Mr Saheed Bott is a 69 year old semi-retired university professor. His wife passed away 12 months ago and Saheed has kept himself busy marking papers from the university, reading and travelling. He has a son who has recently moved interstate for work. Mr Bott is a Muslim and English is his second language.
Mr Bott wears glasses for reading and other than a permanent colostomy (resulting from a large bowel infarction in 2005) he has nil significant medical history to report.
Last night Mr Bott was at dinner with friends when he suddenly became unwell and had difficulties speaking. Mr Bott was brought in by ambulance to the emergency department and was diagnosed as having had a cerebrovascular accident (CVA) with residual right (R) sided hemiplegia, dysphagia and dysphasia.
Mr Bott is transferred to the acute medical ward where you work.
Mr Bott appears drowsy but is responsive. He is currently Nil by Mouth (NBM) whilst awaiting a speech therapist review.
His vital signs on arrival are: T 36.5 degrees C; P 120; R 24; SpO2 94% and BP 180/90.
1a) Identify the factors that you would need to consider prior to and during an assessment? (min 50 words)
1b) Using the information from the case study, identify and define three (3) physical or psychologically factors that will need to be implemented into Mr Bott’s care plan.
1c) Identify which of the following vital signs provided above are outside normal range and provide the correct range for each.
- The registered nurse asks you to perform neurological observations on Mr Bott. Identify what data you would collect and how you would perform a neurological assessment. (min 100 words)
- You are now asked to complete an admission document for Mr Bott. Considering Mr Bott’s age, cultural, spiritual and religious data, identify six (6) ways in which these could be addressed in a plan of care.
- As a result of the (R) sided hemiplegia, Mr Bott requires assistance to empty and change his colostomy bag. Outline the steps involved (for the nurse) to change the colostomy bag (100 words – bullet points acceptable)
5a) Outline 3 risk factors associated with immobility, providing a brief explanation of each one chosen. (Bullet points are acceptable when accompanied by an explanation (100 words
5b) Which assessment tool will need to be completed before Mr Bott is moved? (50 words)
5c) Mr Bott has agreed to sit in his chair for lunch. Identify six (6) factors that the nurse will need to consider before assisting with mobilisation. (150 words – bullet points acceptable only when accompanied with a brief explanation of each).
6a) After review by the speech pathologist, Ms Bott is no longer Nil by Mouth (NBM) and has been placed on a modified diet. Identify and provide an example of each of the 3 (three) levels of modified foods and fluids that are recommended to clients with dysphagia (100 words)
6b) Provide 4 examples of ways in which the nurse can promote Mr Bott’s dignity and independence during his lunchtime meal. (Each point must be accompanied by an explanation 100 words)
7a) During the afternoon, Mr Bott indicates that he wishes to lie down. Once Mr Bott is lying down you notice that his right heel is red and non-blanching.
Identify a type of screening assessment, commonly used in the prevention and management of pressure injuries. Provide a brief explanation of the assessment tool you have chosen.
7b) What are the extrinsic and intrinsic factors that cause (or contribute) to the formation of pressure areas/decubitus ulcers? (50 words)
7c) Present a list of strategies specific to Mr Bott’s care, to prevent further pressure injury. (50 words)
7d) Discuss whether or not the indication of a pressure injury would require you to collaborate with any other health professional. In your answer, provide details of the text within the Enrolled Nurse Standards for Practice which directly relates to decision making. (100 words)
7e) Provide an example of a progress note entry for your client to indicate the presence of the new pressure injury to the right heel, include any strategies you have put in place to prevent further injury (50 words)
8a). What is the nurse’s role in the discharge planning of Mr Bott? In your answer include:
- when the discharge planning process should commence
- the members of the multidisciplinary team that should be involved
- any community services he may require
(min 100 words)
8b) Being unwell and receiving care for even a period of time can result in increased risk and complications to the client. Provide 4 examples of those risks or complications. (50 words)
9) After 5 weeks on your ward Mr Bott is preparing to be discharged when his condition deteriorates. You come onto the night shift and in handover hear that Mr Bott is unwell. He is febrile at 38 degrees and has IV hydration in progress. Mr Bott’s fluid input and output are being monitored. Mr Bott’s right heel has now broken down and he has been complaining of pain when he coughs.
You approach the bedside to review your client. Discuss at least 6 factors that you will you need to consider at the beginning of your shift. Include an explanation of why with each? (150 words bullet point list is acceptable)
10a) Mr Bott has developed a chest infection, he slowly and with difficulty explains to you that he does not wish to take antibiotics and wishes to be left to die in peace. Evaluate the role of the nurse in this situation, including the legal aspects of refusal of treatment. (200 words)
10b) In January 2016, The Nursing and Midwifery Board of Australia published a new Standards for practice for enrolled nurses. From this document, identify the most applicable standard relating to client rights. (25 words).
PART B – Care Plan
1a) Identify and name the National Safety and Quality Health Service Standard which focuses on responding to clinical deterioration (25 words)
1b How will an enrolled nurse make sure that any new information or changes in the required treatment or care of a client are recorded and implemented into the client’s care plan? (25 WORDS)
1c) You have monitored Mr Bott’s care plan and in consultation with the registered nurse, the pressure injury to the right heel is added to the care plan below. A week later, there is no further evidence of breakdown and the redness on the right heel has reduced. Complete the evaluation by adding at least 3 additional points.
Sample care plan:
|Assessment||Nursing Problem||Goals/Expected Pt Outcomes||Intervention||Evaluation|
Redness to right heel
|Impaired Skin Integrity Stage 1 superficial pressure injury, indicated by non-blanching, redness that does not subside after pressure is relieved||Within 2 weeks
Clean intact skin
Pressure relief is provided by position change and pressure relieving mattress
Nutritional intake is appropriate
|Pt will be turned and /or positon changed every two hours as evidence by nursing documentation
Mobilise twice daily (as per mobility care plan)
Conduct a full skin inspection twice daily paying close attention to the skin directly over bony prominences
Bed linen to be kept clean and wrinkle free
Reduction of moisture to the skin
Monitor nutritional intake with a daily food chart
Offer hourly fluids whilst awake
Use manual handling aids to prevent friction and sheering
Use sheepskin boots for comfort and to reduce sheer
|By the end of day 7 there is reduced redness over the
CASE STUDY 2
Ella is a 6-year-old girl who has cerebral palsy who had been brought into hospital with a chest infection. You have been asked to perform a health assessment for Ella who is distress at being in hospital.
Cerebral palsy can cause different degrees of developmental delay but in order to understand the impact the condition has on a person you need to be aware of the stage of growth and development a person should be at.
1) Discuss the stage of human growth and development that you would expect Ella to be at as a six-year old? (min 100 words)
2a) Refer to the Person Centred Health Care Assessment and the Development of Health Care Plans Core Standards for Practitioners to answer this question.
Identify at least six (6) potential health issues associated with cerebral palsy.
2b) List the four (4) essential skills that you need to draw upon when completing a health care assessment on Ella?
2c) Identify at least six (6) components of a comprehensive care health plan and provide the reasons why they are included in a person’s plan?
3) Ella becomes more distressed as you are performing the health care assessment. Using problem solving strategies and techniques, discuss the actions you could take to reduce Ella’s distress. (min 100 words)
You speak with Ella’s mum, Karen, who is staying in hospital with Ella and she tell you that their family like to take a wellness approach to health.
4) Explain what a wellness approach to health means and provide at least 3 examples of how a wellness approach could be used for Ella. (min 100 words)
5) As a family with a young child, identify some of the family health care needs that Ella and her family may require. (min 50 words)
6)….. When checking Ella’s vital signs one afternoon you note that her respiratory rate has increase from 22 to 32 and that her SpO2 has decreased from 98% to 92%. Identify what actions you would take. In your answer, discuss the following:
- who you would inform of Ella’s condition
- what clinical signs suggest that there is a deterioration in Ella’s condition. (min 50 words)
CASE STUDY 3
Sandra is a 42-year-old woman who has been admitted to hospital for some investigations as she has been trying for some time to become pregnant. Sandra has a 14-year-old son from a previous marriage.
- Identify at least 3 possible causes for infertility.
2) Discuss the impact of infertility on Sandra. In your answer ensure that you cover the physical, emotional and psychosocial impacts. (min 100 words)
3) When talking to Sandra about her family, she mentions that her son, Dean, has been very moody lately and is difficult to talk to. What information about adolescent growth and development could you share with Sandra? (min 100 words)
4) When Sandra’s son visits, you notice that he is physically very similar to his mother, they both have red hair, blue eyes, freckles and both are tall.
Discuss the influence of both genetics and the environment on growth and development. (min 100 words)