Care of the Person with a Medical Condition

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