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

Jack Reacher is an otherwise fit & healthy 28yo Male. He is 85 kg & 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 60 km/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, who was 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 a fractured femur
  • Patient-controlled analgesia (PCA) > Morphine 1mg bolus / 5 min lockout / no background 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).



  1. Care plan template- Patient problem/issues/need in A-G sequence where appropriate. can be 3 actual or 3 potential problems. How do we know the problem exists? What is the evidence and what are the clinical indicators? What are the relevant optimal patient outcomes? Use SMART goals to determine these.
  2. Choose 2 relevant priorities of care that clearly emerge from the case and are identified and discussed accurately in the context of the case.
  3. Physiological & pathophysiological priorities of care relevant to the patient’s case are comprehensively identified with reference to the patient’s presentation and vital signs.
  4. Nursing Interventions – Interventions are succinctly defined and specifically relevant and appropriate to the patient’s case.
  5. Evaluation – All patient outcomes for each intervention are identified, clear, accurate, and relevant to the specific patient case.