Nursing practise

Nursing Practice

Assessment 1: Case Study
Nursing management of a patient requiring hospitalisation

Length: 2500 words

The aim and purpose of Assessment 1 is to provide students the opportunity to demonstrate they:
• Are developing their ability to locate, interpret, integrate, synthesize and apply nursing knowledge from NUR243, other units they have comleted and a range of current, reliable sources to a patient or scenario they may meet in day to day nursing practice in medical/surgical settings
• Are developing appropriate critical thinking, clinical reasoning and sound clinical decision making processes and strategies essential for safe, evidence-based and competent nursing practice in medical/surgical settings

• Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in health care settings
• Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context
• Are progressing towards the level of professional written communication required for nursing practice in Australia
• Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy

The format for Assessment 1 is objective, academic writing style in proper sentences and topic paragraphs under the headings below.
Note: An introduction and conclusion are not required in this assignment.
• Item 1: Clinical presentation
• Item 2: Nursing management – Adequate oxygenation
• Item 3: Nursing management – Medication management.
• Item 4: Nursing management – Rationale for prescribed treatments and nursing interventions.
• Item 5: Safe, effective nursing care
• Item 6: Health promotion
• Item 7: Culturally responsive nursing care
• References
Assessment 1 is to be presented:
• As a computer generated document in Word format. PDF documents will not be accepted
• 1.5 or double-spaced in either Arial, Times New Roman or Calibri font, size 11 or 12
• In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia
• Using appropriate professional terminology and formal academic language and style
• With no acronyms and abbreviations
• With no dot points, lists, diagrams or tables
• No more that 10% over or under that stated word count
• The word counts for each items are a guide for the amount of content for each item
• Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice

Your lecturer and assignment markers will check your sources where they have concerns as to the originality of your work.
Academic Integrity: Use of current, reliable evidence for practice
Markers must be able to access ALL your sources. All resources must be accessible via CDU databases or freely available by internet search.
• All resources for NUR243 assignments must be from quality, reliable and reputable sources and must be relevant to nursing. Carefully evaluate the material you locate in nursing, medical and allied health journals or texts as it may not always address or be related to, the nursing management issue you are asked to address and/or the Australian context.

• All resources must be dated no earlier than 2006

• There must be at least 12 peer-reviewed journal articles reporting original research or formal systematic or literature reviews cited in your assignment and all must have complete and correct referencing details. Note: This includes the 3 articles for Item 2 of the assignment

• Only one textbook can be cited as a reference in the assignment and it must be a current edition.
• Relevant documents from reputable, reliable, professional websites may be used where it is appropriate to do so.
Resources that are NOT appropriate
The following are NOT appropriate resources as they cannot be considered reliable sources of information:
• Dictionaries
• Journal abstracts
• Journal articles that are not in English
• Journal articles that cannot be accessed via CDU databases or search engines
• Websites such as Wikipedia, myDr, Nurse.com, Scribd, and other nursing/health/medical blog sites
• Information from organisational intranet sites or other sites that require registration or log in to access material. This is not publicly available information.
• Consumer websites such as the Better Health Channel or consumer information from government departments or agencies
• Preview copies of books from online retailers

 

Topic
Brian’s story
Brian is 65 years old and lives with his dog ‘Spider’ in a town flat on the first floor of a block of units in a government housing estate.
About a year ago Brian had to move to town from his home community because his increasing health needs could not be readily met in his community. He misses his community, the close bonds with family and friends back home and is worried about his family’s welfare in his absence.
Brian has been a smoker for 30 years. He smokes 20 cigarettes per day and has a history of recurrent chest infections, hypertension, sleep apnoea and gout. He has a persistent cough that he calls a ‘smoker’s cough’. Recently he has noticed his cough is getting worse and producing greenish coloured sputum.
Over the last few days he has been finding it increasingly difficult to walk up stairs and to look after himself. He now has to stop every few minutes to catch his breath and decided it was time to come to the Emergency Department at the hospital where you are practicing.

On your shift today, the Emergency Nurse gives you the following handover as part of Brian’s admission to the setting where you are practicing today as a registered nurse:
Brian presented to the Emergency Department because his respiratory function has been deteriorating over the last few days. After medical review, his provisional medical diagnosis is an acute chest infection exacerbating suspected chronic obstructive pulmonary disease. He is being admitted for treatment and further investigation of his respiratory function.
Brian’s current medications include allopurinol, cilazipril and metoprolol and in the emergency department he has had first doses of ampicillin and a combination bronchodilator by metered dose inhaler which are to continue until review. The doctor also ordered low flow oxygen via nasal prongs, chest physio after the bronchodilator therapy and a high energy, high protein diet.
The Emergency nurse also tells you that Brian has reported he hasn’t had a shower for two days because he gets “too puffed out’ and that he is very worried about his dog ‘Spider’ who has been left locked up alone in his flat. He also is concerned that his family back in the community doesn’t know that he’s not well and had come to hospital.
Your task in Assessment 1 is to critically discuss some of the key nursing issues related to Brian’s care on your shift. Details of the specific nursing issues to address are identified on the following pages.

Tasks
Based on Brian’s case and the information you have available, address the following seven (7) items.
Do not make up or assume information in relation to Brian’s case. Only use what you know from the case study information on the previous page.
Note: In most items Assessment 1, textbooks are not appropriate resources.
Item 1: Clinical presentation No Textbooks are to be used in this section
Brian is part of your patient allocation for your shift today. You haven’t met or seen him as yet. An important first step in the clinical reasoning process is to anticipate what you might see, hear and feel when you first meet Brian.
Using current, reliable journal articles to support your thoughts and ideas (Textbooks are not appropriate sources in this section)
• Describe what you might expect to see, hear and/or feel when you do your initial assessment of Brian AND
• Explain why you might expect to see, hear or feel these findings

(150 words)

Item 2: Nursing management – Adequate oxygenation
No Textbooks are to be used in this section
Brian is likely to be prescribed continuous or intermittent oxygen saturation or pulse oximetry monitoring, especially while he has oxygen therapy in situ.
A new nursing student you are working with today reports to you that Brian’s saturation monitor is continually alarming and saturation reading is 86%. You review Brian to assess his respiratory function to determine if you need to seek medical review and find that aside from the saturation reading on the monitor, Brian is in no respiratory distress and is not cyanotic.
Using only the CDU Library databases and search engines, locate three (3) current journal articles that report original research or formal systematic or literature reviews relating to oxygen saturation monitoring or pulse oximetry.
Using only these 3 articles (Textbooks are not appropriate resources in this section),
• Identify what you need to ensure the nursing student knows and understands about how pulse oximetry works and the factors that might impact on accurate, reliable oxygen saturation monitoring or pulse oximetry readings

• Explain why it is important the nursing student knows and understands this information AND

• Explain why oxygen saturation monitoring on Brian may not always give you an accurate picture his current level of oxygenation

(500 words)

Item 3: Nursing management – Medication management
Two important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications and to monitor the patient to ensure they are responding to prescribed medications as they should.
• Briefly explain why Brian has been prescribed ampicillin and a combination bronchodilator by metered dose inhaler on this admission

• Explain how you will monitor Brian to ensure he is responding to these medications as he should

(250 words)
Item 4: Nursing management – Rationale for prescribed treatments and nursing interventions
No Textbooks are to be used in this section.
Brian has been prescribed several treatment interventions to stabilise his current health problems and improve his overall health status. From your assessments so far, you recognise that Brian should be nursed in an upright or tripod position and to ensure that he has supplemental oxygen, supervision and assistance when showering, toileting and mobilising around the ward.
Using current, reliable journal articles to support your thoughts and ideas (Textbooks are not appropriate sources in this section)
• Explain why Brian has been prescribed:
o Chest physio (postural drainage, percussion and vibration, effective coughing) after administration of the prescribed bronchodilator therapy
o A high energy, high protein diet

• Explain why you have decided that today Brian needs
o To be nursed in an upright position
o Supplemental oxygen, supervision and assistance when showering, toileting and mobilising around the ward

(500 words)
Item 5: Safe, effective nursing care
No Textbooks are to be used in this section.
Nurses have a professional responsibility to ensure that patients in their care remain safe and well in health care settings.
Using current, reliable journal articles to support your thoughts and ideas (Textbooks are not appropriate sources in this section)
• Explain the strategies you will implement to keep Brian safe and well in the hospital environment during your shift today

AND
• Strategies you will implement to monitor Brian to ensure you can identify if Brian is not responding to prescribed treatments and/or your nursing care as he should (500 words)

Item 6: Health promotion
Brian requires a chronic obstructive pulmonary disease management plan to be put in place before he can be discharged home. Part of any management plan is patient teaching and strategies to promote health and minimise exacerbation of his health problems.
• Identify two (2) health promotion topics you will address with Brian during your shift today that are part of Brian’s chronic obstructive pulmonary disease management plan.

AND
• Explain why these 2 topics are appropriate for Brian as part of a chronic obstructive pulmonary disease management plan.

(300 words)
Item 7: Culturally responsive nursing care
An important part of nursing practice is to be responsive and sensitive to the cultural practices, beliefs and values of patients in your care.
• Explain why Brian’s cultural background might impact on how he interprets, understands and complies with prescribed treatments and health promotion information that is given to him this admission.

Note: The case study information does not identify Brian’s cultural heritage. Do not make any assumptions about what it might be.
This section requires a discussion of general principles and concepts. The cultural background of the patient is not necessary information for you to address this item.
You are, however, encouraged to provide examples of cultural practices, beliefs and values to support your statements. There are many examples in the relevant literature.
(300 words)