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Case Study 3: John Wong (Transurethral Resection of the Prostate).

Case Study 3: John Wong (Transurethral Resection of the Prostate).
John Wong is an 80 year old male of Chinese origin. John’s medical history includes
hypothyroidism and osteoporosis and he smokes 10 cigarettes per day. His gait has
recently been increasingly unstable and he has difficulty with simple tasks, such as
getting up his house stairs and getting up from chairs.
In the last 4 weeks, he has noticed that he has been having difficulty passing urine and
some abdominal discomfort. His GP referred him to a urologist and a prostate biopsy
was taken. This showed BPH (benign prostate hyperplasia) and it was recommended
that he undergo a Transurethral Resection of the Prostate (TURP).
While conducting John’s pre-admission assessment it is noted that John is slightly
hypertensive and is fidgeting and moving around the waiting room. After some education
John states that he is pleased to have the surgery as he hopes it will relieve some of the
discomfort he has been experiencing. John tells the nurse that he currently lives alone.
John’s surgery is uneventful during the intra-operative stage. On arrival to PACU John is
placed in a supine position. He is drowsy and restless and oxygenated through a
facemask on 02 at 5l/min. A wheeze and non-productive cough is noted. John has an
IDC insitu with continuous bladder irrigation with output noted to be a reddish pink. A
number of blankets are placed on top of him as he is shivering. His observations are T
36.5c, HR 90, RR 30, BP 150/90 and SpO2 91%.
John is transferred to the surgical ward after a 65 minute stay in PACU. John remains
drowsy but easily rousable. He is oxygenated via intra-nasal cannulae at 2l/min and he
states his pain is 3/10. He has 0.9% sodium chloride infusion running at 125ml/hr. Postoperative
orders include IVF, analgesia (PRN Endone, 5mg 6hrly and Paracetamol, 1g
4-6hourly), strict FBC and continuous bladder irrigation for 24 hours, with an aim of rose
urine output.
Four hours after John’s return to the ward he is observed to be in pain and distressed.
He is diaphoretic and restless and states that his bladder feels full and he feels the urge
to urinate. At this time, vital signs are noted to be: T 36.9c, HR 91, RR 28, BP 146/91 &
SPO2 98%. On review of his documentation it is found that his fluid status has a positive
500ml balance and his urine is of red colour. There are blood clots in his urine.
QUESTIONS
Please refer to the rubric on page 14 on the Unit Outline for full marking criteria
1. In relation to your chosen patient, discuss the pathophysiology of their
condition and using evidence based practice explore current treatment options
for your patient’s condition, include any pharmacological and nonpharmacological
considerations.
2. Critically discuss four (4) components of the PACU discharge criteria
outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in
your case study.
3. Develop a discharge plan to support your patient on discharge. Include
any education you deem relevant, any referrals to allied health professional/s
required, and discuss your rationale.
NRSG258 Acute Care Nursing 1, Semester 1 2015 Page 12 of 19;
Assessment Task 1: Case Study
Description: Students are to choose one (1) of the case studies available (see
LEO) and answer the associated questions. The assignment is to
be presented in a question/answer format, and not as an essay
(i.e. no introduction or conclusion). Each answer has a word limit;
each answer must be supported with citations. Students should
follow the recommended formatting for academic papers
http://students.acu.edu.au/308971 Students must provide in-text
referencing and a reference list must be provided at the end of
the assignment.
Due date: Friday 27th March: Midnight (Week 5)
Weighting: 40%
Length and/or format: 1500 words
Purpose: Facilitate the development of critical thinking in relation to nursing
management along the perioperative continuum including
effective care, safety and evaluation.
Learning outcomes assessed: 1, 2, 3, 5 & 6
How to submit: Students are to submit the following via Turnitin Case Study
submission folder as one document:
?? Assignment
?? Reference List (adhering to APA style)
Return of assignment: Case Study submissions will be returned to students online via
LEO.
Assessment criteria: This assessment task will be graded against a standardised
criterion referenced rubric. Please follow these criteria closely
during the planning and development of your assignment.
For more comprehensive information on this assessment task, including the available case studies and
the Aldrete resource required for this assignment, please refer to the Case Study Folder in LEO under
‘My Assessments’.
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