URN: QUT174806 | PATIENT: JANKOVIC, Ivan Janos This case study

URN: QUT174806 | PATIENT: JANKOVIC, Ivan Janos This case study is based on Mr Ivan Jankovic who is 78 years old. He is admitted for a left total hip replacement. He undergoes surgery and is now three days post-operative, in the orthopaedic ward. NSB335 Assessment 3 Page 2 of 8 Caring for a patient post-operatively with arthritis and multiple co-morbidities. Setting the scene Background- social: Mr Jankovic is 78 years old and has enjoyed good health over his lifetime. He moved to Australia in his late teens following the communist uprising in his home country in Eastern Europe in the late 1950s. His education was disrupted, and he has worked in a variety of skilled and semi-skilled jobs that have required manual labour at times, retiring 12 years ago. He says his English is good. Ivan lives independently with his wife in a retirement living unit. His wife Marla is 74 years old and is in good health but recently had a fall and suffered a # wrist that required surgery. She is unable to drive for 8 weeks. They have 2 children – one daughter lives a fair distance away and works full time in a high-pressure job. Their son lives interstate and visits infrequently. They report having a lot of friends and social contact in the retirement village, but their friends are all elderly and are unable to assist at all. Epidemiology / pathophysiology of disease processes The National Health Priority Areas (NHP) of Arthritis and Musculoskeletal conditions, Mental Health Disorders, Cardiovascular Disease, and Injury Prevention and Control were established with the aim of improving health outcomes in these areas. They were established in response to the World Health Organization’s global strategy of Health for all by the year 2000. They are also the areas with the highest economic and health burden for Australians; this assessment considers the following NHP areas in relation to a case (Ivan Jankovic): • Musculoskeletal conditions are conditions of the bones, muscles and their attachments (e.g. joints and ligaments). Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. They have substantial influence on a person’s quality of life and impose a heavy economic burden on the community (AIHW, 2018). • Injuries are adverse effects on the human body. They are a significant source of preventable illness, disability and premature death in Australia (AIHW, 2018). • Mental Health Disorders relate to behaviours and conditions which interfere with social functioning and capacity to negotiate daily life. They can occur acutely at times of illness (AIHW, 2018). • Obesity is when the energy consumed from food and drink is greater than the energy used, fat is deposited on the body, which over time can lead to obesity. Obesity increases the risk of many other chronic and potentially lethal diseases (AIHW, 2018). NSB335 Assessment 3 Page 3 of 8 Your Task: Use the Clinical Reasoning Cycle (CRC) on the following pages to review the nursing priorities in relation to the care of Ivan. Consider the CRC on the following pages and following your work on the modules that encompass the NHP and National Health and Quality Safety (NHQHS) Standards, you should be able to answer the workbook questions. This task will assist you to critically think about typical clinical situations that will arise when you are a Registered Nurse and you will be required to assess and make clinical decisions for your patients. When you have done this, answer the questions at the end of this workbook and submit into Turnitin in the provided template. NSB335 Assessment 3 Page 4 of 8 Now we shall step through the CRC in relation to Ivan’s’ case to prepare you for the workbook assessment questions. Watch the video –At home Gain an initial impression of your patient Consider Ivan’s situation, both socially and health wise. What is your initial view of this patient? Consider Ivan’s osteoarthritis and obesity and how these may be linked. Ivan is at risk of injury – both at home and when he comes to hospital. Consider why and what can be done in these settings to prevent injury. Further background information Mr Jankovic is 78 years old and has enjoyed good health over his lifetime. He has gained a lot of weight over the past few years and has severe osteoarthritis in his hips. He also has had resection of a prostatic cancer that has no current treatment and has residual prostatamegaly. He has occasional angina, high blood pressure and obstructive sleep apnoea, using a CPAP machine infrequently as it dries his mouth and nose and the noise annoys his wife. Past medical history • Osteoarthritis (diagnosed 10 years ago) • Mild left cardiac failure and occasional angina (diagnosed 2 years ago) • Hypertension (diagnosed 5 years ago) • Frequent gout Surgical history: • Internal fixation left tibia and fibula following motor cycle accident at age 21years • Appendectomy at age 23 years • Resection prostatic carcinoma (7 years ago) Medications: • Omeprazole 20mg nocte • Frusemide 20mg mane • Isosorbide Nitrate 60mg mane • Atorvastatin 40mg mane • Prazosin 5mg mane • Panadol osteo tds • Brufen 400mg mane • Glycerol Trinitrate 5mg S/L prn • Colchicine 0.5mg prn • Allopurinol 300 mg mane Now watch the videos of Mr Jankovic- 1. Waiting room: 2. Pre-operative preparation – checklist: 3. Pre-operative preparation – medication: 4. Patient’s conversation after pre-operative checklist NSB335 Assessment 3 Page 5 of 8 (a) Review current information (b) Gather new information (c) Recall knowledge (A&P, ethics, law, cultural safety) Consider the pre-operative phase. What are the issues here with the communication? What may be contributing to this? Ensure you understand the co-morbidities Ivan has presented with and how they may complicate a surgical recovery. Now watch the video below and review the clinical documents for Mr Jankovic. Day 3 post-operative Handover Nursing Documents: 1. Pre-operative checklist [document link] 2. Nursing Notes [document link] 3. Med Chart [document link] 4. Observation chart [document link] 5. Neurovascular obs [document link] For your convenience a transcript of the handover is provided at the end of this workbook. Interpret data – what does it all mean? It is important to consider the potential inter-relationships between mental health, cardio vascular, obesity, musculoskeletal problems and injury prevention. What are the general nursing problems for patients undergoing major orthopaedic surgery? What do you anticipate may be post-operative complications for this gentleman given his co-morbidities? Synthesize all information that has been collected and processed. You need to consider Ivan’s priority problems and any actual or strong potential problems he may experience while in hospital, based on your assessment of him and your knowledge of the pathophysiology of his presenting condition and co-morbidities. Consider the pre-operative, acute post-operative and recovery phase. NSB335 Assessment 3 Page 6 of 8 As a nurse, what are your desired outcomes for Ivan? Now you have identified his problems, you need to identify your goals of care for each problem using the SMART acronym. What action/interventions will you do? The next step is to consider what you will do and ensure your nursing interventions suit the context and are evidence based. Assess the effectiveness of actions Now think about your interventions and how you will evaluate them. What have you learned from this experience? Now consider what you have learnt and what you need to follow up with. References: AIHW, (2018), Australia’s health 2018, Retrieved 4/12/18 https://www.aihw.gov.au/reports/australias-health/australias-health-2018 NSB335 Assessment 3 Page 7 of 8 Workbook Questions Complete the following questions in the provided template following the instructions in your task booklet. • Do NOT replicate the questions, just identify by number. • You must attempt all questions, incomplete papers will be asked to resubmit • References must be provided – remember no reference provided = 0 marks. • Include a reference list at the end. • Word count is up to 2000 words; responses beyond this will not be marked. • You will be awarded 10 marks (total) for academic writing and quality of references and reference formatting- see CRA in your task booklet. 1. Mr Jankovic has presented with severe osteo-arthritis requiring a hip replacement. Discuss briefly the pathophysiology of obesity and its link to Ivan’s arthritis. (2 marks) 2. When you watch the pre-operative videos, what communication issues do you observe? Critically analyse the situation and consider both the patient and the nurse perspective and what may have contributed to this? (4 marks) 3. Explain the importance of the pre-operative checklists and how these link to patient safety and the NSQHS standards? (2 marks) 4. State 3 risks to Mr Jankovic linked to his obesity pose when having a General Anaesthetic? Support your answer with contemporary literature. (3 marks) 5. You realise that Ivan has been given incorrect medication. He received the medication for the person in the next bed and has incorrectly received • Metformin 500mg • Gliclazide 5mg • Aspirin 100mg • Omeprazole 20mg What are your immediate responsibilities as an RN to ensure Ivan’s safety? (1 mark) What responsibilities do you have in regard to medication administration? Discuss this incident with relation to 2 of the NSQHS Standards. (4 marks) 6. Ivan becomes very confused and a little aggressive in the immediate post-operative period. He does not have a history of dementia or confusion. This is quite distressing for his wife, Marla. Discuss what is happening here in relation to the case study patient and outline briefly 2 key areas of nursing management linking to the evidence. (4 marks) 7. Effective and accurate clinical assessment skills are imperative for the nurse working with Ivan at all times. State 3 priority nursing problems and justify for Ivan in the acute post-surgical phase. Following left total hip replacement. Phrase your problem statements as “Problem related to cause” (3 marks) 8. For each problem state a goal in SMART format. (no reference required for this response) (3 marks) 9. For each problem above, state 2 nursing interventions to address these and briefly justify. These interventions can be independent or collaborative. (6 marks) NSB335 Assessment 3 Page 8 of 8 10. Based on the clinical priorities of care and short-term goals, state 2 means you would use to evaluate the outcomes of each intervention. Justify with links to the evidence to support your answer. (6 marks) 11. Ivan is having difficulty voiding post-operatively. He is demanding to get out of bed post his hip replacement. He passes 120mLs into the urinal with difficulty. What further two assessments should you perform and state 2 nursing actions that may assist him? (4 marks) 12. On day 3 the nurse handover says that Ivan does not greet his wife Marla when she arrives to visit and she reports she can’t understand him. He appears confused and when you investigate further, he is quite drowsy, has slurred speech and does not give comprehensible answers to your questions, you can’t decide if he is orientated or not. There are several possibilities for this – review the documentation provided and state one possible reason for this List and briefly justify 3 further assessments that should be done? (4 marks) 13. Ivan’s wife, Marla discloses that she is very worried about Ivan’s return home and that she is concerned how they will cope. Outline the importance of discharge planning and 3 realistic strategies that could be put into place for this elderly couple. (4 marks) Transcript of nursing handover (video 5) Situation: Mr Jankovic is a 74 year old and is day 3 post-operative left total hip replacement. He has an IV cannula still in place in his left hand. Background: Ivan has a history of osteoarthritis, prostatic malignancy resected, hypertension and mild left heart failure with infrequent angina. He also uses CPAP infrequently for sleep apnoea. Post-operative he has not been himself and was a bit aggressive and confused. Assessment: His neurovascular obs are intact. The toes of that left leg have been pink and warm with full movement and sensation, pulses normal. His left hip wound remains intact with no strike-through. He has been doing deep breathing and leg exercises. He has been resting quietly. At 1400 hours vital signs: BP 174/80 mmHg; HR 96 BPM; RR 18 BPM; O2 sats 98%; Temperature 36.9 degrees. I noticed that he wasn’t very responsive to his wife, Marla, this morning and he refused his tablets, so I think he is still confused. His wife just told me she is having trouble understanding him. I have not got round to calling the doctor yet. Recommendations: I think you should do a more comprehensive assessment on him and call the doctor. I am a bit concerned but I have been too busy to do a full assessment.

Don't use plagiarized sources. Get Your Custom Essay on
URN: QUT174806 | PATIENT: JANKOVIC, Ivan Janos This case study
From $10/Page
Order Essay
My Course Writer
Order NOW For A 35% Discount!
Pages (550 words)
Approximate price: -

Why Choose Us

Quality Homework Writing

Do you need to ace your test? We have qualified writers to assist you in writing 100% quality homework writing. Mycoursewriter offers students unique and personalized custom papers that help them in getting good grades. Our academic experts will assist you with your dissertation papers, thesis writing, research papers, term papers, and case study homework help. Our writers are experienced and have perfected the art of crafting the best essay writing papers regardless of your academic level. Order now and get our superb homework writing services.

Expert Academic Writers

A student needs professional assistance outside class time. Before hiring our writers, they undergo thorough tests and strict educational backgrounds. After passing a test, our writers undergo training to ensure they deliver expert professional papers to our customers. We ensure they meet the timely delivery of papers and follow our customers' provided instructions. Every writer is an ENL writer and is from the USA, Canada, UK, or Australia. Our experts approach papers effectively depending on their area of specialization.

Affordable Price Guarantees

Is the deal too good to be true? Mycoursewriter is the most affordable assignment help website on the market. We consider students' daily needs for academic help. Our paper costs are reasonably priced to approximately 90% of students around the globe. Our main aim is to ensure students achieve academic excellence, and we believe inconsiderable prices should not hinder students from getting quality homework writing help. In case of any dissatisfaction, we offer unlimited revisions and rewrites without extra charges.

Timely delivery of papers

Tight deadline? Is your paper due in the next few hours? Worry no more. Our writers are here for your rescue. Many college students find it hard to balance their social and academic life and get caught up with academic deadlines. Drafting your paper at the last minute does not allow you to conduct extensive research and craft the correct answers. We have expert writers ready to work on your assignment writing. Urgent writing services are the ultimate solutions you need. We guarantee you timely delivery of papers at your convenience and specified time delivery of the customer.

100% Original Tasks

The ultimate deal-breaker in achieving good grades is submitting imitative papers. Plagiarism is a breach of examination standards and has serious consequences. Students need to deliver papers written in their understanding by paraphrasing their research findings and relevant citations. Our expert's primary consideration is providing free plagiarized papers that meet the lecturers' requirements. Our editors will proofread your paper before delivery ad ensure your papers will not be substandard. We guarantee extreme originality, and in case of any customer concerns, we offer a plagiarism report.

All Round the clock Customer Support

Our website is user-friendly and super useful! Mycoursewriter is the most trusted online writing website always available to provide you with assignment writing services that you need. Our primary concern is meeting customer need specifications by our friendly customer support team that Is available all the time. Our website usability is self-learnable but in case of any problem, feel free to contact us directly through our website email: support@mycourserwiter.com. We have diligently satisfied thousands of students, and you can witness this on our sites' review page.

Try it now!

Calculate the price of your order

We'll send you the first draft for approval by at
Total price:
$0.00

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Advantages of Using Our Assignment writing Services

Mycoursewriter welcomes you for superb essay writing services. We are a legit site offering help with your most challenging homework writing assignments at affordable prices. Your essay paper will be assigned to a professional writer who will craft the paper from scratch according to your provided instructions.

Essays

Essay Writing and Proofreading Services

Essay writing is a common assignment writing for most college students. It takes a lot of time to craft a complete perfect essay. Mycourserwiter offers the best essay writing and proofreading services for most college students. Your paper is assigned to an expert writer who does thorough research on fresh ideas and personalizes your essay paper according to your assignment writing guidelines. Our essays are entirely exceptional and undergo a strict procedure that includes papers free from plagiarism and thorough proofreading.

Admissions

Admission and Business Papers

Writing an admission paper is not every student's desire, and this should not hinder any student from earning an admission. Writing a perfect personal statement to earn a position in a dream school or job can be stressful. Personal statements should display a high level of confidence and uniqueness. Admission essays require you to have a vast knowledge of the current happenings in the world and knowhow of the business world. We have qualified writers with skills who will write your admission paper through comprehensive research. All you have to do is provide us with little details about yourself, instructions and our writers will craft a perfect paper for you.

Editing

Editing and Proofreading

Mycoursewriter offers you assignment writing services free from grammatical and formatting mistakes. An error-free paper is significant in scoring the desired maximum grades. We have a team of editors who will go through your paper after our expert writers have delivered their fully crafted papers. Our writers will cover all the aspects of your paper instructions, such as fonts, spacing, and educational formats. Our team of editors will check through your paper to make sure it meets the formatting style provided in the paper instructions. Under no circumstances will a poorly formatted paper will be forwarded to you as our team of editors will ensure careful proofreading.

Coursework

Technical Papers

Assignment writing is part of a learning process, and one may not have the knowledge to answer all questions correctly. This should not be a stress to you as we have qualified essay writing experts to help you. Our qualified writers are holders of PhDs, Degrees, and Masters in different areas of study and can handle any papers regardless of the complexity. Multiple assignments may be challenging to finish on time. Our skilled professional writers are here to assist you in crafting all the correct answers for your assignment. Stop stressing about your homework writing and place an order with us, and our expert writers will provide you with the best assignment help.

Open chat
Chat with us Live Here
Get in Touch with Our Live Chat Agents via WhatsApp on +1(346) 416-0954. Get Unlimited Access to Answers on Any Queries With Your Paper.