NUR250 Medical Surgical Nursing 2 Assessment 1

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?
I will be discussing Mr. Peter Newman’s case study. Considering the patient is a
requirement as the first step in the Clinical Reasoning cycle by (Levett-Jones, et al., 2010). In
general, clinical reasoning is the central point for repeated nursing and clinical practices
involving judgments and decisions made in the healthcare sector (Johnsen, Slettebø, & Fossum,
2016). The significance of this step of considering the patient is that it leads to the precision and
effectiveness of decision making by looking at all necessary data regarding the condition, effect,
presentation of the disease among many others (Gummesson, Sundén, & Fex, 2018; Johnsen et
al., 2016). In Newman’s Scenario there some issues that should be reflected in his presenting
chronic condition of infective exacerbation of Chronic Obstructive Pulmonary Disease (COPD).
Peter only has the dominant indicative sign as breathlessness. The effect of breathlessness
in the daily activities of Peter (especially driving) is subject to consideration, being one of the
primary symptoms of COPD. Peter is also a smoker and therefore it is not a coincidence that he
is suffering from the chronic condition. COPD has been determined to be unusual in non-
smokers (Kaufman, 2013). This calls for the consideration of Peter’s smoking history. Peter is
also a social drinker. From research by National Institutes on Alcohol Abuse and Alcoholism
(2007), people with alcohol addiction are thrice more likely to be smokers than the average
population. Peter’s social drinking behavior is a factor to consider as it decreases the lungs'
ability in keeping a healthy airway. It is argued that excess drinking leads to decreased levels of
glutathione, antioxidant that helps protect the lungs from damages of cigarette smoke. Peter’s
likeliness to give up drinking because of diagnosis of COPD is also subject to consideration as it
was discovered that those diagnosed with the condition do not give up alcoholism just because
they have were diagnosed with the condition. Furthermore, drinking affects social support
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Last name__ _student number_NUR250 S1 2019 Assessment 1

NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
negatively and that is not limited in a family setting like Peter’s. (Chen, Fan,
Belza, Pike, & Nguyen, 2017).
Peter is 44 years old meaning he is living the best days of life and has many more
potential years to live when if in a healthy state. Age also has an impact on patient psychological
and clinical outcomes of patients of COPD (Holm et al., 2014). Moreover, he is a family man
providing to his wife and his two teenage kids. The family unit is an essential consideration since
patients draw energy and motivation from it. It is also to consider how the disease and the care
plan will impact on Peter’s family (Nakken et al., 2015). Peter works two weeks on –two weeks
off roaster as a FIFO truck driver and is not as efficient because of breathing problems. That is a
risk to himself as he can cause an accident or die on duty amidst illness. It is also important to
consider whether his work as a truck driver is a predisposing and aggravating factor to COPD.
Truck drivers usually are at more risk of developing COPD because of exposure to air pollution
(Marino, Caruso, Campagna, & Polosa, 2015). All these roles and responsibilities are most likely
going to be affected by his diagnosed condition and are therefore to be reflected.
Task 2. Nursing assessments
Identify three (3) nursing assessments you will conduct and explain why they are a priority for
you.
Nursing assessment involves collecting data about a patient. The received data is then
used to implement care and to provide optimal patient outcomes, by incorporating the best
available evidence. These are the principles of evidence-based nursing that are universally
accepted in any plan of care to a patient like Peter. Peter’s assessment should be completed and
documented to rationalize any intervention in his care plan in an accurate, computable and a
well-versed method of care. That necessitates the reference to the Clinical Reasoning Cycle in
providing a structure to Newman’s care (Levett-Jones, et al., 2010). The NICE COPD quality
standard necessitates practitioners in a healthcare facility to ensure a diagnosis of COPD
comprises more than one suggestive symptom (Gruffydd-Jones, & Jones, 2011).
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Last name__ _student number_NUR250 S1 2019 Assessment 1

NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
After reflecting on the requirements by the Clinical reasoning cycle,
the initial assessment of Peter’s infective exacerbation will entail a careful history taking, signs,
and symptoms (Kelly, 2009). It includes smoking and drinking behaviors, work environment, the
duration of the worsened symptoms, number of previous exacerbations, additional disorders, and
use of mechanical ventilation in the past, and the current treatment (Lea & Susan, 2013). Peter
has an exacerbation of COPD to mean that his condition keeps worsening from the stable state
and outside the day- to day variants. The critical thing with COPD is that it can proceed slowly
and lung functioning might weaken before the symptoms of the disease become apparent
(Kaufman, 2013). The lung function may go down up to 50% before the patient realizes.
Assessment is necessary for Peter as most smokers cough always and is short of breath, and they
do not regard that with so much caution as they often let go signs of continued airflow blockade
as natural consequences of smoking (Kaufman, 2013).
Secondly, when new aggravating symptoms are presenting, it is easy to establish the
diagnosis of the condition in combination with the pulse oximetry and blood gas analysis which
can then be used to determine how severe the exacerbation is (Kelly, 2009). That together with
clinical examinations and chest X-ray can help rule out diagnoses similar to the Infective COPD
like CVD, pneumothorax, pneumonia or pulmonary embolus (Lea & Susan, 2013).
Thirdly, assessing the impact of the exacerbation on Peter both socially and
physiologically is useful in establishing the need for more support during the exacerbation and
recovery (Kelly, 2009; Lea & Susan, 2013). In our case, Peter is showing poor performance in
his workplace because of problems in breathing. He might lose his job out of the poor
performance and the risks involved, and as a result, he might not be able to support his family.
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Last name__ _student number_NUR250 S1 2019 Assessment 1