35813/02 Case Study of Lia Akintola – Medical Science Assignment Help

Assignment Task

Task

Case study background information – Lia Akintola 

Lia Akintola is 24-year-old female (who’s birthday is on April 17th) who has presented to the emergency department, at 1200, after 6 hours of increasing persistent abdominal discomfort. 

Lia states the pain has moved from the middle of her abdomen to the right lower quadrant.  She has rebound tenderness and is finding it increasingly difficult to find a comfortable position.  Lia has stopped her gastrostomy feed yesterday at 2200.

A urinalysis, midstream urine specimen and urine hCG is requested by the ED medical officer and CBE and hCG bloods are sent to pathology.

Lia was diagnosed with cerebral palsy at 6 weeks of age and has a permanent gastrostomy tube.  She has had a recent upper respiratory tract infection over the past 2 weeks.  

On presentation to the ED, 1200, her vital signs are as follows:

•    Temperature: 39.2oC
•    BP: 135/70 mmHg
•    Pulse: 96 beats per minute
•    Respirations: 26 breaths per minute
•    SpO2: 94% on air
•    Pain Score:  9/10, R) Lower abdominal quadrant

Q1. Outline four (4) additional signs or symptoms for appendicitis.

Q2. State four (4) important nursing responsibilities in completing Lia’s pre-operative theatre checklist.

Q3. Complete the following care plan for Lia in relation to two (2) pre-operative actual or potential problems. 

Q4. How would you maintain Lia’s airway immediately postoperatively in the recovery ward including how to clear her airway and what monitoring devices you would use?

Lia returns to the ward at 1800 she is drowsy however opens her eyes to your voice. Lia’s post-op medical orders are:
 

• PICC line inserted in the operating theatre
• IV fluid
• IV antibiotics 
• PCA 
• Incision line- dressing to remain intact
• Post-operative observations as per clinical pathway
• Nil by mouth until review in am

Estimated Discharge Date: 4 days 

Lia had a litre of 4?xtrose and 1/5 normal saline from 1400-1530.  She currently has, IV normal saline, 1000mls over 8 hours, running which commenced at 1530.  She has vomited 100 mls at 1600 and at 1700.  Lia last voided 300mls at 1300.  Her gastrostomy feed is to be recommended in the am after finishing at 0200 this morning (200mls).  (This must be documented on the fluid balance chart you are required to complete as part of Clinical Skill 26.1 Assessment of Fluid Balancing Charting)
 
Lia states her pain is 5/10 and that she is feeling increasingly nauseous and tells you she would like to “have something to take away the nausea as she has had it for some time now….”  You tell Lia you will go and discuss this with the RN and will be right back.  As you re-enter Lia’s room you find her trying to get out of bed as she “really needs to go to the toilet…”  As you approach Lia, she appears to lose consciousness and falls back onto the bed.

Q5. What would your actions be whilst waiting for the MET to arrive if Lia had a respiratory arrest?

Q6. What would your actions be whilst waiting for the MET to arrive if Lia had a cardiac arrest?

Q7. Complete the following care plan for Lia in relation to two (2) postoperative actual or potential Problems using the headings outlined. 

Q8. Outline what each letter of the “OLDCART” pain assessment acronym relates to.

Q9. Outline and provide a rationale for three (3) observations required when caring for a patient with a PCA.

Q10. In your role as an EN, state two (2) important aspects of monitoring Lia’s PICC.