Benjamin: part 1

Session content and facilitator:

Jane Fisher

Please make sure you look at the learning outcomes and references for this session before you commence work. 

On the ward where you are working, there is a 70 year old male, Benjamin (as he likes to be called) who 2 weeks previously has had surgery to repair a perforated large bowel. 

Surgery was successful. He was extubated 48 hours ago and is now self-ventilating on 2 litres oxygen (nasal cannulae). He has a history of smoking since his teens.

What to do next:

1. Access the Department of Health Website: www.doh.gov.uk to find out about the guidance on smoking cessation. How influential were Health Action Zones?

2. Access the Department of health Website: www.doh.gov.uk to find out about acute care provision with particular reference to the document Comprehensive Critical Care (2001). Access the website for the Modernisation Agency in relation to acute care provision. Read about the levels of care provision in relation to acute care. What level of care do you think Ben would be classed as and why?

3. What are the effects of delivering nasal oxygen?  Outline the normal physiological action of nasal airways. Provide 2 references to support your reading and share them on the discussion board.

Continued:

Shortly after handover you take over responsibility for Ben's care. You notice that: 

• His temperature is 37.8°C

• There is blood staining in his sputum

• He appears dyspnoeic (rate 34) and complains of chest pain. 

•  Other vital signs: BP 145/85mmHg, pulse 120/min and oxygen saturations 92%.

What to do next:

Consider the following:

4. What may be occurring with this patient and why do you think this? Provide 2 reference sources to support your assertions and share them on the discussion board. 

5. Identify and discuss any other signs/ symptoms that this patient may start to show and why? 

6. How and what would you assess with this patient? Discuss your physical assessment?  What further information do you need to know about?

7. Look up the term differential diagnosis. Is there a differential diagnosis? How may you decide what is occurring? What would you need to investigate?