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 2Assessment 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
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
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.
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 have chosen the first case study of Peter Newman who has infective exacerbation
of Chronic Obstructive Pulmonary Disease (COPD). I will consider several factors
that will enhance delivery of a holistic nursing care. The objective of considering
more than body diagnosis is to adopt a holistic care approach that will improve the
patient’s health outcome. First, I will consider Newman body’s illness diagnosis that
is COPD. The diagnosis is the unhealthy aspect that requires treatment and has led
the patient to be admitted in the ward. This consideration will involve helping the
patient receive health care to improve his condition. Secondly, there will be
consideration of the patient’s age and gender. Peter is 44-years old meaning he is a
middle aged adult. Age and gender are important factors because people’s needs
change with age groups and gender (Berend, 2016). Peter is in an age group that
has responsibilities both at family level and workplace. According to Dury (2016),
middle aged adults will need to communicate and work and a care provider should
assess their ability to communicate and work with family, friends and co-workers.
The third consideration for preparing Peter’s care plan is his social behaviour. Peter
is a smoker and a social drinker and these have impact on his health. The patient
has risky behaviours that can deteriorate his health condition. Smoking increases
risk of death by 80% for COPD patients (Leidy et al., 2014). According to Li et al.,
(2016) smoking is a leading but preventable cause of premature death and harms
nearly all organs of the body. Arora et al. (2014) noted that quitting smoking lowers
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
exacerbation of smoking-related disease adding years to a patient’s
life. The fourth factor to consider in Peter’s condition is work. Peter works as a driver
in a mining company in a FIFO basis. Place of work affects a person emotional,
physical and mental health. Harrison, Brooks, Desveaux, and Goldstein (2015) noted
that workplace stress, injuries, job dissatisfaction, bullying, accidental deaths, and
discrimination can negatively affect an individual health. They found that job loss,
unexpected loss of income or retrenchment cause distress to a person. Working
environment can damage an employee’s health putting their safety at risk (Faisal et
al. 2016). Another consideration that I will making when preparing peter’s care plan
is the family. Peter has a wife and two children and whom are teenagers. Family is
an important part of a person’s health and aspect in provision of holistic nursing care.
According to Dury (2016) a supportive and close-knit family provides economic
wellbeing, emotional support and increase overall health while a bad family has
conflicts and stress that negatively affect an individual. Therefore I will consider all
factors that impact Peter’s condition and as a person when preparing his care plan
for holistic nursing care.
Task 2. Nursing assessments
Identify three (3) nursing assessments you will conduct and explain why they are a
priority for you.
Nursing assessment is an important part in gathering patient’s information and
prioritizing nursing care. The assessment will identify patient’s current and future
care needs. The three nursing assessments that I will conduct are sociological,
psychological and physiological needs. Physiological assessment will involve
physical examination of the patient’s body to assess the physical needs. Physical
assessment differentiates between normal and abnormal conditions in the patient
body (Williams & Hopper, 2015). Peter’s body need to be examined to find out
physiological needs that have to be addressed in order to have continued high
quality life. The physiological areas to be examined are the respiratory, temperature,
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
and blood pressure. Peter had reported breathlessness and there is
need to address assess and outline an intervention for the abnormal condition. The
second assessment is sociological needs of the patient. The sociological
assessment will assess the patient social factors that affect the patient and need for
consideration when providing nursing care. Social factors to be assessed are family,
recreational interests, use of substance, social status, employment and social
patterns. Peter has a family, a wife and two children and they live together. Peter
works in a mining company as a driver on a FIFO basis and there is need to assess
his working condition and social status to find out how they impact his COPD. He
also likes having social drinking and smoking that puts his COPD condition into more
risk (Elbehairy et al., 2015). This means that peter’s recreational interests and use of
substance need an intervention to stop his drinking and smoking in order to manage
COPD and enhance his quality of life. The other assessment is physiological needs.
Psychological assessment evaluates a patient’s mental health and general well
being. Mental health is an important assessment as it can be negatively affected by
physical illness (Hangaard, Helle, Nielsen, & Hejlesen, 2017). Nurse need to assess
the patient’s attitude and thoughts and find inte3rventions for factors that cause
stress or anxiety to a patient. According to Faisal et al. (2016) failure to fulfil one’s
roles and duties as a result of a chronic condition lead to mental stress. Mental
health is important for an individual quality of life and their family member. Peter has
a family, friends and co-worker that can impact his psychological health. The inability
to meet his responsibility as an employee can also impact his mental health (Dury,
2016). The following three assessments are prioritized to meet current and future
nursing care for Peter while adopting a holistic approach that considers nursing
needs behold physical illness or condition.
Task 3. Care planning
Identify three (3) priority nursing diagnoses for your chosen case scenario and
explain why they are relevant.
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Nursing diagnosis aims to addressing potential or actual patient’s
problems for health improvements. The following are three prioritised nursing
diagnosis for Peter; impaired gas rate, ineffective breathing pattern rate and activity
intolerance rate COPD. First, the impaired gas rate diagnosis will find out if there is
deficit or excess in oxygenation or carbon dioxide elimination at the membrane of
alveolar-capillary. The diffusion of carbon dioxide and oxygen occur passively and
follow concentration difference across alveolar-capillary membrane (barrier) unless if
there is abnormality causing the imbalance hence impaired gas exchange (Roberts,
Patel, & Partridge, 2016). Impaired gas exchange increase carbon dioxide build up in
the body that risks organs damage (Strong et al., 2014). Increased carbon dioxide in
the body can also cause shallow and rapid breathing, fatigue and confusion. This
diagnosis will be prioritized to ensure any imbalance is detected early and an
intervention included in the nursing care plan. The second diagnosis is ineffective
breathing pattern rate. Ineffective breathing pattern does not provide the body with
adequate ventilation. Ineffective breathing pattern rate leads to increased
breathlessness and inadequate oxygen supply to the body tissues (Hangaard, Helle,
Nielsen, & Hejlesen, 2017). This diagnosis is prioritized to ensure the patient
breathing pattern is checked and interventions are outlined to enhance effective
breathing pattern. The third nursing diagnosis is activity intolerance. Activity
intolerance is a state which a patient has insufficient psychological or physiological
energy to complete desired or necessary daily activities (Thorpe, Kumar, &
Johnston, 2014). According to Leidy et al., (2014) activity intolerance can be caused
by improper oxygen supply, medication, pain or severe stress. Activity intolerance is
characterized by abnormal discomfort, inability to undertake activities, fatigue and
weakness and abnormal blood pressure (Thorpe, Kumar, & Johnston, 2014). This
diagnosis is prioritized because Peter is not able to undertake his activities as usual.
The diagnosis will ensure a proper intervention is outlined to restore Peter’s ability to
undertake regular activities in a healthy way without feeling any symptoms or signs
of symptom intolerance. Therefore, the 3 nursing diagnosis for Peter will be activity
intolerance, ineffective breathing pattern rate, and impaired gas rate and will be
prioritised to ensure interventions are outlined to enhance continued quality of life.
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Task 4: Patient education
Identify specific education your chosen case scenario will require to effectively
manage their condition post discharge.
There is a need to educate Peter on how to effectively manage his condition post
discharge. The education about COPD management aligns with the interventions
that need to be implemented for Peter’s continued quality of life. The important
things to educate Peter about the management of COPD condition are on;
prescription medications and proper usage of inhaled drugs, coping techniques to
manage the condition, nutritional guidance, and psychosocial issues. First Peter will
need to quit smoking and stay away from dust, smoke and fumes (Ganguly, Das,
Roy, Adhikari, Banerjee, & Sen, 2014). It is important for Peter to quit smoking and
working in the mining company as both negatively impacts his health due to his
COPD condition. Peter will learn about the importance of quitting smoking and
support groups that can help him quit. The second area to educate is on the
breathing technique to cope with the COPD. This will involve techniques like pursed-
lip breathing that reduces respirations at the same time improving expiratory phase
(Arora et al., 2014). Controlled and slow expirations do postpone small-airway
collapsing. The third area to educate is on patient proper positioning. There is a need
to educate about tripod position where the patient stands or sits leaning forward
supported by arms as it forces the patient’s diaphragm forward and down stabilising
the check while at the same time reducing work of breathing (Arora et al., 2014). The
fourth education needed is about energy-conservation techniques. Peter need to
pace activities, use assistive devices, take frequent breaks and break a task into
smaller tasks in order to reduce dyspnea development (Thorpe, Kumar, & Johnston,
2014). Filth, there is need to educate about improving nutritional status. The patient
needs to eat small but frequent meals that have high proteins and not to eat gas-
producing foods. It is also important for the patient to monitor food intake and weight.
Lastly is to educate about psychosocial issues that will arise as a result of COPD.
The patient might experience lack of symptoms control, increased dependency and
decreased energy (Faisal et al. 2016). COPD can also cause failure in sexual
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function where male develop erectile dysfunction (Harrison, Brooks,
Desveaux, & Goldstein, 2015). The patient needs to understand and be educated on
how to verbalize what they fell in order to develop healthy behaviours for coping.
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
It will take a team to deliver health care to Peter’s COPD condition. The Allied Health
team members who will be included in Peter’s COPD care provisions are; Primary
care physician, respiratory therapist, pulmonologist, nutritionist, exercise specialist
and a therapist or counsellor. A primary care physician will undertake diagnosis
through breathing tests, chest X-rays and measuring levels of oxygen that the patient
has in the blood. A pulmonologist is the doctor that has specialised skills for treating
ling disease and suggests the best treatments for the symptoms that are diagnosed
for primary care physician additional tests undertaken. Third is the respiratory
therapist who will teach the patients about the COPD condition. This role can also be
undertaken by a nurse. The fourth allied health team in COPD is a nutritionist or
dietician. The nutritionist will help the patient have a healthy diet for healthy body
weight and optimal energy. The fifth allied team member is an exercise specialist
who will help the patient to start exercise regimen. Exercises are important for
maintaining COPD patient’s body weight. The other member to help in the COPD
health care team is a therapist or psychologist or counsellor who will help the patient
to set up a support group and handle anxiety or depression as a result of the COPD
condition.
References
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Arora, P., Kumar, L., Vohra, V., Sarin, R., Jaiswal, A., Puri, M. M., ...
& Chakraborty, P. (2014). Evaluating the technique of using inhalation device
in COPD and bronchial asthma patients. Respiratory medicine, 108(7), 992-
998. https://doi.org/10.1111/resp.12644
Berend, N. (2016). Contribution of air pollution to COPD and small airway
dysfunction. Respirology, 21(2), 237-244. https://doi.org/10.1111/resp.12644
Dury, R. (2016). COPD and emotional distress: not always noticed and therefore
untreated. British journal of community nursing, 21(3), 138-141.
https://doi.org/10.12968/bjcn.2016.21.3.138
Elbehairy, A. F., Ciavaglia, C. E., Webb, K. A., Guenette, J. A., Jensen, D., Mourad,
S. M., ... & O’Donnell, D. E. (2015). Pulmonary gas exchange abnormalities in
mild chronic obstructive pulmonary disease. Implications for dyspnea and
exercise intolerance. American journal of respiratory and critical care
medicine, 191(12), 1384-1394. https://doi.org/10.1164/rccm.201501-0157OC
Faisal, A., Alghamdi, B. J., Ciavaglia, C. E., Elbehairy, A. F., Webb, K. A., Ora, J., ...
& O’Donnell, D. E. (2016). Common mechanisms of dyspnea in chronic
interstitial and obstructive lung disorders. American journal of respiratory and
critical care medicine, 193(3), 299-309. https://doi.org/10.1164/rccm.201504-
0841OC
Ganguly, A., Das, A. K., Roy, A., Adhikari, A., Banerjee, J., & Sen, S. (2014). Study
of proper use of inhalational devices by bronchial asthma or COPD patients
attending a tertiary care hospital. Journal of clinical and diagnostic research:
JCDR, 8(10), HC04. doi: 10.7860/JCDR/2014/9457.4976
Hangaard, S., Helle, T., Nielsen, C., & Hejlesen, O. K. (2017). Causes of
misdiagnosis of chronic obstructive pulmonary disease: A systematic scoping
review. Respiratory medicine, 129, 63-84.
https://doi.org/10.1016/j.rmed.2017.05.015
Harrison, S. L., Brooks, D., Desveaux, L., & Goldstein, R. S. (2015). Self-
management following an acute exacerbation of COPD: a systematic
review. Chest, 147(3), 646-661. https://doi.org/10.1378/chest.14-1658
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Leidy, N. K., Murray, L. T., Monz, B. U., Nelsen, L., Goldman, M.,
Jones, P. W., ... & Sethi, S. (2014). Measuring respiratory symptoms of
COPD: performance of the EXACT-Respiratory Symptoms Tool (E-RS) in
three clinical trials. Respiratory research, 15(1), 124.
https://doi.org/10.1186/s12931-014-0124-z
Li, J., Sun, S., Tang, R., Qiu, H., Huang, Q., Mason, T. G., & Tian, L. (2016). Major
air pollutants and risk of COPD exacerbations: a systematic review and meta-
analysis. International journal of chronic obstructive pulmonary disease, 11,
3079. doi: 10.2147/COPD.S122282
Roberts, N. J., Patel, I. S., & Partridge, M. R. (2016). The diagnosis of COPD in
primary care; gender differences and the role of spirometry. Respiratory
medicine, 111, 60-63. https://doi.org/10.1016/j.rmed.2015.12.008
Strong, M., Green, A., Goyder, E., Miles, G., Lee, A. C., Basran, G., & Cooke, J.
(2014). Accuracy of diagnosis and classification of COPD in primary and
specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional
study. Primary Care Respiratory Journal, 23(1), 67.
https://doi.org/10.4104/pcrj.2014.00005
Thorpe, O., Kumar, S., & Johnston, K. (2014). Barriers to and enablers of physical
activity in patients with COPD following a hospital admission: a qualitative
study. International journal of chronic obstructive pulmonary disease, 9, 115.
doi: 10.2147/COPD.S54457
Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical nursing. FA
Davis.
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
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 anemerging 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.
3 – 4 marks
Demonstrates a developing ability to
acknowledge the work of others. Most
5 marks
Demonstrates high level ability to
acknowledge the work of others. All
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
No or limited in-text citations
and/orincomplete reference list and/or
inaccurate and/or incomplete
referencing details and/or inconsistent
referencing format.
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.
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 -
research (5)
0 – 2 marks
Less than 7 peer reviewed
journals/evidence for practiceand/or
More than 2 current text books cited.
Some journals or texts are more than
10 years old.
Numerous inappropriate resources in
reference list.
3 – 4 marks
7 - 10relevant 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.
5 marks
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.
3 – 4 marks
Less than 1-2 presentation guidelines
not adhered to: -
Assignment is not on required template
5 marks
Assignment is on required template and
submitted as a word document.
Font is either; Arial, Calibri or Times New
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NUR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
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
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
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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