NRSG258 Acute Care Nursing 1, Semester 1 2016/Case Study A: Louise (Graves’ disease – Thyroidectomy)
Louise is a 32 year old woman who works as a Registered Nurse in the Emergency
Department of a large public hospital. Louise is the sole provider for her two young
children, who are in primary school. She has been separated from her husband for six
months and he has moved interstate.
Louise has recently been diagnosed with Graves’ disease. Her endocrinologist referred
her to an surgeon who recommended a total thyroidectomy.
On admission to hospital Louise told the ward nurse that she had lost a lot of weight
recently and had been feeling very tired. Louise stated that she currently smokes but she
is “trying to quit”. She appeared anxious and was constantly fiddling with her mobile
phone, handbag and clothes. Louise said that she is very worried about having time off
work and that she is concerned that her parents will not be able to cope with looking
after her two children while she is in hospital.
Louise returned to the Post Anaesthesia Recovery Unit (PARU) having undergone a
total thyroidectomy. She received a general anaesthetic and the surgery was
uneventful. There was no visible ooze on the small dressing covering the incision site,
which has been sutured using a subcuticular stitch to hold the wound edges together
and a Redivac drain in situ with 50mls of blood in it.
Initially Louise was noted to be drowsy but when she started to rouse spontaneously
her voice was hoarse and she complained that she was cold and that her neck felt tight
and painful. Louise was positioned in a high Fowler’s position and was receiving
oxygen, via a Hudson mask, at 6L/min. Her vital signs were as follows: BP 110/56, HR
105bpm, Temp 35.5oC, RR 12, Sp02 95%.
Louise returned to the ward after 60 minutes in PARU. She remained drowsy but was
easy to rouse. Louise had an intravenous infusion of 1000mls 0.9% Sodium Chloride
running at 125ml/hr and was ordered IV/Oral Paracetamol 1g 8/24, Tramadol Oral 50mg
6 hourly PRN and IV Ondansetron 4mg 8/24 PRN. Louise was given a discharge
prescription for oral thyroxine 150mcg daily and oral tramadol 100mg q8h PRN.
The next day Louise was assessed as ready for discharge. Her Redivac drain was
removed but her subcuticular suture was to remain in place for 7 days. Her voice
remained hoarse and she told the nurse that her neck “felt weird” and that she “just
couldn’t bear to look at it”. Louise said that her car is parked outside and asked if she
can drive straight to her parents’ house to pick up her children.
NRSG258 Acute Care Nursing 1, Semester 1 2016
QUESTIONS
Please refer to the rubric on page 11-12 of the Unit Outline for full marking criteria.
Question 1 (10%)
In relation to your chosen patient, discuss the pathophysiology of their presenting
condition, and using evidence based literature explore current surgical treatment options
for your patient
Question 2 (15%)
Critically discuss the assessment of ventilation, circulation and consciousness prior to
the patient’s discharge from PARU. Discussion must relate to the effects of anaesthesia
and surgery on these three physiological functions, and be directly related to your chosen
patient.
Question 3 (10%)
Develop a discharge plan to support your chosen patient on discharge home. Include
any education you deem relevant, any referrals to allied health professional/s required,
and discuss your rationale.
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ASSIGNMENT GUIDANCE – NRSG258 ASSESSMENT 1: CASE STUDY
Dear students here are some guidelines to assist you in writing Assessment 1: Case
Study.
If, after reading through these, you still have questions please post on the relevant
forum. If you are still unsure then please contact your campus specific lecturer to
arrange to discuss your assignment. We ask that you bring these guidelines to any
meeting and highlight the areas about which you are still unsure.
In this case study you do not need an introduction or conclusion for this case study
of 1500 WORDS ± 10% due by midnight 8th April Turnitin. Just answer the
questions. Turnitin is located in your campus specific block.
Although we suggest you do your background reading in the current textbooks for
basic information, the case study also requires you to find current
literature/research/articles to support your discussion throughout the case study.
Do NOT use Better Health Channel, WedMed, dictionaries, encyclopaedias etc.
These are NOT suitable academic sources. If you use these you will not meet the
criteria for this question and you will lose marks.
You must follow the APA referencing format as directed by ACU in your case study
and in your reference list. The Library website has examples of how to do this
referencing and you can find the correct format at the end of your lectures and
tutorials as well as in the free Student Study Guide.
This essay should have approximately 10 relevant sources. Textbooks, if cited,
should be a range of medical-surgical, pathophysiology, anatomy & physiology and
pharmacology for specific information e.g. organ function or drugs.
Do not copy information from books or articles or information from previous
students’ assignments. This is plagiarism and you will be heavily penalised. Turnitin
will highlight copied information to markers.
? Please give a title to your essay e.g. Case Study – Louise and
ensure your name and student number are on each page as a footer.
Although you do not need a conclusion or introduction, and are answering
each question, you must write in sentences not point form as this does
not show critical thinking.
? Do not use abbreviations e.g. i.e. etc. in your essay. Write e.g. in full
if you need to explain something further. Do not use etc. in an essay. This
suggests to the marker that you do not know what else should go into your
case study.
? You must explain any terms you use not just copy them out of a
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book/article/research. The markers need to know that you understand
your chosen patient’s condition and management for safe care.
ASSIGNMENT WRITING TIPS
Question 1 (10%)
In relation to your chosen patient, discuss the pathophysiology of their presenting
condition and using evidence based literature explore current surgical treatment
options for your patient (10%). (Suggested length for your answer approximately 350
words).
? First, give a very brief overview of the anatomy and physiology
i.e. what and where is it and how does it function. E.g. Louise –
function of the thyroid gland, Zhao – function of the ovaries, Raoul –
function of the knee joint (e.g. A and P textbooks e.g. Martini/Marieb
and/or research/articles). You could write pages on the structure and
function but you must do this in a 3-4 sentences.
? Then provide a definition of the presenting condition i.e. the
pathophysiology and how the condition is currently treated surgically
E.g. Louise – what is Grave’s Disease & current surgical treatment;
Zhao what is polycystic ovaries & current surgical treatment; Raoul
what is rheumatoid arthritis & current surgical treatment (you can find
this information in pathophysiology textbooks for a description of the
condition e.g. Bullock and Hales and current research for current
surgical treatments) (remember the suggested word limit).
Question 2 (15%)
Critically discuss the assessment of ventilation, circulation and consciousness
prior to the patient’s discharge from PARU. Discussion must relate to the effects of
anaesthesia and surgery on these three physiological functions and be directly
related to your chosen patient. (Suggested length for your answer approximately 700
words).
? Note this says ‘critically discuss’. You need to support your
discussion with a range of evidence. An example of critical
discussion might be: whereas Jones (2010) suggested surgery as
the best treatment, others (Brown 2012, Green 2013) suggested
radiation OR a number of studies (Jones, 2010, Brown 2012, Green
2013) have suggested that surgery is the best option for this
condition.
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? The markers want to know you understand the effects of
anaesthetics/opioids/surgery on consciousness, breathing
circulation, body temperature; potential changes in fluid
volume/blood loss. Your discussion will demonstrate that you can
provide safe patient care after surgery. NB: As this is a case study –
all your discussion should be linked and specific to your chosen
patient.
? The effects of anaesthetics and opioid analgesia is covered in your
lectures and in pharmacology books e.g. Bryant & Knights 2015
Ch14 (anaesthetics); Ch15 (opioids) & research. Up-To-Date is an
online site, which reviews the current literature on various topics
(search for this resource online) has information about general
anaesthesia).
? An example for ventilation:
You need to discuss the effects of anaesthetics and opioids on the
respiratory system. This needs to be linked to your chosen patient
and their vital signs in the post-anaesthetic recovery unit (PARU)
? Do the same for circulation & consciousness.
Question 3 (10%)
Develop a discharge plan to support your chosen patient on discharge home. Include any
education you deem relevant, any referrals to allied health professional/s required, and
discuss your rationale. (Suggested limit for your answer approximately 350 words).
This answer should be supported by literature/research. In order to understand
the discharge needs of the patient you must understand their condition and their
presenting symptoms. Review your chosen case study to determine the possible
discharge needs of your patient.
? If you just copy out a patient discharge advice sheet you will not
meet the criteria for this question and you may fail this section.
? The discharge plan must be linked & specific to your patient e.g.
think about the patient’s condition, surgery and situation and decide
what referrals are appropriate to your chosen case and their
surgery and the rationale for suggesting a specific referral. You might
need to include members of the multidisciplinary team e.g.
pharmacist as well as allied health professionals e.g. dietician.
? Inappropriate referrals show you do not understand the patient’s
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condition and therefore cannot give safe care and you will lose
marks and may not meet the criteria for this question.