NUR250 Medical Surgical Nursing 2 Assessment 1

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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