You are a nursing student working on a busy surgical ward and it is 10.00am. One of your
patients Gerald is a 68 year old retired barrister who has undergone a laparotomy for acute
bowel obstruction. He is first day post-op and his recovery so far has been uneventful; his vital
signs have all been within normal limits. This morning however his vital signs have altered
somewhat; his heart rate has increased to 92bpm his blood pressure has decreased to
105/70; his temperature is 37.9C although he looks a little pale; also he has not passed urine
since midnight although he has an IV infusion in situ and is receiving adequate hydration.
When you are carrying out his vital sign monitoring he seems rather confused and
disorientated and this is quite marked because you helped Gerald wash himself less than an
hour ago and he seemed fine then. He also becomes a little aggressive towards you and tells
you to go away.
You go to tell your preceptor of your findings because you feel a little unhappy with his
condition and she asks you to return to Gerald and repeat his observations. En route to Gerald
you are held up by a patient who desperately needs a bedpan so you organise this and as
soon as you have removed the bedpan the man in the next bed asks for a urine bottle so
you comply. Then you are called help to turn a patient with another nurse and are then asked
to undertake another couple of urgent tasks. Once you have completed these actions you
return to Gerald; about 25 minutes have passed since you first approached your preceptor to
express your concerns.
As you approach Gerald you see that he has thrown off the bed covers and is naked. He has
also soiled the bed removed the dressing from his wound and is smearing faeces across his
abdomen and onto his surgical wound. Additionally he has pulled out his IV cannula and is
bleeding from the insertion site. You immediately pull the curtains around him to give him some
privacy and return to your preceptor to ask for assistance. She tells you to go and clean him
up while she calls the doctor to come to resite the IV cannula. You return with the items you
need to attend to Geralds hygiene needs and inform him that you need to give him a wash.
However he aggressively tells you that he does not want a wash and is verbally abusive
towards you. How are you going to handle this situation? What are the issues you need to
consider? How are you going to address them? What resources are you going to use
consider the legal and ethical concerns arising in this
situation. You also need to consider the possible actions that could be taken and the
implications of those actions.