CASE STUDY :

Mr George McFarlane is 53year old Male. He has presented tohospital yesterday after he fell while getting out of his truck.The X-ray on admission showed that George has sustained a compoundfracture of his right ankle,which required an open reduction andinternal fixation (ORIF) to repair. Surgery was completed thismorning and George has returned to ward from Operating theatres 2hours ago. Mr McFarlane is 118kg and 180cm in height.Current vitalsigns Resp 26, O2 Sats 97% room air (RA), BP 170/90, HR 110, Temp37.

George’s past Medical History (PMHx) include:

     •        Type ll Diabetesneeding close management. Records BGL daily

     •        Osteoarthritis in L)Knee

     •        Allergy toPenicillin

George social history include:

     •        ETOH (Alcohol) usage ona regular basis

     •        Smoker, averages 15cigarettes per day

     •        Often consumes takeaway/ fast food diet as away from home regularly, Sedentarylifestyle, Little to no exercise

Question 1

Based on the information received in the case study, you need tocomplete a plan of care for George. Use the template below tooutline the anticipated care for George for his post-operativeperiod, considering your EN Scope of Practice. To complete thisquestion you need to:

·         Specifyfour (4) nursing diagnoses or risk factorsassociated with the client’s current health presentations.(Consider manual handling, strict resting in bed, post-operativevital signs, pain score and management, neurovascular and woundmonitoring, Type ll Diabetes requiring close monitoring, smoker,risk of post-operative complications, self-care needs. Reflect onMaslow’s hierarchy of needs)

·         Record atleast two (2) nursing interventions that could beapplied for each diagnosis, these interventions must be in lineswith current best practice standards.

·         Specify atleast one (1) member of the multi – disciplinaryteam who may be able to support your suggestedinterventions.

·         Note at leastone (1) expected outcomes that you would hope foras a result of each intervention. (Consider SMARTgoals when discussing outcomes)

Nursing diagnosis

Planning – (Nursing intervention)

Multidisciplinary member to provide support

Expected Outcome

  

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