Intervention in Medical Surgical Assessment 2022

OPEN BOOK EXAMINATION
Name: Score ________ / 20 marks
Student No: Date Submitted _________________
Scenario I –
An 80-year-old woman is admitted to your unit for
evaluation because of severe allergic response to shrimp that
she had eaten an hour ago.. She manifested edema of eyelids
and. shortness of breathing
Questions:
1. While a health history is being gathered, what
should you do as the nurse examiner if the patient
answered in a simple one word or just a
gesture? Justify ( give the reason why)
______
(1
ma
rk)
Answer:
In this context, the nurse can also implement the RESPECT model of
patient communication. The RESPECT model is dependent on 7 distinct
stages such as the rapport, empathy, support, partnership, explanation,
cultural competence and trust (Dykes et al., 2017).
In this case, as the patient is not comfortable about the conversation of her
past medical history the nurse should effectively focus on the point of view
of the patient and connect with the patient in a social level. Moreover, the
nurse should not judge the patient and also avoid making any assumption
to develop rapport with the patient. Then, the nurse should show proper
empathy by acknowledging the need of the patient and helping her
properly. In this process, the nurse should understand the causes of
behaviour of the patient and rationale for the negative health condition of
the patient. The third step is to support the patient this process can be
done with the help of understanding the barriers of the patient. The fourth
step is to develop partnership and that is focusing on the factor that you
will work with the patient in any kind of medical emergency. The fifth step
is explanation and in this step the nurse should implement the verbal
communication strategies to explain and also understand the patient
needs regarding the health issue. In sixth step, the nurse should respect
the cultural belief of the patient and understand the stereotypic cultural
1
King Saud university NURS 551
College of Nursing ASSESSMENT &
INTERVENTION IN
MEDICAL SURGICAL
2nd Semester AY
1441

and ethnic point of views of the patient as well. Seventh step is the trust
development with time (Aycock et al.,2017).
2. Because the client is in significant discomfort, it
would be difficult for her to move about during the
entire examination. How would you organize your
assessment for her to be able to complete a
physical assessment?
(3
marks
)
Answer:
The patient centred care is a process in which the nurse prioritise the
health condition and the outcome of the patient. Thus, the nurse should
focus on the reduction of any kind of discomfort and negative factors
involved in condition of the patient. Hence, the nurse should provide
continual support to the patient. In this context, it can be found that the
nurse and patient rapport and the therapeutic relationship would be helpful
in the process of the care delivery to the patient. Hence, the factor of
providing proper support to the patient the nurse should understand the
needs of the patient through proper communication. As this is an older
patient the nurse should be able to focus on the positive and empathetic
communication tone for the improved understanding and reduction of the
discomfort of the patient.
Moreover, the nurse should allow the patient to communicate and do not
try to oppose her or make her feel neglected by implementing the active
listening strategy. The engaging behaviour of the nurse in the
communication process would be very much effective in the process of the
trust and rapport development with the patient (Rodriguez, Reinhardt,
Spinner & Blake, 2018). This process will effectively help the nurse to
understand the needs of the patient and certain discomforts of the patient.
Moreover, the in this scenario the patient is an older person and not
effectively communicate with the nurse as well. Hence, the nurse should
analyse the gestures used by the patient in certain cases as well.
Moroever, the in case of the physical assessment the nurse should support
the patient considering her health and age with proper dignity and respect
to the patient. The nurse should position her according to the assessment
needs and considering the reduction of the discomfort of the patient as
well. Hence, the nurse, should communicate and provide the required
support the patient regarding the needs of the patient. In this context, it
can be stated that if the patient cannot move on her own then the nurse
should help her to move or rather provide wheel chair or walker to move
without any hassle. On the other hand, the patient position should be
changed with time and according to the need of the assessment as well as
the comfort of the patient. Hence, the prioritising and supporting the
patient according the need of her would develop the trust and dependency
of the patient on the nurse which would eventually develop the partnership
2
King Saud university NURS 551
College of Nursing ASSESSMENT &
INTERVENTION IN
MEDICAL SURGICAL
2nd Semester AY
1441

with the nurse (Rustam, Makmee, Jugjali & Kongsuwan, 2018).
Thus, this would effectively reduce the discomfort of the patient as well.
The nurse should focus on the effective communication strategies in the
whole assessment process as the therapeutic relationship would be the
way to improve the situation for the patient and also effectively the build
the partnership and rapport as well. Moreover, focusing on the positioning
and helping her move accordingly would be the factors that reduce the
discomfort of the patient in a positive way. Hence, finally it can be
highlighted that the partnership or the therapeutic relationship with the
patient would help the nurse in assessment, planning and informing the
patient according to the care delivery process. Moreover, showing respect
and dignity to the patient with proper empathy can also reduce the
chances of developing any kind of discomfort t for the patient as well.
Scenario II –
A 60 year old male patient has continuous diarrhea for 3 days
and has been prescribed with diphenoxylate with atropine (Lomotil)
. He has taken the drug continuously but returns to his physician
stating that he has had diarrhea 5 times today.
Questions:
1. A ) What is the key priority assessment? Why ?
B ) What are the additional significant assessment
data that the nurse should gather from this
patient?
_______
3
mar
ks)
Answer:
A) In this case scenario the patient has been prescribe with the medicine
required to reduce diarrhea. However, the patient has complaint of diarrhea
in an extensive amount. Hence, the nursing care should be focused on the
proper diagnosis and finding any kind of confounding factor for the
development of the diarrhea in the physiological aspect of the patient. The
assessment and the diagnosis are the two primary factors in the process of
the nursing care delivery and these should be considered with priority. The
context, of the care delivery planning and the understating the patient’s
situation the nurse should focus on the patient’s medical history and also
proper identification of the possible pathophysiology of the patient’s
condition. Thus, it can be stated that the patient assessment with
consideration of the past medical history of the patient and the present
medical situation is most important aspect of the nursing care delivery.
3
King Saud university NURS 551
College of Nursing ASSESSMENT &
INTERVENTION IN
MEDICAL SURGICAL
2nd Semester AY
1441

Hence, it can also be highlighted that the process of the nursing care is
focused on the assessment data and it will effectively organse the care
procedure with patient safety and care quality maintenance (Jang et al., 2019).
In this context, it can be stated that the process of the assessment of the
patient is required with higher priority for the maintenance of the proper care
of the patient.
B) The nurse should gather different health related data of the patient
including the present health assessment data, past medical history, social
history, family history and also the health behaviour related data of the
patient. It has been seen that the patient is constant complaint of the
diarrhea condition and the patient has stated that the issue is increasing. In
this context, the nurse should diagnose the patient’s vital signs, eating habits
and also test the blood sample of the patient for the identification of any kind
of microbial infection or inflammation in the body of the patient. It has been
reported that the microbial infection causing the disruption of the
gastrointestinal barrier of the intestine primarily cause the diarrhea. Thus,
the assessment of the infection of any kind of microbe in the body and also
the assessment of the vitals of the patient relating to the pathophysiology of
diarrhea or any kind of relating gastrointestinal issues should be considered
in this case as well (Freedman et al., 2018). Hence, proper and overall
assessment of the patient should be considered in this case as diarrhea can
be caused due to different issues and the nursing assessment should follow
all the assessment processes as this will effectively identify the actual cause
of the situation of the patient. Moreover, the nurse should also focus on the
reduction of the negative situation for the patient along with the assessment
process as the health outcome of the patient is the most important factor for
the nursing care delivery. Thus, it can be identified that the process of care
for the patient in this situation is focused on the assessment and the
identification of the cause of the situation properly.
2. What are the additional significant interventions
that the nurse should perform for this patient?
(Minimum of 6 ) 3 marks)
Answer:
In this case, the patient is facing a severe diarrhea and the complaints of the
medicines prescribed for the cure of the situation are not working rather the
condition is getting worse. Hence, the assessment of the patient for the
actual cause of the situation should be considered with priority. Based on the
assessment the patient should also be provided with proper intervention. It
can be seen that the issue of diarrhea can occur due to several reasons
including improper water intake or fluid imbalance in the body that is
dehydration, microbial infection and disruption of the gastrointestinal barrier
and improper excretion along with improper food habit as well. Hence, the
nurse should assess the patient based on all these factors and provide the
4
King Saud university NURS 551
College of Nursing ASSESSMENT &
INTERVENTION IN
MEDICAL SURGICAL
2nd Semester AY
1441