nursing case analysis

2000 words +/- 10%

Having completed the activities and readings in themes 4, 5 and 7, you will have an improved understanding of general anaesthesia and pharmacology, anaesthetic emergencies and transfer of care requirements associated with anaesthetic nursing.

The purpose of this assessment is for you to demonstrate your knowledge and understanding of the content in themes 4, 5 and 7. Using a case analysis format, you are asked to contextualise the theoretical content of these themes into perioperative nursing practice.

In Assessment 3 the case analysis revisits our hypothetical patient, Mr Nikolas Costa, who is now at the point of induction. In this part of the assessment you will focus on the delivery of anaesthesia, progression to intubation, maintaining a safe environment and finally his transfer of care to the post- anaesthetic care unit (PACU).

Your case analysis should examine and present a discussion of the following:

• Based on your preoperative assessment of Mr Costa, describe the most appropriate technique for anaesthesia – use evidence to support your response
• Discuss appropriate anaesthesia agents and provide a rationale for your suggestions
• Summarise the airway protection required by Mr Costa in relation to the prone position
• Evaluate the additional nursing actions required to maintain a safe environment for Mr Costa during his procedure and provide your rationale
• Outline the role of the anaesthetic nurse in relation to reversal of anaesthesia for Mr Costa and transfer of care to PACU

Support your analysis with evidence and incorporate relevant professional standards and guidelines.

Appendix 1 Case analysis patient information Mr Nikolas Costa is scheduled for a spinal fusion under general anaesthetic. He was admitted to hospital on the morning of the procedure. • Age: 70 years • Height: 174cm • Weight: 102kg • BMI: 33.7 Examinations • Chest – clear on auscultation, CXR clear • 12 lead ECG shows sinus rhythm and no abnormalities • Skin is clean and intact, no abrasions. Relevant past medical/surgical history • Hypertension diagnosed eight years ago • Gastro-oesophageal reflux disease (GORD) diagnosed approximately five years ago. Relevant past surgical history • Cervical fusion (C3–C5) seven years ago due to degenerative spondylolisthesis. This has left him with limited neck mobility • Right total knee replacement five years ago following a workplace injury. According to the previous notes this was a difficult intubation. Current medications • Irbesartan/Avapro 300 mg mané • Esomeprazole 40 mg mané Patient assessment • Mr Costas has his own teeth, no loose teeth, caps or crowns • ASA II • Mallampati score III • No known allergies. Observations on admission • BP: 135/88