Analysis Situations in Complex Nursing Care - Assignment Example

Student Name Student Number Unit Code/s & Name/s HLTEN505C Complex Nursing Care Assessment Type ☒ Case Study ☒ Assignment ☐ Project ☐ Other (specify) Assessment Name AS1 Mr Barber Case Study Assessment Due Date Assessment Received Date Student Declaration: I declare that this assessment is my own work. Any ideas and comments made by other people have been acknowledged as references. I understand that if this statement is found to be false, it will be regarded as misconduct and will be subject to disciplinary action as outlined in the TAFE Queensland Student Rules. I understand that by emailing or submitting this assessment electronically, I agree to this Declaration in lieu of a written signature. Student Signature Date Assessor Feedback: ☐ Student provided with feedback Attempt 1 Satisfactory ☐ Not Satisfactory ☐ Date / / Attempt 2 Satisfactory ☐ Not Satisfactory ☐ Date / / Supplementary Assessment (Apprentices/Trainees only) Satisfactory ☐ Not Satisfactory ☐ Date / / Assessor Name Assessor Signature Note to assessor: Please record any reasonable adjustment below that has occurred during this assessment e.g. written assessment given orally. PRIVACY DISCLAIMER: TAFE Queensland is collecting your personal information for assessment purposes. The information will only be accessed by authorised employees of TAFE Queensland. Some of this information may be given to the Australian Standards Quality Authority (ASQA) or its successor and/or TAFE Queensland for audit and/or reporting purposes. Your information will not be given to any other person or agency unless you have given us written permission or we are required by law. Instructions to Student General Instructions: Size 12 font , open book Word count 1,400 to 2,150 Number of Attempts: You will receive two (2) attempts for this assessment. Should your 1st attempt be not satisfactory, your teacher will discuss the relevant questions with you and will arrange a 2nd attempt to be scheduled. Should your 2nd attempt not be successful, or you fail to undertake the 2nd attempt, you will be deemed “not satisfactory” for this assessment item. Only one re-assessment attempt may be granted for each assessment item. Assessment Criteria: To achieve a satisfactory result, your assessor will be looking for your ability to demonstrate the following key skills/tasks/knowledge to industry standard: https://training.gov.au/Training/Details/HLTEN505C Format & structure When you are answering your questions, type the answer below each question. You may choose to put the question in bold format if you wish. Please do not change the font. Referencing requirements You must use your own words to answer these questions (not a cut and paste from a textbook or website) and APA style referencing should be used, both in-text and in the form of a Reference List at the end of the paper. Please note that assessments that contain plagiarism will be allocated an unsatisfactory grade. Please refer to the student rules for more information (see link below) http://training.qld.gov.au/resources/about/pdf/tafe-qld-student-rules.pdf Submission details Once completed, you should then up load it the AS1 submission site on CONNECT, ensuring that you follow the instructions carefully (there is an instruction video on the screen). If you are experiencing difficulties uploading your paper, contact your teacher before the due date. If you are unable to submit by this date, you must ask for an extension in writing at least 48 hrs before the due date. You can download an extension request form on CONNECT. Requests for extensions inside this seven day deadline will not be approved unless you have a medical certificate. File Name You should save this file in the following format (including the month and year your course started. This enables your teacher to download your assessments in alphabetical order: Your Surname_group_Number of assessment Example: Wilson_Apr 2015_AS1 If you are required to resubmit an assessment please name your files as follows: Your Surname_resubmit_group_number of assessment Example: Wilson_resubmit_Apr 2015_AS1 Evidence Required to be Submitted and Method of Submission Submit under corresponding assessment number on Connect Note to Student An Assessment Mapping Matrix is available from your teacher upon request. The mapping matrix shows how the knowledge and skills that you are being asked to demonstrate align to the requirements of each Unit of Competency. Instructions: Read the following case study and then answer the following questions. Please note: Other than where word limits are specifically identified, you should answer clearly and concisely, and use an adequate number of words to answer the question and meet the marking criteria requirements. Case Study You are working as an Enrolled Nurse in the Emergency Department (ED) when 82 year old Mr Barber (of Greek heritage – and Greek Orthodox religion) is brought in by ambulance at 8pm on the 6/3/2013. Handover from the paramedics is as follows: 6 hour history: haematemasis and epigastric pain Vomited x 4 bright blood Mr Barber called the ambulance because he felt dizzy, sat down on the floor and was unable to get up Ambulance noted approx 150ml haematemasis in a bucket on arrival Past History: Diverticulitis Emphysema Ischaemic heart disease Osteoarthritis Morbid obesity: BMI 42 ` Social History; Mr Barber is the sole carer for his 80 year old wife who has dementia. Mrs Barber has been left in the care of a neighbour. You note that Mr Barbers clothes are blood stained on arrival. He states that he is feeling nauseous. Please answer each of the following questions: 1. The nurse completes an assessment of Mr Barber’s condition on arrival. Explain the following in relation to the assessment process. a) Discuss the type of infection control policy would be implemented for Mr Barber? (50-100 words) The type of infection control policy to be applied in the case of Mr. Barber’s situation is safe work practice for the workers and clients. This police is made up of five main safe work practices: hand washing; use of PPE, correct handling of waste and disposal, appropriate cleaning of patient care equipment; and hygienic environmental control. b) List the PPE precautions that the nurse would use during assessment. Selection of the PPE precautions is based on the risk assessment of the patient’s condition. According to Barber’s condition, the following PPE precautions would be appropriate: Wear gloves Wear apron and gown Fluid-repellent masks for facial protection c) Review the vital signs on the ADDS chart…. List the assessments that will enable the nurse to evaluate the severity of blood loss? (50 words) The severity of blood loss can be evaluated by carrying out the following assessments: Checking any signs of anaemia Checking postural hypotension Checking pulse rate and blood pressure Monitoring urine output to check if there is a drop Signs of dehydration e.g. reduced skin turgor, dry mucosa and sunken eyes. Signs of shock, such as chest pain, delirium, confusion and cool extremities. d) Review the medication chart and discuss the action of the drug prescribed for nausea. (50-100 words) The drug prescribed for nausea is ondansetron, a drug that belongs to a class of medications known as serotonin 5-HT3 receptor antagonists. Its mode of work in the body is by blocking the actions of chemicals, specifically serotonin (a natural substance) that may cause nausea and vomiting. Serotonin 5-HT3 receptors are found both peripherally – on vagal nerve terminals, as well as centrally – in the area postrema. 2. The RN asks you to complete a 12-lead ECG on Mr Barber. Use the information in the case study to label the ECG below. (include patient identity information as well as symptoms) Family Name: Barber Given Name: Frederick Date of Birth: 2/3/1931 Heart rate: 300/R-R interval = 3/300 = 100bpm (normal) Heart rhythm: Normal sinus rhythm Conduction analysis: Left ventricular hypertrophy Conclusion: The 12-lead ECG is abnormal; Left ventricular hypertrophy 3. Use the information in the presenting history and patient charts to write your initial nursing report in SBAR format for Mr Barber. This report will be written 20 minutes after arrival when you have completed your initial assessment. (100-200 words) MRN: 0598371 Family Name: Barber Given Name: Frederick Date of Birth: 2/3/1931 PROGRESS NOTES Date/Time S “Hello Dr. Owen. This is Brown, the nurse caring for Mr. Barber is. Here is the situation: Mr. Barber is vomiting blood and complaining of epigastric pain. He was also feeling dizzy and nauseous.” B “The background information available is that Mr. Barber has diverticulitis, emphysema, ischaemic heart disease, osteoarthritis, and he is of morbid obesity with a BMI of 42”. A “According to my assessment, Mr. Barber may be having emphysema and osteoarthritis”. R “I recommend that treatment commences on the patient immediately. Do you agree?” 4. Mr Barber is upset that his wife is unable to accompany him to the hospital because she isn't well. Give three questions you could use in your conversation with Mr Barber that would evaluate her safety to remain at home whilst he is in hospital. Ensure that your questions are phrased to take into consideration empathy, cultural or spiritual elements. (100-150 words) Question 1: Are there any objects in your home that could injure your wife, or areas that might be dangerous for her movement in and out of the house, kitchen or garage? Question 2: People with dementia usually have a frequent loss of sense, and physical ability. Do you have a list of conveniently placed emergency numbers or addresses that may be used by your neighbor to contact hospitals, fire departments, poison control helplines, and local police in case of any emergency with Mrs. Barber? Question 3: If a neighbor is looking after your wife while you are in the hospital, is your neighbor aware of her abilities and needs, and is Mrs. Barber comfortable with your neighbor around her? 5. The neighbour looking after Mrs Barber telephones the Emergency Department and asks how Mr Barber is going. How would you respond to this telephone call as the nurse caring for Mr Barber? (50-100 words) Mr. Barber is responding well to treatment after assessment of his situation. He has been given drugs to reduce nausea and vomiting and he is to undergo chest X-ray at the radiology department. We are certain that Mr. Barber’s situation will be under control and he will be released as soon as his health improves. For now, he will still be receiving his treatment from the hospital. The doctor orders a chest X-ray, Mr Barber is to be transferred to the radiology department at 20:40 6. Outline the preparation required to transfer Mr Barber to the radiology department for these tests. Include the following aspects in your answer: a) What type of consent is required for this procedure? (50 words) The type of consent required for the radiologic procedure is express consent. Radiologic procedure is not a simple procedure and it is required that any patient scheduled to undergo the procedure provides an explicitly stated express consent. For this consent to be meaningful and valid, it must be provided after the patient is well informed about the procedure, the benefits and risks involved (Carpenito-Moyet, 2008). b) Review the categories on the ADDS chart and identify the number and qualifications of staff members that should accompany him to radiology. Base this answer on your evaluation of his level of acuity and manual handling requirements.(100-150 words) The total ADDS score for Mr. Barber fall in the range 4-5, which require a closer observation of the patient by the doctor and nurse. Three staff members should accompany the patient to the radiology department; a doctor, a nurse and a radiologic technician. The doctor should have special training in advanced cardiac support, airway and also well experienced in delivery of safe effective practice and critical care. The nurse and technician or paramedic should be qualified and experienced with intensive care procedures in the radiology. The technician should be a radiographic qualified staff member with additional special training in radiography and ability to process radiographs. After returning from radiology, Mr Barber pushes the buzzer 20:55. When you respond, you note that he is vomiting blood. 7. Discuss the nursing interventions you would you initiate. Include the following in your answer: a) Review the NSW rural emergency clinical guidelines for adults, non-traumatic shock guideline. List the assessments that you would complete in each of the DRABCD categories using the table below? D I would first ensure that I take PPE precautions; put on gloves, gown and a facial mask to be safe from external infection before attending to the patient. R Assess for blood loss by checking signs of shock, shock, checking postural hypotension, heart rate and blood pressure. I will also check urine output for signs of a drop in urine production. A I would check if the patient is breathing properly, put him in a recovery position and call out for assistance. B I would assess for breathing by placing my hand on the lower or upper chest of the patient to feel the movement of air in and out of the nose and mouth. C I would carry out an assessment to judge if the patient requires a basic life support. If he is breathing and conscious, a basic life support will not be required. All that I will do is place him in a comfortable position and sought fr help to manage his injuries. If he is unconscious, then I would assess his breathing situation, put him in a recovery position and keep an open airway. D I would check and analyze the heart rate of the patient if there are signs of cardiac arrest. This would be accomplished using an automated external defibrillator. If the heart rhythm is anomaly, I would try to restore it by applying a shock. b) How do these assessments allow you to make a judgment on the severity of his blood loss? (100-150 words) These assessments are critical in making a judgment of how much blood a patent might have lost through vomiting as follows: A drop in the amount of urine output over a steady interval of time is in indication of blood loss. Blood loss is associated with a reduction in blood pressure. Blood loss is also accompanied by a reduced pulse rate A more severe situation of blood loss is associated with reduced blood flow through the brain, causing the patient to appear confused, disoriented, cool extremities (shock), sleepy or even fainting off and becoming unconscious. If the patient is experiencing shock due to severe blood loss, they will experience dehydration signs e.g. dry mucosa or sunken eyes, and signs of shock, e.g. chest pain. This will make you sense that the patient has lost a significant amount of blood. Mr Barber is given analgesia and IV fluids. His pain settles and the bleeding ceases Mr Barber tells you that he usually uses a purple Seretide inhaler for his emphysema. His GP changed his inhaler to a different type and he doesn't really understand how it works although it seems to help him. He is due for a dose and asks you to assist. 8. Discuss the information you would provide to Mr Barber. Include the following in your answer: a) Explain to Mr Barber in simple terms how the actions of this drug relate to the pathophysiology of emphysema. (100-200 words) The drug contains two active ingredients. The first ingredient is called fluticasone and it contains a medicine (corticosteroids) which are hormones that are naturally produced by the adrenal gland. These hormones control the inflammatory responses in the lungs. When the drug is inhaled into the lungs, the cells and airways in the lungs absorb it. Here, its mode of action is by hindering the release of certain chemicals that are of great importance to the immune system. It is this chemicals that are involved in the production of immune and allergic responses leading to inflammation. Preventing the release of these chemicals reduces inflammation in the lungs. Reducing inflammation helps reduce emphysema (Davidson, Ray, & Turkel, 2011). The second active ingredient is known as salmeterol - a long-acting beta 2 agonist. The mode of action of this drug is by working on the beta 2 receptors found in the lungs. When the drug stimulates these receptors, muscles in the airways get to relax, allowing airways to remain open and ease the breathing process. The airways remain open for much more time. b) Review the type of inhaler prescribed on the medication chart provided and list the steps to correctly administer this medication. (50-100 words) Seretide Accuhaler is a type of inhaler containing inhaled bronchodilator medicines. The following steps are followed when admistering this medication: Step 1: Opening Place your thump below the Accuhaler to hold it in one hand. Using a thumb grip, open the cover by pushing the thump around the device. Load the dose, keeping the Accuhaler in horizontal position and pushing the lever until it clicks. Step 2: Sliding Slide the top end to see the lever By holding the mouthpiece close to your, push the lever away until it stops This reduces the number on the dose counter by 1. Step 3: Breath out gently away from the device Breathe out as much as you can and then put the mouthpiece to your lips, ensuring that the lips seal the mouthpiece tightly. Steadily, breathe in deeply through the device. Remove the device and hold your breath for close to 10 seconds. Breathe out slowly. Step 4: Closing Slide the thumb grip back to its position to close the Accuhaler. The dose counter indicates the number of doses left. Wash your mouth after using the device. 9. Please read Mr Barber’s medication chart. Identify which of these medications would be used to treat the pain from his osteoarthritis (OA) – briefly describe the actions of each one and explain why they are used for this condition. (200-250 words) Naproxen – This medicine possess both antipyretic and analgesic properties. Its mechanism of action involves reversal inhibition of cyclooxygenase: COX-1 and COX-2 enzymes. This leads to inhibition of prostaglandin precursors, subsequently reducing the process of synthesis of prostaglandins (Carpenito-Moyet, 2008). Because the drug inhibits the synthesis of prostaglandin, its mode of action can be as a result of reduction of prostaglandins within the peripheral tissues. Prostaglandins – which mediate inflammation, are responsible for sensitizing nerves and initiate the action of bradykinin in causing pain. In addition, naproxen inhibits platelet aggregation by inhibiting platelet thromboxane. Panadol Osteo – This drug also possess both antipyretic and analgesic properties. The mode of action of this drug is similar to that of naproxen. It works by inhibiting the synthesis of prostaglandin, mainly in the central nervous system. This is as a result of inhibition of cyclooxygenase. However, the drug is highly selective for COX-2 and therefore, does not inhibit the production of thromboxanes significantly. Aspirin – The mode of action of aspirin is mainly through inhibition of production of prostaglandins and thromboxanes. This is caused by irreversible inactivation of COX-1 enzyme at the amino acid serine 529. COX enzyme is required for the synthesis of both prostaglandins and thromboxanes. Aspirin is an acetylating agent, with an acetyl group covalently attached to the serine in the active site of the cyclooxygenase enzyme. 10. What questions might you ask him to help determine the severity of his OA and how the symptoms impact on his activities of daily living? (100-150 words) Question 1: Are you able to use stairs without requiring a walking aids (including hand rails)? Question 2: Can you lift and carry a shopping bag of about 5kg without problems? Question 3: Can you grab and use small objects like a pen using your fingers and be able to use it without any problems? Question 4: Are you able to sit down on a chair or bed and stand up without requiring any help? Question 5: Do you experience joint pain and stiffness during or after performing your daily activities at home, during a rest, or even during a minimal movement? Question 6: Do you sometimes experience negative emotional states, depression, anxiety, or even feelings of helplessness? These may be as a result of low self-esteem of self-image 11. You notice a bandage on Mr Barber's lower leg and he says that he cut his shin on a sharp piece of wood a few days ago. Summarize your duty of care in relation to this observation. (100-150 words) First, I will put on gloves to minimize cross-infection before carefully removing the bandage covering the wound to investigate if a piece of wood is embedded in the wound. I would then place a sterile dressing pad on the wound or improvise using a clean dried piece of non-fluffy material. This would be followed by applying a firm pressure to the dressing pad using the palm of my hand. If an object is embedded in the wound, care should be taken not to apply the pressure directly on the object. If possible, I would raise the patient’s limb at a level higher than the heart or let him be in a lying position, so that less blood flows to the wound and minimize shocking effects. I would remove any objects embedded and clean the wound using clean warm water, removing any debris, devitalized tissue, dressing residue and excessive crusting exudates. This will be followed by applying a healing ointment and a fresh dressing to cover the wound. MRN: 0598371 Family Name: Barber Given Name: Frederick Date of Birth: 2/3/1931 Date/Time 7/3/2013 08:00 S Nursing: Seen by Dr Owen at 08:00. Dr Owen noted that his vomiting has settled overnight. PROGRESS NOTES B Mr Barber is anxious to go home as he is concerned about his wife. A Vital signs within normal limits. Nil nausea or episodes of vomiting overnight R For admission to surgical ward- Mr Barber informed by Dr Owen Naprosyn ceased, to continue taking paracetamol osteo. For arthritic pain. Scheduled for gastroscopy this afternoon, informed consent completed by Dr Owen and consent form has been signed by Mr Barber…...R Marshal, RN When you go to see Mr Barber he states that he doesn’t think he will stay for the gastroscopy because he has no one to care for his wife during the day. He doesn’t think the procedure is necessary given that the vomiting has stopped and he feels better. This means that he is now refusing consent for the gastroscopy procedure. 12. What actions should you take now that Mr Barber has decided not to proceed with his gastroscopy? (100-150 words) According to training as a nurse, it is necessary to take every step that will save a life. However, sometimes a conflict may arise between respecting a patient’s wishes and saving a life. The best action to take in Mr. Barber’s decision to refusing gastroscopy is to communicate with him and make him understand the consequences of his decision. First, I will need to assure myself that the patient understands what the procedure involves, and why he is making such a decision. Patients often baulk from a treatment due to communication issues (Davidson, Ray, & Turkel, 2011). May be he made this kind of decision because he does not understand the procedure or the reason why he is to go through it. This will provide ma an opportunity not only to teach Mr. Barbers about his condition, but also inform him how performing the procedure will help him. 13. What community assistance would be available for Mrs. Barber whilst Mr. Barber remains in hospital? Give an example of an allied health care worker who would make these arrangements prior to Mr. Barbers discharge. (100-150 words) Community assistance that would be available for Mrs. Barber are services such as home help, meals-on-wheels, and safe living. This may include offering homecare services such as day-to-day household tasks, cleaning and washing, personal care activities such as toileting, bathing, maintaining dental care, dressing and grooming, and other small maintenance tasks such as replacing light bulbs. This will make Mrs. Barber to feel that she is not alone. An example of an allied healthcare worker who can these arrangements is a psychiatric/mental health social worker. The allied healthcare worker can also refer Mrs. Barber’s situation to the Aged Care Assessment Team that may be in a position to provide some of these services based on the need assessment of Mrs. Barber’s situation. Mr Barber agrees to admission once arrangements for his wife are provided. Gastric ulceration is identified on gastroscopy, this resolves with pharmacological treatment and changing osteoarthritis medication. References Read More