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Problem-situational tasks with standards of answers




NURSING IN SURGERY

Task number 1

In the surgical department, there is a patient with a diagnosis of gastric disease. The patient is concerned about pain in the epigastrium , not associated with food intake. Over the past 3 months, he lost 8 kg. Notes a decrease in appetite, aversion to meat food, a feeling of fullness in the stomach after eating. Sometimes he induces vomiting for relief.

An examination revealed that the tumor is located in the pyloric stomach. On the round, the doctor told the patient that he was going to have an operation, after which the patient began to worry, in a conversation with his sister he expressed concern that he was unlikely to undergo the operation, since his friend allegedly died from such an operation.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Draw up and coordinate with the patient a preparation plan for the operation.

3. Prepare everything you need to determine your blood type .

RESPONSE STANDARD

Patient's problems:

- weight loss;

- constant pain in the epigastric region;

- decreased appetite;

- aversion to meat food;

- fear of the upcoming operation.

Priority problem : fear of the upcoming operation.

The goal is short-term: the patient will overcome the fear of the upcoming operation.

Plan Motivation
1. M / s daily for 5-10 minutes. will discuss with the patient his fears and worries. - provide moral support
2. M / s, answering the patient's questions, will acquaint him with the methods of anesthesia, the plan of preoperative preparation, the course of the postoperative period. - instill confidence in the patient that all the actions of health workers are aimed at preventing complications during anesthesia and the postoperative period
3. M / s will introduce the patient to a patient who has successfully undergone a similar operation - reinforce your words with the words of another patient who underwent the same operation
4. M / s will provide moral support to the patient from relatives. - provide moral support to the patient from loved ones
5. M / s organizes the leisure of the patient. - distract the patient from thoughts of an adverse outcome
6. By the time of the operation, m / s will verify that the patient has overcome fear. - evaluate your actions

The student will draw up and agree with the patient a preoperative preparation plan:

1. On the eve of the operation, feed the patient a light dinner in the evening and warn him not to eat and drink in the morning.

2. At night, make a cleansing enema.

3. In the evening, carry out a complete sanitization.

4. As prescribed by the doctor at night, give sleeping pills.

5. On the morning of the day of surgery:

a) measure the temperature

b) put a cleansing enema


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c) shave the surgical field

g) as directed by a doctor, flush the stomach through a tube

d) before sedation, invite the patient to urinate

e) carry out premedication

g) take the patient on a gurney to the operating room

The student will perform the manipulation in accordance with the algorithm.

Task number 2

A patient underwent a radical mastectomy for breast cancer. In the postoperative period, it was proposed to conduct a course of chemotherapy. The patient is upset, because the preoperative chemotherapy course was poorly tolerated: hair fell out, during chemotherapy she noted weakness, nausea, and vomiting. In the general analysis of blood changes were noted. In a conversation with m / s, he doubts the need for chemotherapy.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Talk with the patient about the need to continue chemotherapy in accordance with the doctor's recommendations.

3. Put a bandage on the mammary gland.

RESPONSE STANDARD

Patient's problems:

The real ones:

- doubts about the need for chemotherapy.

- Fear of possible complications of the upcoming chemotherapy.

- hair loss.

Potential problem: risk of metastasis.

Priority issue: fear over possible complications of upcoming chemotherapy.

The goal is short-term: the patient will be convinced of the need for chemotherapy and overcome fear of its possible complications.

Plan Motivation
1. M / s, once a day, he will talk with the patient for 5-10 minutes about the need for chemotherapy, assuring her that many negative manifestations (nausea, vomiting) can be smoothed out with drug therapy. To convince the patient of the possibility of removing the negative manifestations of chemotherapy
2. M / s will convince the patient that after chemotherapy the hair will recover. He will introduce the patient to a patient who has undergone previous chemotherapy. The moral and psychological support of the patient
3. M / s will recommend the patient to wear a wig until the hair grows back. Reducing a cosmetic defect, maintaining a psychologically comfortable state
4. M / s will answer the patient's questions regarding the purpose of chemotherapy. She will select the necessary literature for the patient. To expand the patient's level of knowledge about the possibilities of chemotherapeutic treatment
5. M / s will conduct a conversation with the patient’s relatives. The moral and psychological support of the patient
6. By day 4-5, the patient will agree with the opinion of m / s about the need for chemotherapy. Determine the effectiveness of measures m / s.

The student talks with the patient about the need to continue chemotherapy in accordance with the doctor's recommendations.



The student will perform the manipulation according to the dressing algorithm.

Task number 3

The patient was operated on for mechanical obstruction. During the operation, a sigmoid colon tumor was detected and a colostomy was applied. On the 2nd day after surgery, the dressing began to soak profusely with intestinal contents. The patient is upset, depressed, she is concerned about the attitude of relatives to her. She believes that she will be a burden to the family of the daughter with whom she lives. Most of all, she is concerned about the presence of an intestinal fistula. She doubts that she herself will be able to provide skin care in the area of ​​the fistula.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Talk with the patient about the principles of protecting the skin around the fistula, recommend the necessary preparations.

3. Assemble the abdominal surgery tool kit.

RESPONSE STANDARD

Patient problems

The real ones:

- fecal fistula

- violation of the integrity of the skin (surgical wound)

- restriction of motor activity

- self-care deficit

- lack of knowledge on colostomy care

- feeling of inferiority

- fear of upcoming family life

Potential :

- the risk of ulceration of the skin around the fistula,

- the risk of metastasis.

Priority problem : intestinal fistula, lack of knowledge on fistula care.

The goal is short-term : the patient will not have any gross skin changes during her stay in the hospital.

Long-term goal: by the time of discharge, the patient and her daughter, after training by a nurse, will be able to independently carry out skin care around the fistula.

Plan Motivation
1. M / s, as the dressing becomes contaminated, it will conduct its change with the treatment of the skin around the fistula. Protect the patient's skin from irritation, maceration, ulceration
2. M / s will teach the patient and her daughter how to care for the skin around the fistula: - 1-2-3 times a day will conduct dressings in the presence of relatives, explaining to them the need for frequent dressings, ways to remove stool from the skin, familiar with preparations for protection skin, demonstrating the manufacture of an impromptu kalopriemnik from dressings; - within 4-5 days, he will verify the correctness of the actions of the patient and her daughter, make adjustments; - within 7-8-9 days, he will teach the patient and her daughter how to use the colopriemnik, and will monitor their actions. Train patient and daughter on skin care and the use of a colostomy bag
3. M / s will conduct a conversation with the patient about the nature of nutrition and fluid intake.
4. M / s will hold a conversation with relatives about the need for moral support of the patient. Psychological support for the patient
5. Before discharge, the patient m / s will verify the correctness of the manipulation. Assess the effectiveness of their work and the level of knowledge of the patient

The student talks with the patient about the principles of protecting the skin around the fistula.

Recommends the use of thick petroleum jelly, zinc paste, BF-6 glue, lifusol.

The student will perform the manipulation according to the algorithm.

Task number 4

A patient was admitted to the dental department with a diagnosis of a closed fracture of the lower jaw on the right. M / s upon questioning revealed that the patient is worried about pain, cannot chew on her own. On examination, hematoma and edema were detected in the region of the angle of the lower jaw, malocclusion. After R-control, the doctor performed splinting of the lower jaw. Having entered the ward m / s, I found out that the patient is upset, does not know how he will eat, brush his teeth.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Educate the patient on the rules of oral care, recommend the necessary antiseptics .

3. Apply a bridle bandage.

RESPONSE STANDARD

The real problems of the patient:

- moderate pain at the site of injury;

- the inability to chew food on one's own;

- difficulties in communication;

- lack of oral care knowledge.

Potential problems:

- the risk of developing stomatitis;

- risk of delayed consolidation;

- weight loss.

Priority problems : inability to chew on one's own, lack of knowledge on oral care.

Short-term goal: the patient by the end of 2 days after training will independently take food, process the oral cavity after eating.

Long-term goal: by the time of discharge, the patient’s weight loss will be no more than 2 kg, the patient’s stomatitis will not develop.

Planning Motivation
1. M / s will order a jaw table on the catering unit. Provide patient nutrition
2. M / s on the first day will hold a conversation with the patient about the nature of the food taken and the conditions for its intake, control the patient’s food intake using a drinker. Train patient to eat
3. M / s will conduct a conversation with relatives about the nature of the programs. Provide Nutrition
4. M / s will hold a conversation with the patient about the need to treat the oral cavity after eating with Esmarch's mug. Prevent the development of stomatitis
5. On the first day m / s will assist in the treatment of the oral cavity by the patient. Assisting in the processing of the mouth
6. M / s will provide the patient with oral solution. Prevent the development of stomatitis
7. M / s will monitor the weight of the patient during his stay in the hospital. Monitoring the effectiveness of actions m / s

The student conducts a conversation with the patient about the rules of oral care, recommends using 0.5% solution KMO 4 , solution furatsilina 1: 5000, 1-2% solution of boric acid to prevent stomatitis.

The student will perform the manipulation according to the algorithm.

Task number 5

In the neurosurgical department there is a patient with a diagnosis of closed fracture of 4-5 lumbar vertebrae with damage to the spinal cord. Torn wound of the right hand. M / s, who went on duty, during an interrogation revealed that the injury occurred 2 weeks ago. Currently, the pain of the patient does not bother, the stool was today after an enema. Upon examination of the patient, m / s revealed the presence of a permanent catheter in the bladder, foam pads were placed under the lower leg. M / s treated the patient's back with camphor alcohol, dared crumbs, straightened bedding. To prevent the development of contractures of the ankle joints, I put emphasis under the feet. Inspecting the brush, she noted that the dressing is dry, lies well. A relative is constantly on duty near the patient’s bed.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Conduct a conversation with the patient and his relative about current principles for the prevention of pressure sores.

3. Put on a mitt.

RESPONSE STANDARD

The real problems of the patient:

- lack of movement and sensitivity of the lower extremities;

- drained bladder;

- violation of the integrity of the skin of the right hand.

Potential patient problems:

- the risk of fecal and urinary incontinence;

- risk of pressure sores;

- high risk of infection of the drained bladder;

- the risk of developing muscle atrophy and vicious position of the feet;

- the risk of developing pneumonia.

Priority problem : drained bladder, high risk of infection.

Purpose: the patient will not have an infection of the urinary system during his stay in the hospital.

Plan Motivation
1. M / s will daily wash the bladder with a warm solution of furatsilin 1: 5000 or 0.1% solution of potassium permanganate in an amount of 50-100 ml. For the prevention of bladder inflammation
2. M / s will ensure the outflow of urine into the urinal. For the prevention of infection by the ascending path
3. M / s visually controls the color and amount of urine released per day. To detect changes in urine (flakes, turbidity)
4. During the day, at least 6 times will ensure the emptying of the urinal with subsequent disinfection of its 0.5% solution of chloramine. To prevent infection in the urinary tract
5. M / s at least 1 time in 5 days will provide a urine test in the laboratory. Early diagnosis of the inflammatory process in the urinary system

The student talks with the patient and his relative about the principles of bedsore prevention.

The student will perform the manipulation in accordance with the algorithm.

Task number 6

A woman came to the surgical room complaining of severe pain in the right breast. Breast-feeding, the baby two weeks.

On examination: a painful infiltrate of 6 cm in diameter in the upper outer quadrant of the right breast is determined, hyperemia above it, axillary lymph nodes on the right are enlarged and painful, the temperature rises to 39 ° C.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Talk with the patient about the prevention of a possible relapse.

3. Put a bandage on the right mammary gland.

Answer standard

Patient problems

The real problems are:

- severe pain in the right mammary gland;

- temperature rise;

- a hungry child;

- stagnation of milk.

Potential problems: risk of breast abscess.

Priority problem : pain in the right mammary gland and stagnation of milk due to the development of lactational mastitis.

Short-term goal: to reduce pain and restore lactation.

Plan Motivation
1. M / s will fulfill the doctor’s prescription: - inject an antibiotic into the nipple diluted in novocaine; - will control the intake of drugs lactin and parlodel. Relieve inflammation, anesthetize, relieve spasm of the milk ducts and improve lactation
2. Applies a supporting bandage to the mammary gland. Create peace and reduce pain
3. Conduct a conversation about the causes and preventive measures for the development of mastitis. Eliminate the lack of knowledge and prevent relapse
4. M / s will carry out massage of the gland, expressing milk. Relieve inflammation and anesthetize
5. M / s will accompany the patient to phonophoresis. Reduce stagnation pain

Assessment: pain decreased, lactation restored. The goal is achieved.

The student talks with the patient about the causes and preventive measures for the development of lactational mastitis.

Prevention of mastitis:

- preparation of nipples before childbirth;

- treatment of nipples before feeding;

- skin and clothing hygiene;

- expressing milk after feeding.

A student on an extra puts a bandage on the mammary gland.

Task number 7

A patient was admitted to the purulent surgery department with complaints of compaction and pain in the right axilla. According to the patient, a few days ago she shaved her hair in the armpits.

On examination, the nurse found a round-shaped seal in the right axillary cavity, painful to the touch, the skin above it was hyperemic, and a local temperature increase was noted.

Tasks

1. Identify the patient's problems; formulate goals and make a plan for nursing care on a priority issue with the motivation for each nursing intervention.

2. Talk with the patient about the disease and the possible causes of its occurrence.

3. What type of bandage is needed for the patient and do it.

Answer standard

Patient problems

The real problems are:

- pain and compaction in the right axillary region;

- lack of self-care.

Potential problem: risk of transition of the disease to the stage of abscess formation.

Priority problem : pain and tightness in the right armpit due to the development of hydradenitis.

The goal is short-term: the patient's pain will decrease and abscessing will not occur, the patient will demonstrate knowledge about measures to prevent a possible relapse of the disease.

Plan Motivation
1. Call a doctor. For prescribing and treatment
2. Ensuring aseptic environment (axillary skin toilet, dry shave) To reduce infection of the surrounding skin
3. As prescribed by the doctor, a warming compress on the right armpit For resorption of infiltrate
4. Наложение косыночной повязки на правое предплечье Для создания покоя и уменьшения боли
5. Обеспечение физиотерапевтического лечения Для рассасывания инфильтрата
6. Обеспечение проведения антибиотикотерапии по назначению врача. Для проведения противоспалительного лечения
7. Беседа о заболевании, его возможных причинах и мерах профилактики рецидива Для предупреждения рецидива заболевания
8. Контроль за температурой тела, пульсом, АД, общим состоянием пациентки, повязкой Для оценки эффективности лечения

Оценка: к концу четвертого дня боль стихла, уплотнение уменьшилось, признаков абсцедирования не выявлено. Пациентка демонстрирует знания о своем заболевании. Цель достигнута.