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Nursing Assignment Analysing Surgical Case Study


Task: Nursing Assignment Instructions:
Case Study
Incident: 72 yr old female Mrs Geraldine Berry sustained left fractured neck of femur (#NOF) and laceration to her head 5cm while walking her dog. Tripped on an uneven pathway. PMH: Hypertension and depression

Current Medications:

  • Coversyl 5mg
  • Doxepin 25mg daily
  • Atorvastatin 40mg daily

SHx: Lives with elderly husband. Is the primary carer for elderly husband who has had a stroke previously and is mildly impaired. Attends church every Sunday and is responsible for arranging flowers for every Sunday service. She has started volunteering at the St Vincent De Paul’s Meals on Wheels distribution centre two days a week. She lost two children 5 years ago in a car accident. Geraldine is concerned who will look after her husband and their dog Nala. Geraldine and her husband have no children or relatives nearby.

Current Presentation
Day 3 post op left total hip replacement, increasing pain in hip unable to weight bear, pain score currently 7/10. Geraldine has been prescribed oral tramadol tds, lbroprofen prn, paracetamol prn, IV Amoxicillin 1000mg tds and Clexane 40mg SC BD. Suture line on hip appears red and swollen.

Observations-10am Day 3

Pulse Rate-120

Respiratory rate-22

Blood Pressure-120/80

Pain score-7/10



BGL-6.8 mmol/l

Glasgow Coma Score 15

Heat, pain and redness at suture site

Refusing to mobilise due to pain

Refer to the above case study and answer the following questions: 1) Using the CRC and the information presented about Geraldine, identify the abnormal cues, and discuss why these are considered abnormal.

2) Using relevant literature, discuss the pathophysiology related to the two post-operative issues of concern from the abnormal cues you have identified in question one.

3) Address the following points:
a) Identify the nursing goal for each identified issue/problem
b) List at least two nursing interventions for each issue/problem
4) Using relevant literature, provide a rationale for the listed interventions and discuss how the interventions will be evaluated.

5) Identify 2 medications that were prescribed for the patient’s pre-operative condition. (Coversyl 5mg, Doxepin 25mg daily, Atorvastatin 40mg daily) used in this case study. Provide the mechanism of action, side effects correct dosage and contraindications for each medication. Explain how this might affect Geraldine in the post-operative period.

6) Using the Roper-Logan Tierney Model, identify one potential cultural/bio psychosocial issue/problem and discuss how this will affect the patient post-operatively or on discharge.


Answer 1: abnormal cues:
With the help of the Clinical Reasoning Cycle of nursing consider in the present context of the nursing assignment, the following clinical cues of the patient. Mrs. Geraldine has been evaluated and assessed which includes, considering the patients, collection of cues, processing information, and evaluation (Levett-Jones, Courtney-Pratt & Govind, 2019). From the case study of Mrs. Geraldine berry, it was found that 2 days post-operation of total hip replacement, she was unable to bear weight and was witnessing severe pain. Her pain score showed 7/10 which indicates severe pain which hampers the ability to perform daily life activities. Her pulse rate was indicating 120bpm, which was abnormal was the normal blood pressure of the patient should be 72 bpm. It was also found that she was witnessing an increased respiratory rate which indicated 22 bpm which in the case of a healthy person remains 20 bpm. When the blood pressure was measured, it was found to reflect normal (Chu et al., 2019). Oxygen saturation level was found normal while the body temperature was slightly rising up to 39.1 which in case of normal condition rages up to 37°C. one of the major signs of Mrs. berry indicated brain injury as her Glasgow coma scale was 15. Also, she was found to have a mild case of diabetic Mellitus as he Blood Glucose level was silently increased (Mehta & Chinthapalli, 2019). These vital signs of the physical assessment of Mrs. berry indicated the abnormalities she has been witnessing after the post-operative condition of replacement of her total left hip. Also, at the location of operation, redness, pain, as well as heat, was observed which was also developing a condition of discomfort in the case of Mrs. berry.

Answer 2: two post-operative issues- pathophysiology:
Deep vein thrombosis: it is known as a condition of veins where the formation of blood clots or the thrombus takes place in the deep veins of the patients. It is thus also known as venous thrombosis, phlebothrombosis, or thrombophlebitis. The thrombus takes place in the venous cusps of the patient’s deep veins where due to alteration in blood flow tends to develop cloth or blockage. In the case of deep vein thrombosis, often vessel trauma tends to stimulate the condition of clotting cascade (Zhang et al., 2020). In this condition, the platelets are found to aggregate within the site of the trauma or injury when they witness the presence of venous stasis. The platelets as well as the fibrin tend to develop the initial cloth in the deep vein where the red blood cells get trapped in the meshwork of the fibrin. These cloths thus form reddish coloration o the area of development along with releasing heat or feeling of warmth. Also, severe pain is witnessed by the patient suffering from deep vein thrombosis. It has been found to have a common association with the condition of Mrs. berry as she has undergone total hip replacement which tends to develops the risk of deep vein thrombosis in the area of surgery. It is because the deep veinsustains trauma and injury during hip replacement which further tends to initiate the condition of a blood clot (Stone et al., 2017). Mrs. berry also witnessed through the same issue as she was found to witnesses red rashes at the area of injury as well as heat and was unable to move due to severe pain which scored 7 out of 10 on the pain scale.

Mild head injury: it is known to have an impact on the cells of the brain for a temporary period. Though major traumatic brain injuries often cause torn tissues, bruising, as well as belling with indicates physical damage. It has been found that these injuries can also take a turn long-term illness or even lead a patent to death. Post-operative neurological injuries include traumatic brain injury due to several reasons such as inflammation, high energy acceleration, cerebral blood flow alteration, tissue necrosis, as well as hypermetabolism. It was found that the Glasgow Coma Scale or GCS is used for the assessment of any severe brain injury caused in the patient and it ranges from 3 to 15 (Capizzi, Woo & Verduzco-Gutierrez, 2020). In the case of Mrs. berry, the score was 15 which indicated a severe condition of brain injury post-operation of hip replacement which may have developed due to primary injury sustained during fall as well as hypermetabolism during operation. It thus explains that she has been sustaining a major issue of brain injury in her health condition apart from deep vein thrombosis which needs to be provided with proper intervention and supervision to minimize the threat of mortality due to compilations (Jassam et al., 2017).

Answer 3:




1.      Deep vein thrombosis

The main goal for the health issue in the case of Mrs. berry includes minimizing pain

Provide the patient with adequate hydration along with anti coagulating medication in order to remove the clot as well as manageviscosity of the blood to help recover deep vein thrombosis in the case of Mrs. berry (Franco et al., 2017). 


To sustain recovery from the condition of deep vein blood clots and inflammation.

Providing heat pads to minimize the condition of pain in the sufferingindividual. It will be necessary to move the hip and place aheating pad at the location of the pain in order to reduce the inflammation and soothe the pain (Rys, Blostein & Lemarié, 2018).

2.      Traumatic brain injury

To maned the malfunctioningandcondition of trauma in the brain cells

It will be significant to provide Mrs. berry with antiseizure drugs in order to minimize the risk of any further complications and help her restore her brain's functioning (Engel, 2019).


Provide her with stable and balancedcognitive and brain health.

Physical therapies in order to help her move, and balance her body along with having a fresh and healthy environment for her brain to recover quickly (Zaninottoet al., 2019).

Answer 4: rationale and evaluation of interventions:
Rationale and evaluation for delivering adequate hydration:

It is necessary to provide mars. berry with proper hydration in order to maintain blood viscosity as an increase in blood viscosity tends to increase the risk of clotting as well as venous stasis. Also, it is necessary to ensure adequate hydration in order to maintain minimal blood viscosity which will thus help in managing the condition of deep vein thrombosis. Also, anticoagulation drugs help in breaking and removing any clot that may have occurred in the deep vein due to which Mrs. Berry was suffering from severe pain. In order to evaluate the condition and effectiveness of the intervention, it will be necessary to use a magnetic resonance (MR) image as well as a Doppler system that shows significant outcomes in the case of blood viscosity measurement and evaluation (Sloop et al., 2020).

Rationale and evaluation for heating pads:
It is necessary that Mrs. berry is provided with a heating pad in order to facilitate vasodilation as it helps in decreasing blood pressure as well as improve circulation of blood in the area where the injury has occurred and also help in relieving pain. it functions by minimizing the flow of pain signals and increase the blood circulation within the affected area will this also helps Mrs. berry to sustain recovery from stiffens. It will provide her with the ability to move and conduct her daily necessary activities by herself. It will be evaluated by assessing the condition of the pain of Mrs, berry using a pain scale (Dargo et al., 2020).

Rationale and evaluation for anti-seizure drugs:
It has been found that seizer is common in case of traumatic brain injury which is found to have a significant chance of occurrence in the case of Mrs. berry. Thus, it is recommended to provide her with anti-seizer drugs. It will help in minimizing the condition of occurrence of seizer and help her overcome form the condition of brain injury. The efficacy of the condition can be assessed with the help of assessing the mental health of Mrs. berry as well as using the Glasgow Coma Scale or GCS (Albrecht et al., 2017).

Rationale and evaluation for physical therapy:
Physical therapy has a significant role in helping a patient with developing better cognitive health and manage any issue or trauma sustained by the brain. It helps in maintaining the brain as well as the body fit and active enough to sustain a healthy living. It will be evaluated by assessing the mental as well as cognitive health of Mrs. berry ad ensure how actively she is capable of performing her daily activities and move without any assistance (Aida, Chau & Dunn, 2018).

Answer 5: 2 medications, mode of action, side effects, correct dosage, and contradictions focusing in case:
Atorvastatin (Lipitor) 40 mg:
Atorvastatin (Lipitor) 40 mg has been provided to Mrs. berry as it is known to have a major impact on the condition of cholesterol by inhibiting the HMG coenzyme. It limits the rate of cholesterol synthesis. It tends to help in managing cholesterol levels in the body and minimize the threat of any cardiovascular disease. It has been provided to Mrs. berry as she has been found to have a cardiovascular disease due to having an increased condition of hypertension. It has certain side effects which may have a negative intact on the patients’ health which includes diarrhea, hemorrhagic stroke, urinary tract infection, musculoskeletal pain, nausea insomnia, arthralgia, and many more. apart from these severe side effects, their certain mild side effects include cough, dizziness, rapid heartbeat (El-Nabarawi, El-Wakd & Salem,2017). Rashes in the skin, weakness, chest tightness, muscle cramps as well as stiffness which was found common in the case of Mrs. berry as well. The typical dosage for the medication includes 10, 20, 40, or 80 mg on a daily dosage. The contradiction with the medication states that it is necessary to ensure that the medication is not administered to people with active liver diseases, pregnancy, hyperthyroidism, stroke, diabetes as well as key disease. it was found that Mrs, the berry was found have a slight elevation in her blood glucose level which thus needs to be considered while administering her with the medication (Mohsin,AL-Ezzi & Abdul Khaleq,2020).

Doxepin 25 mg:
Doxepin has been prescribed to Mrs. berry before her operation. It has been found to function by increasing the serotonin concentration as well as noradrenaline among with increasing the action performed at the nerve cell junctions. It helps in addressing the issues of cognitive health and mental health complications by enhancing the ability to memorize things, promotes attention, alertness, feeling of wellness, happiness, and contentment (Ma?lanka et al., 2020). The side effects include urinary retention, loss or gain in weight, dry mouth, blurred vision, seizure, rashes, and low blood pressure. It is known to prescribe 75 mg of Doxepin daily to patients but it was recommended to Mrs. berry to intake 25 mg. It is recommended to not provide the drug to patients under the age of 12 as well as those who have been suffering from glaucoma or urinary retention (Scoccia et al., 2017).

Answer 6: Roper-Logan Tierney Model
The Roper-Logan-Tierney Model is a well-known nursing theory with is based on patient’s ability to carry out activities of daily living, and focusing on the theory of nursing, it has been found that after discharge, Mrs. berry is going to have a major issue with the biopsychosocial aspect of her life. She is found to suffer from depression and has not sustained proper mobility without any assistance, thus after discharge she might witnesses disability to move all by herself and carry out her daily activity without any assistance. It will develop her social as well as cultural aspect as she will no longer be capable of providing her service to the community which she was continuing before the injury and operation. It will impact ion her cognitive health and may trigger the condition of depression (Williams, 2017). Thus, it is necessary to consider it and provide her with supportive measures in order to help her carry out her daily activity without any trouble.

Aida, J., Chau, B., & Dunn, J. (2018). Immersive virtual reality in traumatic brain injury rehabilitation: A literature review. NeuroRehabilitation, 42(4), 441-448.10.3233/NRE-172361 Albrecht, J. S., Mullins, D. C., Smith, G. S., & Rao, V. (2017). Psychotropic medication use among Medicare beneficiaries following traumatic brain injury. The American Journal of Geriatric Psychiatry, 25(4), 415-424.

Capizzi, A., Woo, J., & Verduzco-Gutierrez, M. (2020). Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. The Medical clinics of North America, 104(2), 213-238.DOI: 10.1016/j.mcna.2019.11.001 Chu, M. (2019). Integrated Stretchable Electronics for Human Vita Signs Monitoring.

University of California, Irvine. Retrieved from: Integrated Stretchable Electronics for Human Vita Signs Monitoring - ProQuest

Dargo, L. D., Borton, K., Roths, R., & Dougal, Z. (2020). Deep Vein Thrombosis in Lower Extremity of a Female Collegiate Volleyball Athlete. Clinical Practice in Athletic Training, 3(2), 55-62.

El-Nabarawi, N., El-Wakd, M., & Salem, M. (2017). Atorvastatin, a double weapon in osteoporosis treatment: an experimental and clinical study. Drug design, development and therapy, 11, 1383.doi: 10.2147/DDDT.S133020

Engel Jr, J. (2019). Epileptogenesis, traumatic brain injury, and biomarkers. Neurobiology of disease, 123, 3-7.

Franco, L., Giustozzi, M., Agnelli, G., & Becattini, C. (2017). Anticoagulation in patients with isolated distal deep vein thrombosis: a meta?analysis.

Journal of Thrombosis and Haemostasis, 15(6), 1142-1154.
Jassam, Y. N., Izzy, S., Whalen, M., McGavern, D. B., & El Khoury, J. (2017). Neuroimmunology of traumatic brain injury: time for a paradigm shift. Neuron, 95(6), 1246-1265.

Levett-Jones, T., Courtney-Pratt, H., & Govind, N. (2019). Implementation and Evaluation of the Post-Practicum Oral Clinical Reasoning Exam. In Augmenting Health and Social Care Students’ Clinical Learning Experiences (pp. 57-72). Springer, Cham.

Ma?lanka, A., ?mudzki, P., Szlósarczyk, M., Talik, P., & Hubicka, U. (2020). Photodegradation assessment of amisulpride, doxepin, haloperidol, risperidone, venlafaxine, and zopiclone in bulk drug and in the presence of excipients. Monatshefte für Chemie-Chemical Monthly, 151(4), 483-493. Mehta, R., & Chinthapalli, K. (2019). Glasgow coma scale explained. BMJ, 365.

Mohsin, A. R., AL-Ezzi, M. L., & Abdul Khaleq, M. A. (2020). Evaluation of Lipids Profile in Hyperlipidemic Mice Treated with some Herbs Plants and Compares their Action with Atorvastatin. Prensa Med Argent, 106, 3. Retrieved from: Evaluation-of-Lipids-Profile-in-Hyperlipidemic-Mice-Treated-with-some-Herbs-Plants-and-Compares-their-Action-with-Atorvastatin.pdf (

Rys, R. N., Blostein, M. D., & Lemarié, C. A. (2018). Deep vein thrombosis induced by stasis in mice monitored by high frequency ultrasonography. Journal of visualized experiments: JoVE, (134).doi: 10.3791/57392

Scoccia, J., Castro, M. J., Faraoni, M. B., Bouzat, C., Martín, V. S., & Gerbino, D. C. (2017). Iron (II) promoted direct synthesis of dibenzo [b, e] oxepin-11 (6H)-one derivatives with biological activity. A short synthesis of doxepin. Tetrahedron, 73(20), 2913-2922.

Sloop, G. D., De Mast, Q., Pop, G., Weidman, J. J., & Cyr, J. A. S. (2020). The Role of Blood Viscosity in Infectious Diseases. Cureus, 12(2).doi: 10.7759/cureus.7090

Stone, J., Hangge, P., Albadawi, H., Wallace, A., Shamoun, F., Knuttien, M. G., ... & Oklu, R. (2017). Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovascular diagnosis and therapy, 7(Suppl 3), S276.doi: 10.21037/cdt.2017.09.01

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Zaninotto, A. L., El-Hagrassy, M. M., Green, J. R., Babo, M., Paglioni, V. M., Benute, G. G., & Paiva, W. S. (2019). Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review. Dementia & neuropsychologia, 13(2), 172-179. Zhang, L., Feng, X., Zhang, D., Jiang, C., Mei, H., Wang, J., ... & Xie, M. (2020). Deep vein thrombosis in hospitalized patients with COVID-19 in Wuhan, China: prevalence, risk factors, and outcome. Circulation, 142(2), 114-128.


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