NUR250 Medical Surgical Nursing 2 Assessment 1

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.

NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Description/Focus: Care of the person with a medical condition
Value: 40%
Due date: Friday 12th April 2019 by 1300 ACST
Length: 1800 - 2000 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.
Or
Miss Violet Paterson is a 77-year-old woman admitted to the ward following an Acute
Myocardial Infarction (AMI). Miss Paterson is currently in a stable condition. She has a
history of primary hypertension and longstanding osteoarthritis. Over the last few
months the arthritic pain has increased significantly, and both her blood pressure and
osteoarthritis are impacting on her ability to meet her daily living needs. Miss Paterson
lives alone in an apartment on the 3rd floor (with no lift access) with her cat Molly and
has no extended family.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Based on the information provided in the above case scenarios complete the following
tasks.
Task 1. Consider the patient
What will you consider when preparing the care plan for your chosen patient?
The chosen patient is Mr. Peter Newman who is aged 44 years and he admitted to
the ward following an infective exacerbation of the Chronic Obstructive Pulmonary Disease
(COPD). In the preparation of a care plan for Mr. Peter, I would consider multiple factors to
ensure that provision of a holistic, individualised, and patient-centred type of care for the
achievement of a positive outcome. The first thing I would consider is breathing pattern
since COPD is a respiratory disease that is associated with persistent obstruction of the
bronchial airflow.
COPD presents with chronic dyspnea associated with the limitation of expiratory
airflow which significantly fluctuates less. The primary causes of airway obstruction may
change from mucous plugging, inflammation of the airway, narrowing of airway Lumina ( It
should be Lamina the plural of Lumen, the spaces between the airways) and airway
obstruction. This may be possible since chronic bronchitis presents with widespread airway
inflammation, marked cyanosis, airway blockage, and increased mucoid sputum production.
Based on the pathophysiology of COPD, I think it would be essential for me to consider the
breathing pattern of Mr. Newman (Adeloye et al., 2015).
The second key component I would consider when preparing the care plan would be
oxygenation or oxygen saturation of the patient. From the case study, Mr. Newman
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
presents with complains of having difficulties in meeting his responsibilities
at the place work following increased breathlessness. The issue of increased breathlessness
is a key indicator that he has low levels of oxygen in the body. This can result to other
complications such as respiratory acidosis due to reduced oxygen levels. Therefore, I would
be crucial to consider his oxygen saturation in the preparation of the care plan (Caramori,
Kirkham, Barczyk, Di Stefano, & Adcock, 2015).
The third factor I would consider in the preparation of Mr. Newman’s care plan his
knowledge on the causes, pathophysiology, risk factors, and management or preventive
strategies or interventions for COPD. Some of the causes and risks factors of COPD are
cigarette smoking, asthma, age above fourth years, genetics, occupational exposure to
chemicals and dusts, and genetics (Caramori et al., 2015). According to the case study, Mr.
Newman is a social drinker and heavy smoker which is one of the primary causes and risks
factor for COPD.
He also works with a remote mining company whereby he is exposed to dusts and
other chemicals present. Based on this, Mr. Newman’s condition seems to have been
exacerbated by some of these conditions, that is, prolonged exposure of dusts and heavy
smoking. It would therefore be essential to consider his level of knowledge as a far the
management and prevention of COPD are concerned (De Marco et al., 2013). It is essential
since the patient is one of the key components in nursing care. It is important when the
patient has adequate knowledge on their condition since they contribute to the
management and outcome of the nursing care.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Another factor I will consider in the preparation of Mr. Newman’s
nursing care plan is nutrition which is crucial for his health. A patient with COPD generally
presents with reduced appetite, lack of energy, fatigue, swelling of legs, feet, or ankles, and
unintended loss of body weight. Additionally, a patient with COPD may have difficulties
maintaining his adequate nutritional intake as required. As the medical condition
progresses, he may develop cachexia. It would be crucial to consider the aspect of nutrition
to ensures improved nutritional status of the patient and other related complications which
may lead to poor diseases prognosis (De Marco et al., 2013).
The last aspect I will consider in the preparation of a care plan for Mr. Newman is
functional status. This will involve the assessment of his ability to performance his activities
of daily living and responsibilities at the work without any difficulties or requiring assistance.
In most instances, patients with COPD present with impaired functional status. Functional
status is one of the multidimensional concepts, which primarily focuses on the ability of the
patient to comfortably carry out the ADLs. Typically, COPD is accompanied by dyspnea
which results in decreased physical ADLs and functional status. Consequently, impaired
functional status results in compromised health of the patient. With reference to the case
study, Mr. Newman finds it difficult to meet the responsibilities at work. Therefore, it would
be vital to consider the element of nutrition when planning for Mr. Newman’s nursing care
(Simpson & Jones, 2013).
Task 2. Nursing assessments
Identify three (3) nursing assessments you will conduct and explain why they are a priority
for you.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
1. Increased respiratory rate and breathing workload: This is a priority
for me since it may have been caused by bronchoconstriction, airway obstruction,
ineffective cough, inflammation, or obstruction of the airways. As a nurse, my
priority such an instance is to maintain the patency of the ways through removal of
any obstructing objects, suctioning of secretions, and intubation of the patient to
ensures sufficient oxygen delivery (Donaldson, & Wedzicha, 2014). Additionally,
prioritizing this issue will help in ensuring that the patient is in an optimal position in
order to decrease the breathing workload. Sitting up in the bed will enhance
appropriate lung expansion thus allowing for adequate expiration and inspiration.
This will facilitate better gaseous exchange for the patient.
2. Reduced Oxygen saturation of less than 90 percent: This is a priority for me since it
will enable provide supplemental oxygenation to the patient as appropriate. Ideally,
the supplemental oxygen will increase the patient’s oxygen levels. With the case of
COPD, I will intervene cautiously since he is unable to breath adequately, therefore,
over-oxygenation is would be an essential concern since he may have lower baseline
level of SPO2 (Donaldson, & Wedzicha, 2014). This is also a priority since low levels
of oxygen in the body increases the risks of development of hypoxia thus resulting in
life-threatening complications or conditions such as heart failure, acute respiratory
failure, and hypercapnia. The assessment of patient oxygen is a priority since it will
also facilitate rapid sequence intubation to prevent further exacerbation of the
patient’s condition.
3. Unintended loss of body weight of 20 Kilograms within two weeks and reduced
appetite: This is a priority since it is essential to ensure that the patient meets the
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
required nutritional intake based on the caloric needs of the body
(Wedzicha et al., 2017). This will necessitate the implementation of oral care to
prevent infections and protect the mucous membrane especially when the patient is
on oxygen or is intubated. Additionally, this will ensure that the patient gets
adequate nutrition as per body requirement thus giving him energy required in
breathing and performing self-activities (Khan et al.,2014).
Task 3. Care planning
Identify three (3) priority nursing diagnoses for your chosen case scenario and explain why
they are relevant.
1. Infective airway clearance related to allergic airways, bronchospasm, retained
secretions, fatigue, and hyperplasia of the bronchial walls as evidenced by increased
breathlessness. This is relevance because some degree of bronchospasm in COPD
results in airway obstruction which can be controlled through appropriate
interventions to clear the airway and ensure its patency for effective breathing.
Management of this diagnosis would be essential in the prevention of other
complications like hypoxia (Lewis, Collier, & Heitkemper, 2017).
2. Ineffective breathing pattern related to retained secretions, airway inflammation,
and airway obstruction as evidenced by increased respiration rate. This is relevant
since the patient presents with breathlessness which is an indicator of impaired
pattern of breathing by the patient. This will necessitate the implementation of
appropriate interventions for the promotion of lung expansion, liquification of
secretions, and relieve Mr. Newman of dyspnea thus improving his pattern of
breathing (Miravitlles et al., 2016).
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
3. Imbalanced nutrition less than body requirement related to
dyspnea and fatigue as evidenced by weight less, poor muscle tone, loss of muscle
mass and aversion to eating and reduced interest in food. This is relevant since the
patient is in Acute Respiratory Distress and he is anorectic due to dyspnea,
medications, and sputum production (Rennard et al., 2013). Most patients with
COPD habitually eat poorly despite the fact that respiratory insufficiency brings
hypermetabolic state associated with increased caloric requirements. Noxious sights,
smells, and taste are prime deterrents to a patient’s appetite thus producing nausea
and vomiting due to increased respiratory difficulty (Wedzicha et al., 2017).
Task 4: Patient education
Identify specific education your chosen case scenario will require to effectively manage
their condition post discharge.
For an effective management of Mr. Newman’s condition after discharge, he will
require education on the risk factors for the exacerbation of COPD, self-management
strategies, importance of nutrition, importance of adherence to the prescribed medications,
and when to seek medical attention or call a doctor (Wong et al., 2014). Provision of
education on these topics will be essential in the preventive management and reduction of
the frequency of more exacerbations. In discharge planning, it is critical to consider
domestic arrangements and social support for Mr. Newman (Rennard et al., 2013).
The first key element that will be essential in the case of Mr. Newman is the general
information regarding COPD. He needs to be educated on the causes, risk factors,
pathophysiology, prevention and management, and complications of COPD. This will equip
him with adequate knowledge on the possible outcomes of the disease if he does not
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
comply with the prescribed medical regimens (Stoilkova, Janssen, &
Wouters, 2013).). Having knowledge about the medical condition will be essential in the
promotion of health since Mr. Newman will adopt life measures and habits which prevent
the exacerbation of his health condition thus ensuring effectiveness of the implemented
interventions or management approaches for his condition (Verbrugge, de Boer, & Georges,
2013).
Mr. Newman will need to be enlightened on the guidelines and instructions for using
the prescribed medications and the importance of adhering to the regimens. He will need to
be advised on the use of the oxygen devices and inhalation, and plan for the management of
the worsening of the symptoms (Katzung, 2017). He should be educated on when to contact
a healthcare provider immediately or seek medical assistance. To do this, he should consider
the presence of the following; chills or fever, shortness of breath, coughing, wheezing,
increased mucus, chest tightness, bloody, green, yellow, or smelly mucus, swollen ankles,
feelings of increased heart beat, and irregular heartbeat (Menezes et al., 2014).
Mr. Newman should be educated on stopping smoking and drinking since they are
key risk factors to COPD and its exacerbation. He should ensure no one is smoking in his
home compound and avoid other irritants such as dust, chemicals, and cigarette smoke to
prevent further complications and ineffectiveness of the prescribed medications. He should
also be enlightened on infection prevention by regularly washing his hands, avoiding
crowded places, exercising regularly, getting enough sleep, and eating a balanced diet (Price
et al., 2014). He should consume a diet containing plenty of vegetables and fruits, whole
grains, fish, lean meats, and low-fat dairy products. Additionally, he should avoid foods
which are high in sugar and fats.
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Another important aspect that Mr. Newman should be enlightened
on is stress management since stress can worsen COPD. He should do this by finding a quiet
place and lie or sit in a comfortable position. He should also do breathing exercise for some
minutes while closing his eyes. Pulmonary rehabilitation would also be essential to Mr.
Newman since they will improve his condition thus making him feel better. Some of the
programs for pulmonary rehab include breathing techniques, exercise, counselling,
information on COPD, and assistance on quitting smoking (Jones et al., 2014).
Task 5: Team care
Identify and define the Allied Health team members that should be involved in the
patient’s care during admission and in preparation for discharge
The Allied Health Team Members who should be involved in the process of
admission and discharge planning for Mr. Newman are nurses, physician, physiotherapists,
dieticians or nutritionist, and social workers. The nurse is a qualified and professional
healthcare provider who advocates and cares for patients or individuals from diverse ethic
and religions origins and backgrounds and provides holistic support to the patients
throughout the continuum of health and illness. Some of the roles of the nurse in this
scenario include assessing and recording symptoms and medical history, collaborating with
other members to effectively plan for patient care, advocating for the wellbeing and health
of the patient, and monitoring and recording his signs (Fletcher & Dahl, 2013).
Other roles of the nurse include administration of treatments and medications,
operating medical equipment, providing advice and support to the patient, performing
diagnostic tests, and educating him on the effective and appropriate management of his
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
condition (Wedzicha et al., 2017). A physician is professional who has
practised medicines and is concerned with the promotion, maintenance, restoration of
health, diagnosis, treatment, and prognosis of the patient’s illness. A nutritionist is an
individual who provides dietary advice to the patients in relation to his health. He or she will
be required in this scenario to prescribe the most appropriate nutrients for the patient in
the ward and before discharge to promote health (Simpson & Jones, 2013).
A physiotherapist will be required to provide advice and exercise to the patient to
promote healing and prevent further exacerbations. A social worker refers to an individual
who provides social support to individuals, groups, communities, or families to enhance
their social functioning and wellbeing. Since Mr Newman is a heavy smoker and a social
drinker, a social worker will be required to enlighten him on the impacts of alcoholism and
smoking to his health to promote health (Jones et al., 2014).
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References
Adeloye, D., Chua, S., Lee, C., Basquill, C., Papana, A., Theodoratou, E., ... & Chan, K. Y.
(2015). Global and regional estimates of COPD prevalence: Systematic review and
meta–analysis. Journal of global health, 5(2).
Caramori, G., Kirkham, P., Barczyk, A., Di Stefano, A., & Adcock, I. (2015). Molecular
pathogenesis of cigarette smoking–induced stable COPD. Annals of the New York
Academy of Sciences, 1340(1), 55-64.
De Marco, R., Pesce, G., Marcon, A., Accordini, S., Antonicelli, L., Bugiani, M., ... & Pirina, P.
(2013). The coexistence of asthma and chronic obstructive pulmonary disease
(COPD): prevalence and risk factors in young, middle-aged and elderly people from
the general population. PloS one, 8(5), e62985.
Donaldson, G. C., & Wedzicha, J. A. (2014). The causes and consequences of seasonal
variation in COPD exacerbations. International journal of chronic obstructive
pulmonary disease, 9, 1101.
Fletcher, M. J., & Dahl, B. H. (2013). Expanding nurse practice in COPD: is it key to providing
high quality, effective and safe patient care?. Primary Care Respiratory
Journal, 22(2), 230.
Jones, S. E., Green, S. A., Clark, A. L., Dickson, M. J., Nolan, A. M., Moloney, C., ... & Bell, D.
(2014). Pulmonary rehabilitation following hospitalisation for acute exacerbation of
COPD: referrals, uptake and adherence. Thorax, 69(2), 181-182.
Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Khan, J. H., Lababidi, H. M., Al-Moamary, M. S., Zeitouni, M. O., AL-Jahdali,
H. H., Al-Amoudi, O. S., ... & Alorainy, H. S. (2014). The Saudi guidelines for the
diagnosis and management of COPD. Annals of thoracic medicine, 9(2), 55.
Lewis, S. M., Collier, I. C., & Heitkemper, M. M. (2017). Medical-surgical nursing: assessment
and management of clinical problems. Elsevier, Incorporated.
Menezes, A. M. B., de Oca, M. M., Pérez-Padilla, R., Nadeau, G., Wehrmeister, F. C., Lopez-
Varela, M. V., ... & PLATINO Team. (2014). Increased risk of exacerbation and
hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest, 145(2),
297-304.
Miravitlles, M., Vogelmeier, C., Roche, N., Halpin, D., Cardoso, J., Chuchalin, A. G., ... & Blasi,
F. (2016). A review of national guidelines for management of COPD in
Europe. European Respiratory Journal, 47(2), 625-637.
Price, D., West, D., Brusselle, G., Gruffydd-Jones, K., Jones, R., Miravitlles, M., ... & Bichel, K.
(2014). Management of COPD in the UK primary-care setting: an analysis of real-life
prescribing patterns. International journal of chronic obstructive pulmonary
disease, 9, 889.
Rennard, S., Thomashow, B., Crapo, J., Yawn, B., McIvor, A., Cerreta, S., ... & Mannino, D.
(2013). Introducing the COPD Foundation Guide for Diagnosis and Management of
COPD, recommendations of the COPD Foundation. COPD: Journal of Chronic
Obstructive Pulmonary Disease, 10(3), 378-389.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Simpson, E., & Jones, M. C. (2013). An exploration of self-efficacy and self-
management in COPD patients. British Journal of Nursing, 22(19), 1105-1109.
Stoilkova, A., Janssen, D. J., & Wouters, E. F. (2013). Educational programmes in COPD
management interventions: a systematic review. Respiratory medicine, 107(11),
1637-1650.
Verbrugge, R., de Boer, F., & Georges, J. J. (2013). Strategies used by respiratory nurses to
stimulate self-management in patients with COPD. Journal of clinical nursing, 22(19-
20), 2787-2799.
Wedzicha, J. A., Miravitlles, M., Hurst, J. R., Calverley, P. M., Albert, R. K., Anzueto, A., ... &
Sliwinski, P. (2017). Management of COPD exacerbations: A European respiratory
society/American thoracic society guideline. European Respiratory Journal, 49(3),
1600791.
Wong, S. S., Abdullah, N., Abdullah, A., Liew, S. M., Ching, S. M., Khoo, E. M., ... & Chia, Y. C.
(2014). Unmet needs of patients with chronic obstructive pulmonary disease (COPD):
a qualitative study on patients and doctors. BMC family practice, 15(1), 67.
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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 0 – 2 marks 3 – 4 marks 5 marks
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
- research (5)
Less than 7 peer reviewed journals/evidence
for practice and/or
More than 2 current text books cited.
Some journals or texts are more than 10 years
old.
Numerous inappropriate resources in
reference list.
7 - 10 relevant peer reviewed
journals/evidence for practice.
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.
Minimum of 10 peer reviewed journals/evidence
for practice.
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.
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