Identify Mr Jensen’s actual PRIORITY problems which must be associated to hypovolemic shock

Mr George Jensen, a 65-year old male, was brought into Emergency Department with an open fracture of his right tibia and fibula after falling from his roof while clearing the gutters. The following data were obtained on his admission:

Objective Data Past Medical Admission History Social History

 Weight 122 kgs

 Height 190 cms

 BMI 33

 Diminished peripheral pulses

 eGFR 78mls/min/1.73m

 Hb 11.3gms/dl

 BP 155/100

 HR 110  Diagnosed with type 2 diabetes mellitus 2 years ago – on oral hypoglycaemics

 Hypertension

Current Medications:

 Glibenclamide, 5mgs, Mane

 Captopril, 50mgs, BD

 Simvastatin 40mgs, Nocte,

 Rantidine 150mgs, BD

 Aspirin 75mgs, Mane  Has 3 children and an ex-wife who live out of state;

 Has been working as a real estate agent 20hrs/wk.

 Consumes 15units of alcohol/day

 Smokes 20 roll-up cigarettes per day for last 10 years.

He was taken to theatre as an emergency case where he had an open reduction and external fixation of his fractures. He has returned to your ward at 5.30am post-operatively. You have arrived on the morning shift to find:

 His right leg is cool to touch;

 Pain Score is 7 on a scale of 1-10;

 Fracture site and pin sites are serous ooze with notable swelling of his right leg;

 Blood glucose level of 17mmols/ltr;

 His post-operative vital signs are currently, HR 107BPM, BP 104/55mmHg, temp 37.9°C Axilla, SaO2 95%, FiO2 6ltires via Hudson mask, Resp rate 24BPM;

 Hartmans solution running at 125mls/hr via triple lumen central line situated in the right internal jugular.

 Insulin and dextrose infusion running at 2mls/hr (2 units/hr);

 Urine output via a Foley IDC is >1ml/kg/hr and dilute.

Applying your knowledge and understanding of Type 2 Diabetes, fractures and hypertension, you are asked to write an academic case study applying the following principles throughout your discussion:

Explain, the pathophysiology of Mr Jensen’s post-operative hypovolemia and how some of his post-operative assessment data might have contributed to this. In addition explain how the body might compensate for this physiologically.

Include / Link how the post-op vital signs contribute to hypovolemic shock. DO NOT just mention about loss of blood but more to systemic complication.

Link how stress prior to surgery pathophysiology affect the vital signs.

DO NOT talk about compartment fracture extensively (approximately 800 words).

Identify Mr Jensen’s actual PRIORITY (Airway, Breathing, Circulation & Disability) problems which must be associated to hypovolemic shock. Justify each problem based on the data collected from Mr Jensen’s assessment data (approximately 400 words).

For each problem identified, describe one (1) nursing goal for his care. DO NOT include administration of medications as nursing interventions. I am looking for non-pharmacology evidence base nursing interventions (approximately 200 words).

Choose two (2) of the identified goals, and justify, with a synthesis and an analysis of the evidence-based literature, nursing interventions with rationales to assist in achieving the identified goals (approximately 800 words).

What the markers expect?

DO NOT write an introduction and conclusion.
DO NOT transcribe the question. Simply write this “Q1. Xxxxxxxxxxx “
At the end of each question, please put the word count.
High level of interpretation and critical evaluation of the question.
Excellent understanding of central issues of the question.
Analytical and comprehensive justification.
Excellent application of pathophysiology and physiological concepts.
Clear consistent links from Q1 to Q4.
Excellent content and flow of concepts resulting in clear description and justification.
Appropriate application and interpretation of recent valid 5 years and varied academic sources. Preferable recent and reliable Journal articles, Joanna Briggs, Cochrane, and textbooks.
Clear identification of the question.
Excellent use of appropriate professional non-discriminatory language, evidence of safe reasoning.
Correctly cited all sources both within text and reference list with no errors.
Consistently and correctly used APA 6th Edition referencing style.
Expresse ideas clearly, consistently and fluently with correct spelling and grammar.
Do not use direct quotes.
Keep to word limit
20 references and more.
Can use books as references but maximum of 5 and must be no later than 5 years old

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