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Original Question
Information: Darren is a 51 year old male who lives in Cairns where he is the owner/operator of a diving boat tour company. He has moved to a more sedentary role over the last few years and misses getting out and working with the tourists.Darren has one son, Jake, 15 who lives in Wallan, Victoria with his mum Lisa, step dad Kevin and his 5-year-old stepsister Ruby.Jake and Darren have a good relationship, Jake fly’s to Cairns twice a year during school holidays to stay with his Dad.Darren’s History DOB: 23/11/1970Address: 25 Happy Street CairnsSmoker: 30 per day for last 20 years Social Drinker 2 heavy beers a day after work and up to 10 a day on the weekends – Darren’s favourite saying -It’s 5 o’clock somewhere ^BMI -33 H: 1.8m W: 110Kg Waist: 115cm Darren has a past medical history including, hypertension, :, mild depression and GORD. He currently takes medication for these conditions. Hypertension Hyperlipidaemia Mild Depression Gastric Oesophageal Reflux He has experienced two episodes of upper abdominal pain during the night with associated nausea and vomiting within the last month. Medications Generic name Trade name Dose Atorvastatin Lipitor 10mg Daily Atenolol Noten 50mg Daily Sertraline Zoloft 20mg BD Ranitidine Zantac 150mg daily Darren does not attend regular check-ups with his GP. He last had his medications reviewed when he presented to the GP around 12 months ago with his first presentation of upper abdominal pain, nausea and vomiting. He was commenced on Ranitidine at thiis time. In the last month, Darren has had two more severe episodes of upper abdominal pain with nausea & vomiting. He ignored the first episode and it settled after 24 hours. However, Darren has presented to the Emergency Department in Cairns 1/7 ago with similar symptoms but more severe.Darren’s diagnosis is mild- severe Cholecystitis. Darren has been transferred to the surgical ward where he is awaiting an elective Laparoscopic +/- Open Cholecystectomy. Darren has had pre- operative blood pathology collected including his Cholesterol, which is reading high. This is part of Darren’s pre-operative work up. When possible removal of the Gallbladder is done Laparoscopically, which is also known in lay mans terms as ‘key hole’ surgery. Laparoscopic Cholecystecomy is a minimally invasive, low risk procedure that is often done in Day Procedure or requires only an overnight stay in hospital. Due to Darren’s co-morbidities he was not a candidate for laparoscopic surgery therefore he needed to undergo a Laparotomy (surgical opening of the abdomen) to have his Gallbladder safely removed. Darren has undergone his procedure and has just returned to the surgical ward, where you will be taking care of him. On General Inspection, you note that, he is drowsy but responsive, he has IVT insitu, and he is receiving oxygen via nasal prongs at 3L per minute (FiO2 32%). Questions: problem: Potential for respiratory depression related to anaesthesia and opioid medications and would be evidenced by respiratory rate <10Rpm, SpO2<95% on RA and shallow breathing. 1. discussion on why this problem is priory for Darren's care 2. Three nursing interventions to help Darren's respiratory rate up to at least 12 breath per minute and SpO2 more than 97% (example: deep breathing and effective coughing exercise, educate the patient...) 3. discussion of the evidenced based evaluation and why is it important
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