Saturday 23rd February 2008 Time 0200 Hours Mr Yellow is an 83 year old resident in a hostel who has been experiencing abdominal pain and changes in bowel habits for approximately 3 months. He was referred to a general surgeon for investigation and is now a patient on your ward. Mr Yellow is usually a fit and active gentleman who walks a kilometer every morning with the Sunrise Walking Group at the hostel where he lives. He doesn''t have any physical impairments and appears remarkably fit for an elder of his years. His medications are 1 aspirin and 1 iron tablet daily. He requires some supervision with activities of daily living as over the past 18 months he has become forgetful and can neglect his personal hygeine. He is sometimes confused when in unfamiliar surroundings and therefore needs to have a responsible adult with him when shopping and attending to his personal affairs. No formal application for guardianship has been made by his son who it seems has been a loving and supportive son to his father. Mr Yellow is described as having early dementia although no formal diagnosis has been made. His forgetfulness necessitated his relocation from his own home to residential care. He was assessed yesterday by the psychologist as having a Mini Mental State Examination score of 18 out of a total of 30, so he certainly does have a degree of cognitive impairment. There have been a number of discussions with him, his son, the social worker and his doctor as a group regarding the nature of his illness and intended surgery. Mr Yellow is quite clear about what he wants. He ahs stated that he doesn''t want a bag (meaning colostomy bag) as a consequence of bowel surgery. The decision has been made to proceed with surgery on the understanding that the surgical procedure will be an excision of bowel tumour with end to end anastomosis. If in the opinion of the surgeon, once the abdominal cavity is viewed, this procedure can not be obtained then the abdominal cavity will be closed and no further surgical intervention will be undertaken. His son has signed the operation consent form. Mr yellow will be having surgery today (Saturday) at 1030 hours. Most of this information about your patient you read in the notes. You also note that the 1630 hours entry in the notes from the stomal therapy nurse which indicates that she reviewed the patient and has marked the stoma location on the patients abdomen with an X but noted that the patient doesn''t want a colostomy. She writes that she will discuss this with the surgeon on Monday. In part A, identify and discuss any issues related to the patients preoperative saty and care requirements in hospital (1000 words). In addition provide a concept map to further illistrate the issues and care requirements. The legal and ethical issues related to this case study are to be explicated in this section of the case study. It is essential in this part of the assignment to include ethical definitions of autonomy and competence and how they may be viewed in the scenario provided. Also, discuss the legal definitions of consent (bearing in mind autonomy and competence) and the duty of care of the nurse who finds the potential mistake. Mr Yellow undergoes surgery as planned and you are notified that the bowel tumour was excised and an end to end anastomosis performed on the remaining bowel. in part B describe the nursing care you expect to provide post operatively for the patient in the case study.In addition provide a concept map to further illistrate the issues and care requirements. Use a problem based approach by first identifying the potential or anticipated problems and then describe appropriate nursing actions/interventions you would undertake in response for the person described in the case study. Identify and expected outcome for each of your prioritised potential or anticipated problems and how you would measure this.