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Medical Surgical Nursing Complex Patient Case Study Jack Reacher is…
Medical Surgical Nursing Complex Patient Case Study
Jack Reacher is an otherwise fit & healthy 28yo Male. He is 85Kg & 182cm tall. He has been a pro competition cyclist for the past 6 years who participates in world tour events. Jack was out on a training ride when he was traveling at 60Km/hr and was side swiped my a moving car traveling at 80km/Hr at 5:27hrs 2 days ago. he was thrown from his bike and hit a tree. He has a wife Carli, and a new baby Noah, born 3 weeks ago.
He experienced NO loss of consciousness at the scene. He was BIBA to the ED at 05:47hrs
Trauma series CT scan and x-ray showed:
Right haemopneumothorax (for which an UWSD was inserted)
Right mid-shaft fractured femur
Right rib fractures – Ribs 5 – 8 in the lateral chest wall
Haemoglobin 14.4 g/dl
No head / c-spine abnormality
No intra-abdominal injury
No pelvic fracture
Operating Theatre:
He went to the operating theatre at 1806hrs where the following surgical interventions took place under a general anaesthetic:
Insertion of a right under water sealed drain (UWSD)
open reduction & internal fixation of right fractured femur
Insertion of right femur Bellovac drain
Intraoperative medication:
100mls/hr Compound Sodium Lactate
IV antibiotics
Ondansetron
Right 3 in 1 nerve block for fractured femur
Patient controlled analgesia (PCA) > Morphine 1mg bolus / 5 min lock out / no back ground infusion
Post operative orders:
Transfer to medical surgical ward
2 – 4hrly UWSD observations
2-4 hrly Bellovac Drain observations
Can mobilise day 1 post op – Partial weight baring
DVT prophylaxis including
Post Operative Medications / Fluids:
40mg subcutaneous Clexane daily
Patient controlled analgesia (PCA) > Morphine 1mg bolus / 5 min lock out / no back ground infusion
Oral Ibuprofen 400mg TDS
100ml/hr Compound Sodium Lactate
Timeline details:
Jack was transferred to the operating theatre 12 hours post admission to the ED. He was in surgery for 4 hours and in recovery for 2 hours. Jack returned back to the Medical surgical ward after recovery at 2400hrs.
Day 1 Cares / Case Details (post op 2400hrs – 1200hrs):
Medications as charted
100ml/hr Compound Sodium Lactate insitu
Allowed to eat and drink as tolerated
Jack complains of significant pain
Pain scores 6-8 / 10
refuses to get out of bed and / or mobilise
Pain service called and they report no complaints no nausea / no vomiting
Day 1 Observations at 1200hrs:
Resps: 18 bpm on 2L via nasal prongs
Air Entry: R=L
SaO2: 98%
HR: 104 bpm
Temp: 37.6 degrees C
BP: 107/74mmHg
UO last 12 hours: 500 ml
Hb: 8.0 g/dl
Creatinine: 80
Bellovac Drainage: 750 mls
UWSD: Swing; no air leak
Centrally warm / peripherally cool
Day 2 Post Op – 1330hrs:
Resps shallow: 22 bpm on 4L via nasal prongs
Air Entry:
