As a new graduate nurse on your last rotation, you are working on a busy acute combined medical / surgical ward. You have arrived for an evening shift and receive handover from the staff from the previous shift.
You have been allocated to care for the following five patients.
1. Steven is a 27 year old who presented with acute appendicitis via the Emergency Department that required emergency appendectomy overnight. He is currently NBM and has IV 0.9% Sodium Chloride infusing at 100mls per hour. Steven is complaining of abdominal pain and has a temperature of 39.2. He has been reviewed by the surgical team and has been ordered intravenous Metronidazole 500mg TDS.
2. Peter is a 55 year old male who had an ERCP today (endoscopic retrograde cholangiopancreatograghy) and removal of gall stones x 3 after persistent epigastric pain for 2 days. He is currently complaining of nausea and mild right shoulder tip pain.

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3. Phillip is a 68 year old male who has been admitted for infective exacerbation of his COPD. He is currently on nasal prongs at 2 litres a minute and is due for his IV hydrocortisone (100mg BD) and Piperacillin with Tazobactam (Tazocin) IV (4.5G TDS). His oxygen saturation is 94%.
4. John is 75 year old male who was admitted with chest pain via the Emergency Department earlier on in the day. He has a background history of angina and coronary heart disease. He has been commenced on an intravenous heparin infusion and aspirin 100mg daily. The APTT is to be kept between 50 to 75 seconds.
5. Melinda is a 42 year old female who presented with sudden onset of severe headache. She has been admitted under neurosurgery. Her CT scan revealed a small (Grade 1) subarachnoid haemorrhage from a cerebral artery aneurysm which was successfully coiled in the interventional radiology suite 5 days ago. She is currently prescribed Nimodipine 60mg oral tablets. She has a GCS of 15.

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Questions:
Q1. Discuss how you will initially prioritise your care according to your patient’s conditions and treatment (250 words).
Q2. When reviewing Peter in bed 2, he states that his nausea is becoming worse. You review the medication chart and no antiemetic is ordered. Discuss what your actions would be in this situation (250 words).
Q3: While assessing John in bed 4, you review his last coagulation profile and note that his APTT is > 150 seconds. What is the significance of this result? Referring to the ward protocol below, rationalise your actions. (250 words)

Q4. When reviewing Melinda in bed 5, she complains of feeling faint when she gets out of bed to mobilise to the bathroom. You assess her blood pressure and it is 80/40. What is the significance of this result and what could be contributing to the hypotension? What would be your response? (750 words)

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