HNB2205 : Nursing and Acute Care – Nursing Assignment Nursing Assignment Scenario : Mr Peter Jones.. 

HNB2205  : Nursing and Acute Care – Nursing Assignment

Nursing Assignment Scenario :

Mr Peter Jones is a 62-year- old man who lives in a Western suburb of Melbourne. He retired a few years ago after many years of service as a truck driver. He weighs 84kgs, leads a sedentary lifestyle and spends most of his day watching television. He is a smoker and drinks about four stubbies a day. He also has hypertension for the past eight years. For the last couple of months, Mr Jones has been noticing blood in his stool but ignored it and did not care to mention to Mrs Jones. In the last week, he has also been experiencing abdominal pain that comes and goes in waves and he is very constipated. Since this morning, he has been experiencing increased bloating and discomfort in his abdomen, which then progressed as severe abdominal pain, not relieved by any remedies offered by Mrs Jones. Soon he was taken to the emergency department of the closest hospital. Initial abdominal x-ray and a CT scan revealed a tumour obstruction in the recto sigmoid region of the colon and multiple lesions in the liver.

Question :

1) What is intestinal obstruction? What are the types of intestinal obstruction? What is the difference in the clinical manifestations of small or large intestinal obstruction?

2) What are some of the presenting complaints of Mr Jones that is indicative of bowel obstruction?

3) What are the surgical goals and the pre-operative preparation for a patient going for colorectal surgery?

4) How will you assess and prepare Mr Jones for the emergency laparotomy?

5) What is the surgical management for colorectal cancer?

6) What type of surgery does Mr Jones need for his recto sigmoid tumour? Why is a colostomy performed in Mr Jones’ case?

7) What are the types of ostomies? What are the specific nursing management after ostomy surgery?

8) How long will it take for Mr Jones’s colostomy to be active? What are some of the possible areas of concerns of Mr Jones 
going home with a colostomy?

9) Identify some of the general post-operative nursing care concerns after a laparotomy?

10) Prepare a patient & family teaching guide for Mr Jones & Mrs Jones on ostomy self care. What are the effects on food on 
stoma output?

Part 2

During the post operative period Mr Jones was referred to a medical oncologist for further management of his colon cancer with metastasis to the liver. The treatment plan for cancer requires Mr Jones to make frequent visits to the ambulatory care setting for the continuation of his chemotherapy. Mrs Jones told the nurse she was having trouble coping with the diagnosis and anxious about the thoughts of regular travel to have the treatment. She also expressed feelings of helplessness in not knowing what she could do to help her husband. Mrs Jones also worries about their children, who are now in their 30s, if there is chance of them inheriting the cancer? You read in the notes that Mr Jones’ paternal aunt had colon cancer at the age of 78. In addition, an older brother of Mr Jones was diagnosed with colon cancer 5 years ago at the age of 68.

Question :

1) What are the nursing and collaborative care concerns leading up to Mr Jones’s discharge?

2) How will you address Mrs Jones’s fears about the possibility of their children getting bowel cancer?