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Case Study 2: Alan Jones

Alan Jones is 60 year old man who was admitted to hospital for surgery following urinary symptoms that led to a diagnosis of benign prostatic hyperplasia (BPH). He has a history of obesity and type 2 diabetes mellitus. Alan lives alone but his adult son is with him on admission and reports that his father drinks a lot of alcohol (at least a bottle of wine per night).

Alan was taken to surgery and underwent a transurethral resection of the prostate (TURP) under spinal anaesthesia.

After 2 hours in the post-anaesthetic recovery room (PARU) he was transferred to the ward. He has continuous bladder irrigation via a three lumen urethral catheter. His urine contains large blood clots.

PRESENTATION TO THE WARD:

On return to the ward Alan’s observations are as follows:

• Respirations 30 breaths per minute
• BP 160/90mmHg
• Pulse 128bpm
• Temperature 35.0oC.
• Pain score 0/10

It is planned for Alan to be discharged after two days on the ward.

QUESTIONS TO BE ADDRESSED

In relation to Alan Jones:

• Discuss the aetiology and pathophysiology of the patient’s presenting condition (LO1; LO3)

Briefly discuss your chosen patient’s presenting condition in relation to their diagnosis (i.e. why they came to into hospital), cause of the condition, the reasons the patient may be susceptible i.e. risk factors & complications of the condition. You are not required to discuss the surgical procedure but you need to show you understand it in the care of the patient.

vPrioritise your patient’s needs. Think about Airway Breathing Circulation Disability. Which of your patient’s needs come first e.g. pain is in D (disability). What comes before that you need to address?

• Critically discuss the underlying pathophysiology of the patient’s post-operative deterioration. Prioritize, outline and justify the appropriate nursing management of the patient during this time (LO1; LO2; LO3; LO5: LO6)

Link the changes that the patient is experiencing in the ward to the presenting condition and the effects of surgery and anaesthesia.

v Discuss the reason for the changes in the patients vital signs with references e.g. low blood pressure – what could have caused this in your patient?

vDiscuss how you would manage each of the abnormal vital signs in priority order needs. What do you need to do?

• Identify three (3) members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement. (LO1; LO4: LO5; LO6)

Identify three specific members of the MDT you might refer the patient to during their admission. You are not required to discuss the role of the multidisciplinary team who would normally care for the patient e.g. surgeon, nurses etc.

You must not make inappropriate referrals such as aged care assistance for a young person. Review the case study. Does the chosen patient have specific needs that require specific referrals i.e. would not normally see the patient unless called in by staff?

The case study is in essay format. You need an introduction a conclusion. You must write sentences and link ideas into paragraphs. Do not write points as this does not show critical thinking. Do not use abbreviations such as e.g. i.e. etc. in your essay and you must explain terms not just copy them out of a book. Do not use headings e.g. introduction. It should be clear from what you have written what part is next.

Ø The marker needs to know you understand the condition & care of the patient for safe practice. Unsafe practice will be penalised heavily.

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