NURS20024-Applied Nursing Practice
Assignment
Case Study
Mr Franks, 67-year-old man, who underwent cardiopulmonary bypass surgery for an aortic valve replacement (mechanical valve) via a median sternotomy 2 days ago. He was extubated 6 hours post return to ICU. Chest drains were removed yesterday. He was transferred to the cardiothoracic ward last night (day 2 post op) where you are working the morning shift.
Current medications
Captopril: 25 mg BD PO (to be administered if SBP >130mmHg)
Paracetamol: 1g, QID PO
Frusemide: 20mg BD PO
Enaxoparin sodium: 40mg daily, subcut till INR >2
Slow K: 2 tabs, BD PO
Warfarin (Dose as per INR)
Todays 0600 observations:
Weight: 89kg
BP: 134/88mmHg
HR: 91 beats per minute (regular)
RR: 18bpm
Temp: 36.9
SpO2: 95% on 4L via NP
Pain score: 7/10
Laboratory test from this morning are as follows:
Sodium: 142
Potassium: 3.6
Urea: 7.4
Creatinine: 121
Chloride: 92
Bicarbonate: 19
Magnesium: 0.69
Questions
1. Mr Franks has needed to undergo an aortic valve replacement. Consider this history and describe;
a. The two valve disorders that may lead to a patient needing to undergo a valve replacement.
b. Two signs that the nurse may have noted when performing a cardiopulmonary assessment on Mr Franks.
c. Two symptoms that Mr Franks may have complained of prior to needing valve replacement surgery.
2. Explain what Cardiopulmonary bypass (CPB) is.
a. Why is it (CPB) necessary for Mr Franks when undergoing an aortic valve replacement?
b. List and describe two (2) physiological effects cardiopulmonary bypass can have on a patient.
3. Which (if any) of the above laboratory results do you need to bring to the attention of the doctor and why?
4. Considering the current medications that Mr Franks is on, list the rationale (why are they given) considering his recent surgery and diagnosis.
a. Captopril
b. Paracetamol
c. Frusemide
d. Enaxoparin sodium
e. Slow K
f. Warfarin
5. Consider this patients 0600hrs vital signs. Which if any would you determine need to be more closely monitored and why?
