Posted: April 10th, 2015
You are a registered nurse working on an Orthopaedic ward. Mr Dwight Simons, 67 years, is
being transferred to you from the Emergency Department via operating theatres. You need to
assess, plan, prioritise and provide care for Mr Simons who has just undergone a total hip
replacement to treat a fractured neck of femur of his right leg.
Mr Simons waited in the Emergency Department 12 hours for surgery. Prior to this he was
laying where he fell, on the floor at home, for 18 hours before help arrived. Mr Simons is a
semi-retired pharmacist and has been working 3 days per week. His wife died earlier this year
and he now lives alone.
On arrival to your ward, Mr Simons is confused but otherwise in a stable condition. He has
an IV cannula in situ right lower arm, with IV Normal Saline running at 40mls/hr and a
Fentanyl PCA. There is approximately 200mls left in the IV bag. His GCS is 14 and his
pupils are equal & reactive. His blood pressure is 137/78 mmHg, his pulse is 87 bpm and he
is afebrile at 36.6 degrees. The surgical incision is dressed with minimal strikethrough. There
are 2 Belovac drains that are patent and draining from the incision site- a total of 500mls
emptied in operating theatres. His integument is otherwise intact but you notice a large bruise
and swelling on his (R) temple – the theatre nurse explains that his head was bumped during
the transfer from the operating table to his bed. His IDC is patent and draining a strong
yellow coloured fluid.
Mr Simons is awake but appears confused. He is able to remember his date of birth but
cannot recall why he is in hospital or what day it is. He keeps trying to sit up even though he
has been frequently reminded not to. He keeps dropping his PCA button and asking staff to
call his wife to come and pick him up.
Task: Your task is to write an essay of 2000 words in which you explain the decisions you
would make in assessing, planning and prioritising the care of Mr Simons. You are to assume
you are the Registered Nurse assigned to care for him for the duration of an 8 hour shift. In
the essay you need to:
1) Identify & prioritise the nursing care of Mr Simons
2) Describe, prioritise and provide a rationale for the nursing assessments you will
3) Describe, prioritise, and provide a rationale for the planned care of Mr Simons
that demonstrates client centred care
Ensure that you use relevant academic literature to support the decisions you would
make in order to provide an evidenced-based approach to the nursing assessment
and nursing care………………
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