URN: QUT174806 | PATIENT: JANKOVIC, Ivan Janos This case study is based on Mr Ivan Jankovic who is 78 years old. He is admitted for a left total hip replacement. He undergoes surgery and is now three days post-operative, in the orthopaedic ward. NSB335 Assessment 3 Page 2 of 8 Caring for a patient post-operatively with arthritis and multiple co-morbidities. Setting the scene Background- social: Mr Jankovic is 78 years old and has enjoyed good health over his lifetime. He moved to Australia in his late teens following the communist uprising in his home country in Eastern Europe in the late 1950s. His education was disrupted, and he has worked in a variety of skilled and semi-skilled jobs that have required manual labour at times, retiring 12 years ago. He says his English is good. Ivan lives independently with his wife in a retirement living unit. His wife Marla is 74 years old and is in good health but recently had a fall and suffered a # wrist that required surgery. She is unable to drive for 8 weeks. They have 2 children - one daughter lives a fair distance away and works full time in a high-pressure job. Their son lives interstate and visits infrequently. They report having a lot of friends and social contact in the retirement village, but their friends are all elderly and are unable to assist at all. Epidemiology / pathophysiology of disease processes The National Health Priority Areas (NHP) of Arthritis and Musculoskeletal conditions, Mental Health Disorders, Cardiovascular Disease, and Injury Prevention and Control were established with the aim of improving health outcomes in these areas. They were established in response to the World Health Organization's global strategy of Health for all by the year 2000. They are also the areas with the highest economic and health burden for Australians; this assessment considers the following NHP areas in relation to a case (Ivan Jankovic): • Musculoskeletal conditions are conditions of the bones, muscles and their attachments (e.g. joints and ligaments). Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. They have substantial influence on a person’s quality of life and impose a heavy economic burden on the community (AIHW, 2018). • Injuries are adverse effects on the human body. They are a significant source of preventable illness, disability and premature death in Australia (AIHW, 2018). • Mental Health Disorders relate to behaviours and conditions which interfere with social functioning and capacity to negotiate daily life. They can occur acutely at times of illness (AIHW, 2018). • Obesity is when the energy consumed from food and drink is greater than the energy used, fat is deposited on the body, which over time can lead to obesity. Obesity increases the risk of many other chronic and potentially lethal diseases (AIHW, 2018). NSB335 Assessment 3 Page 3 of 8 Your Task: Use the Clinical Reasoning Cycle (CRC) on the fo ...

1. URN: QUT174806 | PATIENT: JANKOVIC, Ivan Janos
This case study is based on Mr Ivan Jankovic who is 78 years
old. He is admitted for a left total hip replacement. He
undergoes surgery and is now three days post-operative, in the
orthopaedic ward.
NSB335 Assessment 3 Page 2 of 8
Caring for a patient post-operatively with arthritis and multiple
co-morbidities.
Setting the scene
Background- social:
Mr Jankovic is 78 years old and has enjoyed good health over
his lifetime.
He moved to Australia in his late teens following the communist
uprising in his home country in Eastern Europe in the late
1950s. His education was disrupted, and he has worked in a
variety of skilled and semi-skilled jobs that have required
manual labour at times, retiring 12 years ago. He says his
English is good.
Ivan lives independently with his wife in a retirement living
unit. His wife Marla is 74 years old and is in good health but
recently had a fall and suffered a # wrist that required surgery.
She is unable to drive for 8 weeks. They have 2 children - one
daughter lives a fair distance away and works full time in a
high-pressure job. Their son lives interstate and visits
infrequently. They report having a lot of friends and social
contact in the retirement village, but their friends are all elderly
and are unable to assist at all.

2. Epidemiology / pathophysiology of disease processes
The National Health Priority Areas (NHP) of Arthritis and
Musculoskeletal conditions, Mental Health Disorders,
Cardiovascular Disease, and Injury Prevention and Control were
established with the aim of improving health outcomes in these
areas. They were established in response to the World Health
Organization's global strategy of Health for all by the year
2000. They are also the areas with the highest economic and
health burden for Australians; this assessment considers the
following NHP areas in relation to a case (Ivan Jankovic):
• Musculoskeletal conditions are conditions of the bones,
muscles and their attachments (e.g. joints and ligaments).
Osteoarthritis, rheumatoid arthritis and osteoporosis are the
most commonly occurring musculoskeletal conditions. They
have substantial influence on a person’s quality of life and
impose a heavy economic burden on the community (AIHW,
2018).
• Injuries are adverse effects on the human body. They are a
significant source of preventable illness, disability and
premature death in Australia (AIHW, 2018).
• Mental Health Disorders relate to behaviours and conditions
which interfere with social functioning and capacity to
negotiate daily life. They can occur acutely at times of illness
(AIHW, 2018).
• Obesity is when the energy consumed from food and drink is
greater than the energy used, fat is deposited on the body, which
over time can lead to obesity. Obesity increases the risk of
many other chronic and potentially lethal diseases (AIHW,
2018).

3. NSB335 Assessment 3 Page 3 of 8
Your Task:
Use the Clinical Reasoning Cycle (CRC) on the following pages
to review the nursing priorities in relation to the care of Ivan.
Consider the CRC on the following pages and following your
work on the modules that encompass the NHP and National
Health and Quality Safety (NHQHS) Standards, you should be
able to answer the workbook questions. This task will assist you
to critically think about typical clinical situations that will arise
when you are a Registered Nurse and you will be required to
assess and make clinical decisions for your patients.
When you have done this, answer the questions at the end of
this workbook and submit into Turnitin in the provided
template.
NSB335 Assessment 3 Page 4 of 8
Now we shall step through the CRC in relation to Ivan’s’ case
to prepare you for the workbook assessment questions.
Watch the video –At home
Gain an initial impression of your patient
Consider Ivan’s situation, both socially and health wise. What is
your initial view of this patient?
Consider Ivan’s osteoarthritis and obesity and how these may be
linked.
Ivan is at risk of injury – both at home and when he comes to
hospital. Consider why and what can be done in these settings

4. to prevent injury.
Further background information
Mr Jankovic is 78 years old and has enjoyed good health over
his lifetime. He has gained a lot of weight over the past few
years and has severe osteoarthritis in his hips. He also has had
resection of a prostatic cancer that has no current treatment and
has residual prostatamegaly. He has occasional angina, high
blood pressure and obstructive sleep apnoea, using a CPAP
machine infrequently as it dries his mouth and nose and the
noise annoys his wife.
Past medical history
• Osteoarthritis (diagnosed 10 years ago)
• Mild left cardiac failure and occasional angina (diagnosed 2
years ago)
• Hypertension (diagnosed 5 years ago)
• Frequent gout
Surgical history:
• Internal fixation left tibia and fibula following motor cycle
accident at age 21years
• Appendectomy at age 23 years
• Resection prostatic carcinoma (7 years ago)
Medications:
• Omeprazole 20mg nocte

5. • Frusemide 20mg mane
• Isosorbide Nitrate 60mg mane
• Atorvastatin 40mg mane
• Prazosin 5mg mane
• Panadol osteo tds
• Brufen 400mg mane
• Glycerol Trinitrate 5mg S/L prn
• Colchicine 0.5mg prn
• Allopurinol 300 mg mane
Now watch the videos of Mr Jankovic-
1. Waiting room: [video link]
2. Pre-operative preparation - checklist: [video link]
3. Pre-operative preparation - medication: [video link]
4. Patient’s conversation after pre-operative checklist [video
link]
NSB335 Assessment 3 Page 5 of 8
(a) Review current information
(b) Gather new information

6. (c) Recall knowledge (A&P, ethics, law, cultural safety)
Consider the pre-operative phase.
What are the issues here with the communication?
What may be contributing to this?
Ensure you understand the co-morbidities Ivan has presented
with and how they may complicate a surgical recovery.
Now watch the video below and review the clinical documents
for Mr Jankovic.
Day 3 post-operative Handover [video link]
Nursing Documents:
1. Pre-operative checklist [document link]
2. Nursing Notes [document link]
3. Med Chart [document link]
4. Observation chart [document link]
5. Neurovascular obs [document link]
For your convenience a transcript of the handover is provided at
the end of this workbook.
Interpret data – what does it all mean?
It is important to consider the potential inter-relationships
between mental health, cardio vascular, obesity,
musculoskeletal problems and injury prevention.

7. What are the general nursing problems for patients undergoing
major orthopaedic surgery?
What do you anticipate may be post-operative complications for
this gentleman given his co-morbidities?
Synthesize all information that has been collected and
processed.
You need to consider Ivan’s priority problems and any actual or
strong potential problems he may experience while in hospital,
based on your assessment of him and your knowledge of the
pathophysiology of his presenting condition and co-morbidities.
Consider the pre-operative, acute post-operative and recovery
phase.
NSB335 Assessment 3 Page 6 of 8
As a nurse, what are your desired outcomes for Ivan?
Now you have identified his problems, you need to identify
your goals of care for each problem using the SMART acronym.
What action/interventions will you do?
The next step is to consider what you will do and ensure your
nursing interventions suit the context and are evidence based.
Assess the effectiveness of actions
Now think about your interventions and how you will evaluate
them.
What have you learned from this experience?

8. Now consider what you have learnt and what you need to follow
up with.
References:
AIHW, (2018), Australia’s health 2018, Retrieved 4/12/18
https://www.aihw.gov.au/reports/australias-health/australias-
health-2018
NSB335 Assessment 3 Page 7 of 8
Workbook Questions
Complete the following questions in the provided template
following the instructions in your task booklet.
• Do NOT replicate the questions, just identify by number.
• You must attempt all questions, incomplete papers will be
asked to resubmit
• References must be provided – remember no reference
provided = 0 marks.
• Include a reference list at the end.
• Word count is up to 2000 words; responses beyond this will
not be marked.
• You will be awarded 10 marks (total) for academic writing and
quality of references and reference formatting- see CRA in your
task booklet.
1. Mr Jankovic has presented with severe osteo-arthritis
requiring a hip replacement. Discuss briefly the

9. pathophysiology of obesity and its link to Ivan’s arthritis. (2
marks)
2. When you watch the pre-operative videos, what
communication issues do you observe? Critically analyse the
situation and consider both the patient and the nurse perspective
and what may have contributed to this? (4 marks)
3. Explain the importance of the pre-operative checklists and
how these link to patient safety and the NSQHS standards? (2
marks)
4. State 3 risks to Mr Jankovic linked to his obesity pose when
having a General Anaesthetic? Support your answer with
contemporary literature. (3 marks)
5. You realise that Ivan has been given incorrect medication. He
received the medication for the person in the next bed and has
incorrectly received
• Metformin 500mg
• Gliclazide 5mg
• Aspirin 100mg
• Omeprazole 20mg
What are your immediate responsibilities as an RN to ensure
Ivan’s safety? (1 mark)
What responsibilities do you have in regard to medication
administration? Discuss this incident with relation to 2 of the
NSQHS Standards. (4 marks)
6. Ivan becomes very confused and a little aggressive in the

10. immediate post-operative period. He does not have a history of
dementia or confusion. This is quite distressing for his wife,
Marla.
Discuss what is happening here in relation to the case study
patient and outline briefly 2 key areas of nursing management
linking to the evidence.
(4 marks)
7. Effective and accurate clinical assessment skills are
imperative for the nurse working with Ivan at all times. State 3
priority nursing problems and justify for Ivan in the acute post-
surgical phase. Following left total hip replacement. Phrase
your problem statements as “Problem related to cause” (3
marks)
8. For each problem state a goal in SMART format.
(no reference required for this response) (3 marks)
9. For each problem above, state 2 nursing interventions to
address these and briefly justify. These interventions can be
independent or collaborative. (6 marks)
NSB335 Assessment 3 Page 8 of 8
10. Based on the clinical priorities of care and short-term goals,
state 2 means you would use to evaluate the outcomes of each
intervention.
Justify with links to the evidence to support your answer. (6
marks)
11. Ivan is having difficulty voiding post-operatively. He is
demanding to get out of bed post his hip replacement. He passes

11. 120mLs into the urinal with difficulty. What further two
assessments should you perform and state 2 nursing actions that
may assist him? (4 marks)
12. On day 3 the nurse handover says that Ivan does not greet
his wife Marla when she arrives to visit and she reports she
can’t understand him. He appears confused and when you
investigate further, he is quite drowsy, has slurred speech and
does not give comprehensible answers to your questions, you
can’t decide if he is orientated or not.
There are several possibilities for this - review the
documentation provided and state one possible reason for this
List and briefly justify 3 further assessments that should be
done? (4 marks)
13. Ivan’s wife, Marla discloses that she is very worried about
Ivan’s return home and that she is concerned how they will
cope.
Outline the importance of discharge planning and 3 realistic
strategies that could be put into place for this elderly couple. (4
marks)
Transcript of nursing handover (video 5)
Situation: Mr Jankovic is a 74 year old and is day 3 post-
operative left total hip replacement. He has an IV cannula still
in place in his left hand.
Background: Ivan has a history of osteoarthritis, prostatic
malignancy resected, hypertension and mild left heart failure
with infrequent angina. He also uses CPAP infrequently for
sleep apnoea. Post-operative he has not been himself and was a
bit aggressive and confused.

12. Assessment:
His neurovascular obs are intact. The toes of that left leg have
been pink and warm with full movement and sensation, pulses
normal.
His left hip wound remains intact with no strike-through.
He has been doing deep breathing and leg exercises. He has
been resting quietly.
At 1400 hours vital signs: BP 174/80 mmHg; HR 96 BPM; RR
18 BPM; O2 sats 98%; Temperature 36.9 degrees.
I noticed that he wasn’t very responsive to his wife, Marla, this
morning and he refused his tablets, so I think he is still
confused. His wife just told me she is having trouble
understanding him. I have not got round to calling the doctor
yet.
Recommendations: I think you should do a more comprehensive
assessment on him and call the doctor. I am a bit concerned but
I have been too busy to do a full assessment.