perforation was seen.
Dane was kept Nil by Mouth, prescribed ondasetron antiemetic, a Ryles tube was inserted for aspiration aiming to decompress the stomach. An infusion of omeprazole was prescribed.
The vital signs were as follows:
Blood pressure :90/40
Pulse 140 beats per minute
Resp rate 45 breaths per minute
O2 saturation 88% on 24 % O2.
Temperature 38 degrees celcius
An arterial blood gas sample showed a pH of 7.23 and PaO2 of 7.5 Kpa and PaCO2 of 4.2 Kpa.
Patient had no urine output. The Blood investigations showed a lactate of 7 mmol/l, and a creatinine of 312 mmol/l, so the patient was prescribed 2 litres of IV fluid and the medical team together with Outreach team were alerted, who suggested patient to be transferred to the high dependency unit as there was suggestion that the patient may have aspirated as a chest X-ray showed infiltrates in the left lung.
Question 1.
With reference to evidence based nursing, justify the nursing care required in order to holistically prepare Dane for surgery. .
