For the purposes of this assessment, you are the Registered Nurse working the night shift on the..

For the purposes of this assessment, you are the Registered Nurse working the night shift on the paediatric
ward starting at 1900 hours. It is now 2100 hours and you are receiving care of Haley from the Recovery
nurse who provides you with the following handover:
I – Haley Milangu, 11 years old under Dr Adams.
S – Haley has undergone a laparoscopic appendicectomy for perforated appendix.
B – Haley was diagnosed with Type 1 DM at 9 years of age and self manages this well at home with help of
her parents using an insulin pump. Otherwise, Haley is well and her immunisations are up to date. Haley
began feeling unwell 3 days ago where she experienced vomiting and diarrhoea, a decreased appetite,
abdominal pain and fevers. Haley was transferred from Mepunda District Hospital earlier today, arriving in
our Emergency Department at 1600 hrs this afternoon with worsening abdominal pain, right sided guarding
and an elevated WCC and CRP. An ultrasound of Haley’s abdomen showed the appendix was compressible
with a thickened wall and target sign present, as well as the presence of free fluid within the abdominal
cavity (signs of perforation). As a result, Haley underwent an emergency laparoscopy at 1800hrs and came
to recovery at 1950 hrs.
A – Currently: Haley is maintaining her own airway with a slightly high respiratory rate but otherwise, a
normal respiratory effort. Hudson mask oxygen is insitu at 6L/min. Haley appears pink, warm to touch and
well perfused with a central capillary refill of 2 seconds. Haley remains slightly tachycardic but this settles
with analgesia and has been normotensive in recovery. Haley is alert and orientated, rating her pain score
of 2-5/10 using the numerical pain scale. In recovery, Haley received three doses of IV morphine with good
effect. Haley has a low-grade fever 38 – 38.5 degrees Celsius. Haley has a peripheral intravenous cannula
(PIVC) insitu to her right cubital fossa and has had 900mls of Hartmann’s intraoperatively, however, this has
been clamped for transfer. Haley last passed urine preoperatively and her bowels were open this morning.
Haley’s BGLs have been elevated and she has had an insulin infusion insitu intraoperatively. This has been
currently clamped for transfer and is managed as per insulin infusion protocol. Surgically, there are four lap
sites to Haley’s abdomen with minimal ooze. There are nil drains insitu and blood loss was minimal.
R – Post-op orders from Dr Adams are:
? Routine observations
? NBM until review in am
? Insulin infusion titrated as per protocol – ICU concentration to reduce fluid volume
? Intravenous fluids of 0.9% Sodium Chloride + 5% Glucose at standard maintenance rate
? Morphine infusion 0 – 40 mcg/kg/hr, titrated to pain score
? Regular paracetamol
? Antibiotics
? Daily bloods
? May ambulate as tolerated