Essay Clinical Scenario Information – Nursing Assignment Help

Assignment Task :

Setting the Scene: 

It is Thursday afternoon, 10th April 2020. Haley’s mother Jenny is concerned that Haley has had abdominal pain since Tuesday morning. Haley has not been eating normally and came home from school today with a fever. When Jenny checked Haley’s BGL at 12pm, it was 13.4mmols/L. Jenny decided to drive Haley to the local Community Health Centre. 

On initial assessment, Haley was alert but appeared to be in great discomfort, bending over in pain. Her observations were recorded as the following:
A – Patent
B – RR 30, SpO2 98% in RA 

C – HR 130, BP 115/70, pale in colour, central capillary refill 2 secs
D – Alert, complaining of abdominal pain 9/10
E – Temp 39.1, nil rash, abdomen is tender to palpation with a positive Blumberg sign (rebound tenderness) F – Unable to tolerate diet for past 24 hrs, sips of water only as vomiting. Cannot remember when last PU
G – 15.9 mmols/L 

Haley was assessed and due to her clinical presentation and history of type 1 DM, was transferred to the regional base hospital for further review. At the regional hospital, Haley is diagnosed with acute appendicitis and underwent a laparoscopic appendicectomy. 

For the purposes of this assessment, you are the Registered Nurse working the night shift on the paediatric ward starting at 1900 hours. It is now 2100 hours and you are receiving care of Haley from the Recovery nurse who provides you with the following handover: 

I – Haley Milangu, 11 years old under Dr Adams.
S – Haley has undergone a laparoscopy for a perforated appendix. 

B – Haley was diagnosed with Type 1 DM at 9 years of age and self manages this well at home with help of her parents using an insulin pump. Otherwise, Haley is well and her immunisations are up to date. Haley began feeling unwell 3 days ago where she experienced vomiting and diarrhoea, a decreased appetite, abdominal pain and fevers. Haley was transferred from Mepunda District Hospital earlier today, arriving in our Emergency Department at 1600 hrs this afternoon with worsening abdominal pain, right sided guarding and an elevated lactate, WCC and CRP. An ultrasound of Haley’s abdomen showed the appendix was compressible with a thickened wall and target sign present, as well as the presence of free fluid within the abdominal cavity (signs of perforation). As a result, Haley underwent an emergency laparoscopy at 1800hrs and came to recovery at 1950 hrs. 

A – Currently: Haley is maintaining her own airway with a slightly high respiratory rate but otherwise, a normal respiratory effort. Hudson mask oxygen is insitu at 6L/min. Haley appears pink, warm to touch and well perfused with a central capillary refill of 2 seconds. Haley remains slightly tachycardic but this settles with analgesia and she has been normotensive in recovery. Haley is alert and orientated, rating her pain score of 2-5/10 using the numerical pain scale. In recovery, Haley received three doses of IV morphine with good effect. Haley has a low-grade fever 38 – 38.5 degrees Celsius. Haley has a peripheral intravenous cannula (PIVC) insitu to her right cubital fossa and has had 900mls of Hartmann’s intraoperatively, however, this has been clamped for transfer. Haley last passed urine preoperatively and her bowels were last opened this morning. Haley’s BGLs have been elevated and she has had an insulin infusion insitu intraoperatively. This has been currently clamped for transfer and is managed as per the insulin infusion protocol. Surgically, there are four lap sites to Haley’s abdomen with minimal ooze. There are nil drains insitu and blood loss was minimal. 

R – Post-op orders from Dr Adams are: 

• ?  Routine observations 
• ?  NBM until review in am – ice to suck 
• ?  Insulin infusion titrated as per protocol – ICU concentration to reduce fluid volume 
• ?  Intravenous fluids of 0.9% Sodium Chloride + 5% Glucose at standard maintenance rate 
• ?  Morphine infusion 0 – 40 mcg/kg/hr, titrated to pain score < 3/10 
• ?  Regular paracetamol 
• ?  Antibiotics 
• ?  Daily bloods 
• ?  May ambulate as tolerated