Hey nurses! 👋
We hope that you had a fun time thinking about our first case study from last week! We have posted the answers below under the questions:
Our first case study is going to be on Sam Smith, find it below! 🤗
Case Study #1
Name: Sam Smith
DOB: 01/02/1949 Age 70
Allergies: Penicillin, causes anaphylaxis
Admission Reason: right hip replacement
PMHx: Afib, DM type 2 , HTN, ex-smoker 20 years, had a fall last month- tripped on steps going into his unit causing rt hip #.
Social Hx: Lives at home with wife Mary in a unit, 3 steps into unit, and handrails in unit.
Details about Sam Smith:
- Height: 170 cm Weight: 70kg
- Fully Independent with ADLS pre surgery, using a stick to Mobilize. was transferring independently.
- Alert and orientated
- Wears glasses daily
- Has dentures (upper and lower).
- Observations on admission at 13:30:
- RR 16, 02 Sats 98% RA, BP 182/90, HR 95 Irregular, Temp 36.2, BSL 8.2
- Patient has been fasting since midnight
- Falls risk assessment done, Mr. Smith scored a 7
- Waterlow done, Mr. Smith scored an 11
- Medications: Metformin, Apixaban, Enalapril, Furosemide, Amlodipine, Atorvastatin, Vitamin D.
Answer the following questions about Mr. Smith:
1) Are you concerned about Mr. Smith's admission observations? Why or why not? If you are concerned, what are you concerned about and what would your nursing interventions be?
A: Yes, first I am concerned about his blood pressure. This is especially true because Mr. Smith is on blood pressure medication and a diuretic which would have been held due to being nil by mouth. I would first check Mr. Smith’s blood pressure manually and if it was still found to be high, I would call the doctor to inform him of the increased BP and ask for their guidance; they may decide to give Mr. Smith a one-time dose of a BP medication that is suitable to give pre-op.
I also am concerned about his irregular heartrate. As he has a history of Afib, it is less concerning but I would still get an ECG for the doctors to review before surgery. The rest of the observations are not concerning.
2) Are you concerned at all about Mr. Smith's Falls Risk score or Waterlow score? Why or why not? What are some interventions that should be put in place for Mr. Smith?
A: I am not concerned about Mr. Smith’s Falls Risk Score as he scored under a 9. As he does have a recent history of falls though, I would implement some falls prevention strategies such as ensuring mobility aids are within reach at all times, orientating Mr. Smith well to the ward and ensuring he is aware of the use of the call bell, ensuring the room is free from clutter, and ensuring all nurses are aware of Mr. Smith’s care needs.
For Mr. Smith’s Waterlow score, I am concerned, with a score of 11, Mr. Smith is deemed “at risk”. With this score, I would ensure that Mr. Smith’s skin is inspected at least twice a day and that his position is changed every 2 hours. This is something that Mr. Smith might be able to do himself with prompting but if not, as nurses we must ensure it is being done. I would also try and relieve the pressure on high risk areas (bony prominences) by using pillows and pressure relieving surfaces and mattresses if available.
3) Does an ECG need to be done on Mr. Smith? Why or why not?
A: Yes, an ECG has to be done on Mr. Smith. As stated above in question 1, he has a history of Afib and his heart rate was irregular on admission. Also, it is protocol to do an ECG on all patients pre-op unless informed otherwise by the surgeon or hospital policy.
4) What medications of Mr. Smith's should be on hold prior to surgery and for how long should they have been on hold?
A: The following medications should be on hold for Mr. Smith: Metformin (for 48 hours pre-op), Apixaban (for 48 hours pre-op and for at least 24 hours post-op), Enalapril (for 24 hours pre-op as an ACE inhibitor), Furosemide (for 24 hours pre-op), Atorvastatin and Vitamin D (for 24 hours pre-op)
Amlodipine (can usually be given on the day of surgery, speak with the surgeon/anaesthesiologist),
We hope that you enjoyed our first case study! We look forward to sharing more with all of you this year, please let us know if there are any particular cases, diagnoses, or surgeries you would like us to cover, and feel free to send us an email if you have any questions about this weeks answers: email@example.com! Happy Studying!