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Jack Reacher is an otherwise fit & healthy 28yo Male.

Jack Reacher is an otherwise fit & healthy 28yo Male. He is 85Kg & 182cm tall. He has been a pro competition cyclist for the past 6 years who participates in world tour events. Jack was out on a training ride when he was traveling at 60Km/hr and was side swiped my a moving car traveling at 80km/Hr at 5:27hrs 2 days ago. he was thrown from his bike and hit a tree. He has a wife Carli, and a new baby Noah, born 3 weeks ago.

He experienced NO loss of consciousness at the scene. He was BIBA to the ED at 05:47hrs

Trauma series CT scan and x-ray showed:

  • Right haemopneumothorax (for which an UWSD was inserted)
  • Right mid-shaft fractured femur
  • Right rib fractures – Ribs 5 – 8 in the lateral chest wall
  • Haemoglobin 14.4 g/dl
  • No head / c-spine abnormality
  • No intra-abdominal injury
  • No pelvic fracture


Operating Theatre:

He went to the operating theatre at 1806hrs where the following surgical interventions took place under a general anaesthetic:

  • Insertion of a right under water sealed drain (UWSD)
  • open reduction & internal fixation of right fractured femur
  • Insertion of right femur Bellovac drain


Intraoperative medication:

  • 100mls/hr Compound Sodium Lactate
  • IV antibiotics
  • Ondansetron
  • Right 3 in 1 nerve block for fractured femur
  • Patient controlled analgesia (PCA) > Morphine 1mg bolus / 5 min lock out / no back ground infusion


Post operative orders:

  • Transfer to medical surgical ward
  • 2 – 4hrly UWSD observations
  • 2-4 hrly Bellovac Drain observations
  • Can mobilise day 1 post op – Partial weight baring
  • DVT prophylaxis including


Post Operative Medications / Fluids:

  • 40mg subcutaneous Clexane daily
  • Patient controlled analgesia (PCA) > Morphine 1mg bolus / 5 min lock out / no back ground infusion
  • Oral Ibuprofen 400mg TDS
  • 100ml/hr Compound Sodium Lactate


Timeline details:

Jack was transferred to the operating theatre 12 hours post admission to the ED. He was in surgery for 4 hours and in recovery for 2 hours. Jack returned back to the Medical surgical ward after recovery at 2400hrs.


Day 1 Cares / Case Details (post op 2400hrs – 1200hrs):

  • Medications as charted
  • 100ml/hr Compound Sodium Lactate insitu
  • Allowed to eat and drink as tolerated
  • Jack complains of significant pain
  • Pain scores 6-8 / 10
  • refuses to get out of bed and / or mobilise
  • Pain service called and they report no complaints  no nausea / no vomiting


Day 1 Observations at 1200hrs:

  • Resps: 18 bpm on 2L via nasal prongs
  • Air Entry: R=L
  • SaO2: 98%
  • HR: 104 bpm
  • Temp: 37.6 degrees C
  • BP: 107/74mmHg
  • UO last 12 hours: 500 ml
  • Hb: 8.0 g/dl
  • Creatinine: 80
  • Bellovac Drainage: 750 mls
  • UWSD: Swing; no air leak
  • Centrally warm / peripherally cool


Day 2 Post Op – 1330hrs:

  • Resps shallow: 22 bpm on 4L via nasal prongs
  • Air Entry: <RLL
  • SaO2: 94%
  • HR: 122 bpm
  • Temp: 38.2 degrees C
  • BP: 92/56mmHg
  • UO since 2400hrs: 1000 ml
  • Hb: 6.7 g/dl
  • Creatinine: 150 umol/L
  • WCC: 14.8 10^9/L
  • Platelets: 94 10^9/L
  • Bellovac Drainage since 1200hrs yesterday: 500 mls
  • UWSD: Swing; no air leak
  • Centrally warm / peripherally cool

Your shift starts at 1330 hours (day 2 post op – now) and you have just arrived to receive handover (all of the above).


TASK (Download the following Assessment 2 Guidelines Download Assessment 2 Guidelineshere if you prefer to read them outside of CANVAS):

  • Read the patient case in detail noting key components and linking themes.
  • Think about the case to gain a conceptual understanding of what is happening with your patient.
  • Visualise how the patient is presenting, what you might do and why; and how you might care for him.
  • Download and complete the 92442 ASSESSMENT 1 TEMPLATEDownload 92442 ASSESSMENT 1 TEMPLATE
  • Rename the assessment template as this is the document you will be submitting.
  • Read the embedded guidelines as to how to complete each section.


  • For the Nursing Care Plan (the table), this is where you assess Jack’s presentation recording information that will direct your nursing care.
  • This Nursing Care Plan (table) is NOT included in the assessment word limit. It is your mind map to demonstrate what information you used to inform your answers in the report. It is preparatory to the report.
  • Complete the Nursing Care Plan table in parallel with the example provided in blue.
  • Note there are numbers 1-6. You are expected to change these and alter the rows according to how many you need. You need to decide depending on what you choose to include in the case.
  • You may decide to name these A-G for example rather than – 1-6. The idea here is that you demonstrate what information you are considering in order to care for the patient; as well as what outcomes you want.
  • In the first column, be sure to define the problem – NOT the vital signs. The vital signs that point to the problem are the evidence and should appear in the next column (be sure to follow the example).


  • In this section use the template. Start this section with:

‘From the above care plan, Jack’s condition is (fill in the gap- that is comment on Jack’s condition). The key priorities of care emerging from the template include (fill in the gap, then omit irrelevant text prior to submission)’.

  • Once you complete the nursing care plan, stand back from it and look at what is going on with the patient and 2 priorities of care will emerge. That is there are 2 issues that you as Jack’s nurse are concerned about and need to intervene right away. Note: these are not simply 2 vital signs that need correcting. It may be that multiple vital signs indicate a problem, which then becomes a priority.
  • This section should be brief and to the point. It should summarise what emerged from the above Nursing Care Plan.


  • In this section you will use the information gleaned from assessing the vital signs to unpack the underlying pathophysiology that will ultimately determine your interventions.
  • Discuss what is going on at a cellular level to cause the changes in vital signs that you see in Jack’s presentation.
  • You may like to provide subheadings in this section to signpost discussion for the reader and highlight what systems or patient issues you are referring to.
  • Be sure the pathophysiology is linked directly to the priorities of care that emerged from the Nursing Care Plan.


  • There may be more than one intervention to address the key priority as the priority is not to correct a single parameter or vital sign so please include all interventions necessary to address the key issues.
  • You can identify and discuss medical interventions if these are relevant to your discussion (eg: Insertion of an EVD drain).
  • You can also say that as Jack’s nurse you would request certain things from the Doctor or suggest medical interventions that may be useful.
  • Be sure these interventions speak directly to the pathophysiology, that has been linked to the priorities determined by the nursing care plan.


  • In this section, address how you will evaluate each of the nursing interventions.
  • You may like to refer to your Nursing Care Plan
  • Be sure to explain the intended patient outcomes in detail and state how the effectiveness of the nursing interventions would be evaluated/measured.

Please put more attention in comparing the observation changes between day 1 and day 2. what are the reason in two main nursing priority, physiological reason and nursing intervention and evaluation.