Jack Buun, 69, femoral neck fracture post a fall Jack Buun presented to the emergency department (ED) via ambulance after a fall in his backyard, which lead him to twist and fall directly on the lateral aspect of his right hip. On examination the paramedics reported his right leg to be shortened and externally rotated, and Jack was unable to get up and in a significant amount of pain. His wife Ethel found him and called the Ambulance. Jack has a past history of hypertension that is well controlled. Jack required emergency surgery under general anaesthetic for his femoral neck fracture, and underwent a hemiarthroplasty. You are called to the post anaesthetic recovery unit (PACU) to receive handover, and are happy that he meets the discharge criteria of the hospital. You are told that Jack received the following intravenous medications for pain during and after his surgery: • 20mg Morphine • 100mg Tramadol • 40mg Paracoxib • 1g Paracetamol Jack also received 0.625mg of droperidol in the PACU for nausea. On arrival to the orthopaedic ward you conduct further assessment as follows: • Vital Signs: BP 145/80, HR 120, SpO2 96% on 2L via nasal prongs, Temp 37.1° Celsius, RR 10; • Drowsy but rousable to voice commands; • Pinpoint pupils; • Neurovascular observations (Right Lower Limb): Cool, pale, touch present, movement present, capillary refill sluggish, dorsalis pedis present but thready; • Pain 3/10. You are the RN caring for Jack on the surgical ward. Students will complete a case study which discusses the provision of ethical, legal, evidence-based, holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle Case Study 2: Melody King, 36, Peritonitis following ruptured appendix Ms. Melody King presented to the Emergency department with 2-3 days of severe Left Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix. She has a past medical history of asthma and depression, with her current prescribed and compliant medications list which includes: • Ventolin • Seretide • Sertraline Melody’s observations were as follows: • BP 95/45mmHg • HR 120 • Temp 38.3°Celcius • RR 22/min and shallow • SpO2 95% on room air She complained of increasing nausea and centralised abdominal pain 7-8 on a scale of 0 to10. Physical assessment showed a distended abdomen and generalised abdominal guarding. To investigate her condition further, pathology results reveal a raised white blood cell (WBC) count and CRP. You are the RN caring for Melody post-operatively on the surgical ward. Case study instructions: Utilise the Clinical Reasoning Cycle (Levett-Jones, 2013) (a clinical decision making framework) to plan and evaluate person-centred care: • Considering the person’s situation, collect, process and present related health information; • Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care; • Establish goals for priority of nursing care as related to the nursing problem/issues identified; • Discuss the nursing care of the person, link it to assessment data and history; • Evaluate your nursing care strategies to justify the nursing care provided; • Reflect on the person’s outcomes.