Care of the Person with a Medical Condition

This assignment requires the student to focus on the holistic care of a patient with a medical condition and apply the clinical reasoning cycle to develop nursing care plans. The case scenario involves a 44-year-old man with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The assignment includes tasks such as considering the patient, conducting nursing assessments, developing care plans, providing patient education, and involving the allied health team in the patient's care.

Description/Focus: Care of the person with a medical condition
Value: 40%
Due date: 1st April 2019 by 1300 ACST
Length: 1600 words
This assignment requires you to focus on the holistic care of a patient admitted to
hospital with an acute presentation of a chronic condition and to demonstrate your
ability to apply the clinical reasoning cycle to develop and plan nursing care.
Select one of the following case scenarios:
Mr. Peter Newman is a 44-year-old man admitted to the ward with infective
exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Mr Newman is a heavy
smoker and social drinker. Mr Newman is a Fly-In-Fly-Out (FIFO) truck driver with a
remote mining company and is finding it difficult to meet work responsibilities due to
increasing breathlessness.
Mr Newman lives with his wife Marcy and 2 teenage children in a southern capital city and
works a 2 weeks on/2 weeks off roster.
Based on the information provided in the above case scenarios complete the following
tasks.
Use the learning provided martials to make this this assessment please.
Task 1. Consider the patient (200 words)
What will you consider when preparing the care plan for your chosen patient?
A nursing care plan comprises of several pertinent information related to patient diagnosis,
and the purpose of delivering treatment services, in addition to particular nursing orders, and a
comprehensive evaluation plan. While formulating a care plan for the patient Peter Newman, it must
be taken into consideration that Peter has been a heavy smoker and social drinker all throughout his
life. His smoking habits can be considered as a major risk factor that triggered the onset and
development of COPD symptoms. In addition, he is also a Fly-In-Fly-Out employee. This method of
employment focuses on providing job opportunities to people in remote locations by moving them

to the work site temporarily. Peter is employed in a mining company that makes it
difficult for him to meet the job responsibilities. Recently he also reported breathing problems. He
currently resides with two teenage kids and his wife Marcy in the southern capital of the nation. His
work schedule also comprises of working continuously for two weeks, followed by taking a two week
leave. Hence, at the time of care plan formulation, his workplace circumstances, and family history,
social history must be considered, with the aim of lowering his likelihood of being exposed to factors
that might exacerbate his condition.
Task 2. Nursing assessments (300)
Nursing assessments involve the procedure of gathering vital information related to the
psychological, physiological, spiritual, and sociological status of patient, and is typically conducted by
a registered nurse (Giger, 2016). The primary objective of conducting a thorough and comprehensive
nursing assessment is to recognise pertinent health abnormalities that helps in prioritising necessary
medical interventions. The three nursing assessments that need to be conducted upon Peter include
(i) respiratory assessment, (ii) assessment of dyspnoea, and (iii) vital sign and/or neurological
assessment. The respiratory assessment will encompass an external evaluation of patient
ventilation, which in turn will comprise of observations of the respiration pattern, depth and rate. An
accurate assessment of the respiratory functioning will depend on identification of abdominal and
thoracic movements that generally gets affected in COPD (Des Jardins & Burton, 2019). Conducting
an assessment for dyspnoea will involve assessing the airway patency, while listening to the lungs of
the patient. This is vital since shortness of breath is a common manifestation of COPD due to
obstruction in the lungs. Furthermore, according to Perez et al. (2015) presence of a subjective
experience of discomfort in breathing that eventually consists of distinct sensations can also be
attributed to exposure to allergens, which is prevalent in this case (work in mining site). In addition,
conducting a vital signs assessment will provide a clear insight into the status of the life sustaining
functions of the patient’s body. The measurements related to heart rate, blood pressure, pulse
(heart rate), respiratory rate, and body temperature will help in determining whether COPD has
created an impact on the general physical status of Peter, thus providing necessary clues to the
disease (Villarroel et al., 2014). Neurological assessment will involve collection of subjective data,
mini-mental state examination, and use of the Glasgow Coma Scale. It is vital since COPD has been
found to exert a negative impact on thinking and memory. In addition, presence of low levels of
oxygen in bloodstream might also cause neural damage.
Task 3. Care planning. (500)
Use the provided care plan please. That someone else work, use that in your own wording
including evidence.

The major nursing problem identified in the current scenario is COPD that
leads to an impairment in exchange of respiratory gases, followed by shortness of breath, decrease
in the amount of oxygen saturation levels, and increase in the amount of Pco2. The three priority
nursing diagnosis that have been identified from the case scenario are namely, (i) reducing the
impairment of gas exchange, (ii) lowering risks of septic shock, and (iii) enhancing the patient’s
psychological functioning by lowering stress and anxiety levels. The table provided below contains
the plan of care for Peter:
Goal of care Nursing intervention
and management
Rationale Evaluation
Management of the
impaired gaseous
exchange in the
patient due to COPD
Respiratory rate
assessment and
conducting
auscultation for
determining
breathing sounds
Poor airflow due to
obstruction in the
lungs will lead to
dyspnea and
tachypnea that can
be accredited to low
level of pO2, and
high Pco2. This will
stimulate shallow,
rapid breathing
(Herigstad et al.,
2015)
Subjective-
Peter will be able to
verbalise properly
and will not report
any respiratory
discomfort
Objective-
Respiratory rate and
oxygen saturation
levels will reach
normal levels
Peter will be
provided with a
pillow at the back
and will be made to
sit in high Fowler’s
position (60-90°)
Elevating the bed or
making him sit in
high Fowler’s
position will facilitate
relaxation of the
abdominal muscle
tension and will
expand the chest,
thus improving
breathing (Kubota,
Endo, Kubota,
Ishizuka & Furudate,
2015)
On noting signs of
hypoxemia,
supplemental oxygen
will be delivered
It will increase the
oxygen amount in
the bloodstream,
thus promoting
tissue healing and
restoring normal
blood gas levels

(Murphy et al., 2017)
Provide rest to the
patient
Taking rest will
reduce sleep
problems
Prevent cyanosis by
monitoring skin,
nails, and lips
Oxygen saturation
less than 90% leads
to cyanosis

To lower septic
shock risk
Show adherence to
aseptic techniques
Aseptic techniques
prevent pathogen
transmission and
lower infection rates
(Schub & Schub,
2015)
Peter shows normal
orientation, vital
signs within limits
and absence of
infection
Conduct patient
assessment for
septic shock
Early signs include
fatigue, breathing
difficulty, fever,
rigor, chills, and
nausea
Administration of
antibiotics
They will lower risk
of severe
complication and
eventual death
(Sterling et al., 2015)

Evaluate minor
alterations in HR, RR,
tissue perfusion,
oxygenation and
confusion
Identification of early
signs and symptoms
will prevent further
deterioration
Document the vital
signs
Vital sign
documentation will
help in identifying
circulatory and
respiratory
abnormalities

Provide education on
septic shock
Educating the
patient will help him
adopt self-
management
strategies
Implement fluid
resuscitation
Administering fluids
will increase the
volume of blood
(Sadaka, Juarez,
Naydenov & O’brien,
2014)

To enhance the
psychological health
of Peter and lower
his anxiety and stress
Establishment of a
nurse-patient
therapeutic
relationship
Presence of mutual
trust, faith, and
respect will help to
address the
emotional, spiritual
and physical needs
of the patient
(Tremayne, 2014)
Peter will display less
concerns over his
health and actively
participate in the
care giving process
Counseling This will help Peter
to cope with his
illness

Involving his wife
and teenage kids in
the care process
Involving family
members will help to
meet the needs of
the patient (Coyne,
2015)
Table 1- Care plan for Peter
Task 4: Patient education (300 words)
Discharge planning has the primary objective of enhancing the coordination of clinical
services, and takes into account the needs of the patient within the community. Smoking has been
identified as the major cause for COPD. Owing to the fact that heavy smoking results in a damage of
the air sacs, lining of the lungs, and the airways, the oxygen flow to the cells through the lungs gets
subsequently reduced, thereby causing shortness of breath in COPD (Zuo et al., 2014). Peter will be
advised to quit smoking for protecting his lungs, and preventing further deterioration of the
symptoms. He will be taught about the harmful impacts of smoking and will also be provided
assistance for quitting smoking such as, medicines and nicotine replacement therapy. Referrals to
support groups will also facilitate smoking cessation. Exposure to allergens and fumes at mining sites
also affects lung function, thereby exacerbating the COPD symptoms (Hendryx & Luo, 2015). Peter
will be advised to put on face masks at his workplace to prevent exposure to any kind of fumes or
chemicals that might lead to a flare-up of the symptoms and result in more lung damage. While
involving his family in the care process, they will also be asked to reduce the amount of secondhand
smoke that he is exposed to. Patient education will also involve the concept of pulmonary
rehabilitation that will bring about an improvement in his health and overall quality of life (Garvey et
al., 2016). Peter will also be encouraged to participate in moderate physical activities and exercise
that will improve signs of breathlessness. In addition, he will also be provided training on pursed-lip
breathing that has been considered a mainstay management strategy for COPD (Rossi et al., 2014).
Education will also encompass encouraging him to change the working pattern of two weeks on and
two weeks off roster. Taking breaks in between weeks will reduce his exposure to the mining site,
thus decreasing the pressure on the lungs and airways.
Task 5: Team care (300 words)
Identify and define the Allied Health team members that should be involved in the patient’s care
during admission and in preparation for discharge

Allied Health team members typically comprise of
chiropractors, occupational therapists, exercise physiologists, osteopaths, orthoptists, prosthetists,
podiatrists, psychologists, sonographers, hospital pharmacists, and social workers. An exercise
physiologist will play an important role in this case scenario since they will help the patient
understand the benefits of participation in exercise activities, thus facilitating Peter to gain optimal
fitness, and increasing the quality of life. This allied health professional will be involved in assessing
exertional oxygen, while encouraging Peter to show adherence to exercise rehabilitation, which in
turn will improve arm movement and enhance pulmonary capacity and function. A dietician will also
play an important role during care delivery and discharge planning since breathing needs a conscious
effort among most patients. Owing to the fact that a poor diet will prevent the patient from
compensating for increased energy demands, thus resulting in subsequent loss in weight (Nordén et
al., 2015). There is mounting evidence for the association between continuous smoking and
deficiency of serum vitamin C levels (Zendedel et al., 2015). Having adequate nutrition will prevent
malnutrition and also enhance the pulmonary status of the patient. Hence, a dietician will
recommend the daily intake of food and drinks to Peter in order to meet his energy needs and avoid
weight loss. An occupational therapist will also be involved in educating and monitoring Peter in
techniques of energy conservation by prioritisation and conscious planning (Corhay, Dang, Van
Cauwenberge & Louis, 2014). The therapist will teach Peter ways to maintain balance between rest
and activity, and usage of alternate breathing techniques. Peter will also be provided training on
body positioning, adjusting tempo, and breathing techniques. A counsellor will also be involved in
the care giving process and will provide much needed psychosocial support to Peter for handling the
consequences of COPD, and the alteration in participation abilities, and activities. Counselling will
also prove beneficial in encouraging Peter for smoking cessation (Marques et al., 2015).
Referencing: Reminder marks are allocated for academic integrity. See
the marking criteria below for more details. Breaches of
academic integrity will be lodged on the University system
and may have serious consequences for students.
CDU APA 6th referencing style is to be used for both in-text
citations and end of assessment references.
All resources must be dated between 2010 and 2018
There must be at least 15 peer-reviewed journal articles
and/or evidence based practice guidelines cited in your
assignment. Do not use any health facility or local health
service policies or procedures
Only 1 current Australian medication textbook and 1 current
Australian medical surgical nursing textbook to be referenced
Assessment This assessment will be marked against the following

criteria: criteria:
Ability to interpret and address topic
Written expression
Using the literature effectively
Structure, logical sequencing & flow of information
CDU APA referencing
Please refer to the marking rubric attached to your
assignment task above

References
Corhay, J. L., Dang, D. N., Van Cauwenberge, H., & Louis, R. (2014). Pulmonary rehabilitation and
COPD: providing patients a good environment for optimizing therapy. International journal
of chronic obstructive pulmonary disease, 9, 27. doi: 10.2147/COPD.S52012
Coyne, I. (2015). Families and health care professionals' perspectives and expectations of family‐ ‐
centred care: hidden expectations and unclear roles. Health expectations, 18(5), 796-808.
https://doi.org/10.1111/hex.12104
Des Jardins, T., & Burton, G. G. (2019). Clinical manifestations and assessment of respiratory disease.
Mosby. https://books.google.co.in/books?
hl=en&lr=&id=cdiCDwAAQBAJ&oi=fnd&pg=PP1&dq=respiratory+assessment&ots=Co0UEzb
XfN&sig=ve3N4871gTNbwvUkVIyxZiuJAPI#v=onepage&q=respiratory
%20assessment&f=false
Garvey, C., Bayles, M. P., Hamm, L. F., Hill, K., Holland, A., Limberg, T. M., & Spruit, M. A. (2016).
Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease:
review of selected guidelines. Journal of cardiopulmonary rehabilitation and
prevention, 36(2), 75-83. https://doi.org/10.1097/HCR.0000000000000171
Giger, J. N. (2016). Transcultural nursing: Assessment and intervention. Elsevier Health Sciences.
Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=XCWKCwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+assessment&ots=Ub4dBiESw
J&sig=-bERHkF1D0uIdrwESIO2aLW_1T4#v=onepage&q=nursing%20assessment&f=false
Hendryx, M., & Luo, J. (2015). An examination of the effects of mountaintop removal coal mining on
respiratory symptoms and COPD using propensity scores. International journal of
environmental health research, 25(3), 265-276.
https://doi.org/10.1080/09603123.2014.938027
Herigstad, M., Hayen, A., Evans, E., Hardinge, F. M., Davies, R. J., Wiech, K., & Pattinson, K. T. (2015).
Dyspnea-related cues engage the prefrontal cortex: evidence from functional brain imaging
in COPD. Chest, 148(4), 953-961. https://doi.org/10.1378/chest.15-0416
Kubota, S., Endo, Y., Kubota, M., Ishizuka, Y., & Furudate, T. (2015). Effects of trunk posture in
Fowler's position on hemodynamics. Autonomic Neuroscience, 189, 56-59.
https://doi.org/10.1016/j.autneu.2015.01.002
Marques, A., Jácome, C., Cruz, J., Gabriel, R., Brooks, D., & Figueiredo, D. (2015). Family-based
psychosocial support and education as part of pulmonary rehabilitation in COPD: a
randomized controlled trial. Chest, 147(3), 662-672. https://doi.org/10.1378/chest.14-1488
Murphy, P. B., Rehal, S., Arbane, G., Bourke, S., Calverley, P. M., Crook, A. M., ... & Hurst, J. R. (2017).
Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on
hospital readmission or death after an acute COPD exacerbation: a randomized clinical
trial. Jama, 317(21), 2177-2186. doi:10.1001/jama.2017.4451

Nordén, J., Grönberg, A., Bosaeus, I., Forslund, H. B., Hulthén, L., Rothenberg,
E., ... & Slinde, F. (2015). Nutrition impact symptoms and body composition in patients with
COPD. European journal of clinical nutrition, 69(2), 256.
https://doi.org/10.1038/ejcn.2014.76
Perez, T., Burgel, P. R., Paillasseur, J. L., Caillaud, D., Deslée, G., Chanez, P., & Roche, N. (2015).
Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in
chronic obstructive pulmonary disease. International journal of chronic obstructive
pulmonary disease, 10, 1663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547644/
Rossi, R. C., Vanderlei, F. M., Bernardo, A. F., Souza, N. M. D., Goncalves, A. C. C. R., Ramos, E. M.
C., ... & Vanderlei, L. C. M. (2014). Effect of pursed-lip breathing in patients with COPD: linear
and nonlinear analysis of cardiac autonomic modulation. COPD: Journal of Chronic
Obstructive Pulmonary Disease, 11(1), 39-45.
https://doi.org/10.3109/15412555.2013.825593
Sadaka, F., Juarez, M., Naydenov, S., & O’brien, J. (2014). Fluid resuscitation in septic shock: the
effect of increasing fluid balance on mortality. Journal of intensive care medicine, 29(4), 213-
217. https://doi.org/10.1177%2F0885066613478899
Schub, E., & Schub, T. (2015). Sepsis and septic shock. CINAHL Nursing Guide. Retrieved from
http://www.farmerhealth.org.au/wp-content/uploads/2014/03/Sepsis_and_Septic_Shock.p
df
Sterling, S. A., Miller, W. R., Pryor, J., Puskarich, M. A., & Jones, A. E. (2015). The impact of timing of
antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-
analysis. Critical care medicine, 43(9), 1907. doi: 10.1097/CCM.0000000000001142
Tremayne, P. (2014). Using humour to enhance the nurse-patient relationship. Nursing Standard
(2014+), 28(30), 37. DOI:10.7748/ns2014.03.28.30.37
Villarroel, M., Guazzi, A., Jorge, J., Davis, S., Watkinson, P., Green, G., ... & Tarassenko, L. (2014).
Continuous non-contact vital sign monitoring in neonatal intensive care unit. Healthcare
technology letters, 1(3), 87-91. DOI: 10.1049/htl.2014.0077
Zendedel, A., Gholami, M., Anbari, K., Ghanadi, K., Bachari, E. C., & Azargon, A. (2015). Effects of
vitamin D intake on FEV1 and COPD exacerbation: a randomized clinical trial study. Global
journal of health science, 7(4), 243. doi: 10.5539/gjhs.v7n4p243
Zuo, L., He, F., Sergakis, G. G., Koozehchian, M. S., Stimpfl, J. N., Rong, Y., ... & Best, T. M. (2014).
Interrelated role of cigarette smoking, oxidative stress, and immune response in COPD and
corresponding treatments. American Journal of Physiology-Lung Cellular and Molecular
Physiology, 307(3), L205-L218. https://doi.org/10.1152/ajplung.00330.2013

Needs development Satisfactory Excellent
Ability to interpret &
address tasks 1-5
(25)
5 marks per task
0 – 9 marks
Poor interpretation of most if not all, of the
case scenario tasks. Does not demonstrate
safe practice, knowledge for care planning,
assessment, and/or patient education.
Unsatisfactory rationales or explanations for
care planning and assessments and/ or limited
ability to explain and justify nursing actions
and education.
Demonstrated limited critical thinking using
the clinical reasoning cycle to address case
scenario tasks.
10 - 19 marks
Satisfactory interpretation of the case
scenario tasks. Demonstrates sound
knowledge of safe practice, knowledge for
care planning, assessment and patient
education.
Rationales demonstrate satisfactory ability to
explain or justify nursing action and
education.
Demonstrates an emerging level of critical
thinking using the clinical reasoning cycle to
address case scenario tasks.
20 - 25 marks
Excellent interpretation of the case scenario
tasks. Demonstrates excellent knowledge of safe
practice, knowledge for care planning,
assessment and patient education.
All rationales demonstrate high level ability to
explain or justify nursing action and education.
Demonstrates a high level of critical thinking
using the clinical reasoning cycle to address case
scenario tasks.
Academic Integrity -
referencing (5)
0 – 2 marks
Demonstrates little or limited ability to
acknowledge the work of others.
No or limited in-text citations and/or
incomplete reference list and/or inaccurate
and/or incomplete referencing details and/or
inconsistent referencing format.
3 – 4 marks
Demonstrates a developing ability to
acknowledge the work of others. Most ideas
supported with appropriate in-text citations
and there is a complete reference list. Some
inconsistency, inaccuracy and/or incomplete
details in CDU APA 6th format.
5 marks
Demonstrates high level ability to acknowledge
the work of others. All ideas supported with
appropriate and accurate in-text citations and
there is a complete and accurate reference list.
Minimal direct quotes (<3)
No errors detected in CDU APA 6th format.
Academic integrity standards met at a high level.
Evidence for practice
- research (5)
0 – 2 marks
Less than 7 peer reviewed journals/evidence
for practice and/or
3 – 4 marks
7 - 10 relevant peer reviewed
journals/evidence for practice.
5 marks
Minimum of 10 peer reviewed journals/evidence
for practice.

More than 2 current text books cited.
Some journals or texts are more than 10 years
old.
Numerous inappropriate resources in
reference list.
No more than 2 current text books cited.
Journal articles and textbooks are no more
than 10 years old.
May have occasional inappropriate resources
in reference list.
No more than 2 current text books cited.
Journal articles and textbooks are no more than
5 years old.
No inappropriate resources in reference list.
Presentation &
Academic Writing (5)
0 – 2 marks
Assignment is not on required template
and/or not submitted as a word document.
Font is not; Arial, Calibri or Times New Roman
size 11 or 12 and/or
Line spacing is not 1.5
Use of dot points or tables
Does not demonstrate an appropriate level of
written communication for nursing practice.
Thoughts and ideas are disorganised, or
content does not flow in a coherent manner.
Frequent spelling and/or grammatical errors
and/or
OR
Assignment is more than 20% over or under
the stated word count
3 – 4 marks
Less than 1-2 presentation guidelines not
adhered to: -
Assignment is not on required template
and/or not submitted as a word document.
Font is not; Arial, Calibri or Times New Roman
size 11 or 12 and/or
Line spacing is not 1.5
Use of dot points or tables
Demonstrates an appropriate level of written
communication for nursing practice.
Content is generally well organised with
coherent flow.
Occasional spelling or grammatical errors
and/or
OR
Assignment is 10 – 20% over or under the
stated word count
5 marks
Assignment is on required template and
submitted as a word document.
Font is either; Arial, Calibri or Times New Roman
size 11 or 12
Line spacing is 1.5
No dot points
Within the stated word count +/- 10%
Meets written communication standards for
nursing practice and academic literacy at a high
level.
Content is well organised with a coherent flow.
Assignment is free from spelling and /or
grammatical errors.