Student Assessment

This document provides information on student assessment, including nursing assignments and care plans. It covers topics such as nursing diagnosis, physical assessment, and promoting safe work practices. The document also includes scenarios and questions for reflection.

STUDENT ASSESSMENT
Name :

Student Assessment
HLTWHS002 Follow Safe Work Practices for Direct Patient Care
Question no 14 Identify the following signs or symbols that you are likely to see in a
clinic or a hospital and describe what they mean and where they are used. (9 marks)
Symbol Name, Meaning and Use
Warning sign- Floor is wet, there are chance to slip
No Smoking
Fire Extinguisher
Location of fire fighting equipments
Safety gloves must be worn
Hand protection must be worn in this area
emergency exit
Biological Risk
Health Services First Aid poster
.
Flammable material or high temperature
Electrical hazards
HLTWHS002
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15. Using the rating scale, rate the risks to your health of the following, and explain
your answers. (7 marks)
Risk Risk Taking (Tick) Explain
There is the risk of
severe back injury
from incorrect lifting
and transferring
procedures
 Risk level High It can result in serious
damage such as cuts or
fractures due to accidents.
The most common
musculoskeletal disease
caused by lower back pain
and injury handling of the
action related to the disease
.
There is a risk of
needle stick injury
when working directly
with patients
 Risk level high
Healthcare professionals
have the highest risk for
the needle stick injuries. It
can transmit dangerous
diseases such as HIV
positive disease to the
blood
There is a risk of a
person with impaired
vision slipping and
falling from water
spillage on the floor
 Risk level high Result in
• strains or sprains
• Chance of broken bones
• Chance of a back injury
• may cause burns if hot
items are near the place of
fall
• may result in cuts
because of any sharp
objects.
There is the risk of
burns when handling
patient’s food
 Risk level low Every body should take
necessary care while
handling patient’s hot food,
for those who are careless
have a chance of burn.
There is the risk of
dermatological
reaction from
excessive hand
washing
 Risk level medium Health care workers are
often instructed to maintain
good hygiene and to wash
their hands often to prevent
the spread of infections,
but new studies show that
those who wash their hands
10 times more washed each
day, their sterile exposure
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to dermatitis or "hands
dermatitis".
There is the risk of
being punched by a
patient
 Risk level low very rare occasion. Even
in mental health patients it
is very rare.
There is a risk of a
person with a physical
disability tripping over
a loose mat on the
floor
 Risk level medium Such a risk is rare because
a helper is helping
physically challenged. In
case of accidental collapse,
the possibility of damage
to the damaged area or a
new hit can occur.
.
HLTWHS002 TASK 2
Read the following scenarios and answer the questions that follow
Scenario 1
You are back from your 6 weeks of annual leave. You are allocated to look after Mrs
Smith a 65 yrs old lady with a medical history of Obesity and weighs 102kg, Type 2 DM
and HTN. She was admitted for a Total Hip replacement 2 days ago. Today is POD-3.
She has moved to orthopaedic ward last night from ICU.
Mrs Smith was reviewed by the physiotherapy department and the physio advised the
nurses to hoist transfer Mrs Smith from bed to chair and Hover mat to move her up in the
bed. At 1700hrs Mrs Smith said, she would like to SOOB to have her dinner. When you
go to get the lifting machine, you notice that it is left unattended at the end of the
corridor. Two of the three lifting machines are faulty. The unused batteries are not
attached with charger for charging.
You also notice that one of your colleagues has left a wheel chair in front of the fire exit
as the storage area is full. Since, the resignation of the OHS rep from your ward several
months ago, faulty equipment issues have not been addressed. Your NUM is busy with
KPI’s, staffing and budgeting. Most of the staff in the ward are new or agency. Hence,
issues like these are not taken to NUM and Management team.
In the storage area, you find the sling appropriate to Mrs Smith size, however, it is soiled
by faeces and urine. Finally you find, appropriate equipment to transfer Mrs Smith, and
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Sarah the EN student is happy to assist you in the process of transferring. Sarah is short
girl only 140cm where as you are 180cms tall. How are you going to complete the tasks
without causing personal injury to self, Sarah and Mrs. Smith.
Question 1 Identify the existing and potential hazards in this scenario and record them in
the attached hazard identification form.
A. Two of the three lifting machines are two faulty, the third is unattended. The wheel
chair is not kept in the right place. Most staff members are new or employed by some
organizations. Although the proper equipment is finally available and an N student was
there for help but still there is a risk to the patient's weight and there are concerns about
falling. The situation will be that three may get injured.
Q2. Identify the client related risk factors in this scenario.
A.The client is overweight, aged and admitted for hip replacement. She is type 2 in DM
and HTM. So any kind of injury to her will be a serious challenge to her health.
Q3 Who will you contact to discuss about the identified hazard?
A. In fact the nurse should try to manage the situation by using his own self
consciousness however when it is the question of safety and security of the patient, it is
better to consult with NUM and management team.
Q4. List down the workplace policies and procedures you will follow to promote safe
work practices and to minimize risks specific to this scenario
A For effective implementation, the skills and support processes required to achieve the
security and health policies, objectives, and goals of the organization should be
developed. All employees should be motivated and able to work safely and protect their
long-term health in order to avoid accidents.
Q5: Identify the manual handling hazards and its risks in this scenario.
A. Manual withdrawal of patients must be avoided , for example, situations may develop
threatening life if not properly mplemented.
Q6: List the control measures you will implement to minimise the identified manual
handling risks.
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A.The equipment to lift the pa tient should be in working condition so that the risk can
be minimize.
Q7: List the appropriate manual handling procedures and work instructions you will
follow in this situation to transfer Mrs Smith safely to chair without any injury to self and
others.
A Mechanical lifting aids and other equipment to assist nursing and midwifery workers
in moving, transferring, organizing and managing patients / clients for the minimum
strength or hard work of the nurses or assistants in patient care. Work on ensuring patient
safety.
Q8: Identify the WHS issues in this work place you wanted to bring to the attention of
your NUM according to the organizational policies and procedure
A.The equipment which is necessary for manual lifting of patients in case of urgency,
should be in a state of readiness and the nurses should be accompanied by assists and
physiotherapists to deal with any kind of eventuality.
Q9: Explain the importance of Workplace safety meetings, inspections and consultative
activities
A Nurses, assistants and midwives in nursing and their supports should be allowed to
participate in evaluating risk control strategies like selecting handling aids and other
related equipment and fittings, and other facility like floor design and furniture to
minimize risks of manual handling.
Q10: If your NUM asked you to provide recommendations, what are the
recommendations you will contribute to the development and implementation of safe
workplace policies and procedures in your work place? Students are requested to
complete the attached OHS consultation form
A .Devices like handling aids must and evaluated be tested before purchase so that their
capacity to meet requirements are tested Changes should be made to the workplace in
consultation with the security forces and nursing / midwifery and nursing staff. (Eglseer,
Hödl & Lohrmann, 2019)
Scenario 2
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Mrs. Smith was safely moved to the chair by yourself and Sarah. At 1900hrs, Mrs Smith
wished to go back to bed. This time Penny, RN in-charge of the shift helped to put her
back to bed. However, on the bed Mrs. Smith was lying supine. Hence, you decided to
lift her up in the Bed.
Mr. Smith is lying under a hover mat. Hover mat transfers require four people to operate.
However, Penny said the ward is short staffed, so she rushes you to finish the task just
between yourself and her. Penny also mentioned that, it is her 7th shift in a row. She is
mentally and physically tired. She doesn’t have spare time to wait for another staff
member to come and assist. As she is the in-charge you follow what she said. You both
forgot to apply the strap around Mrs. Smith before inflating the hover mat.
Once the hover mat is inflated, Mrs. Smith fell from the bed. Mrs. Smith hit her head and
broke her left wrist and radial bone. (Kenny et al., 2016)
Q11Identify the manual handling hazards and risks in this situation and explain how this
can be prevented
A Mrs. Smith is to be shifted back to bed. Four persons are required to shift her manually
but only one assist was available, who is also tired, They forgot to apply strap on the
body of Mrs. Smith and when the hover mat is inflated, she fell down from the bed and
hit her head and broke her left wrist and radial bone. (Masters, 2016)
Q12 Identify the incident. Who needs to be notified about the incident? What are the
documentations need to be completed to report this incident
A. After a patient has dealt with an injury, the matter should be reported and the
management r must initiate a risk control process to assess the risks of any other
accident at work to eliminate or reduce another injury.
Q 13 Why it is important to reflect on self-levels of stress and fatigue to promote safe
work practices? Who needs to be reported if you are stressed or fatigued at work?
A Self-levels of stress and fatigue are reflected in the overall performance of the nurse in
promoting safe work practices. In case of inconvenience, the matter should be reported to
the higher authority.
Q14You and Penny are called for a debriefing session by NUM. Explain the importance
of participating in workplace debriefing to address individual needs
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A ..a. The equipment should be in place and in working position.
b. enough staff and assistants should be present.
c. The workplace should be kept clean and there should be enough storage space.
References :
Eglseer, D., Hödl, M., & Lohrmann, C. (2019). Six Nursing Care Problems in
Hospitals. Journal Of nursing Care Quality, 34(1), E8-E14. doi:
10.1097/ncq.0000000000000307
Kenny, P., Reeve, R., & Hall, J. (2016). Satisfaction with nursing education, job
satisfaction, and work intentions of new graduate nurses. Nurse education
today, 36, 230-235.
Masters, K. (2016). Integrating quality and safety education into clinical nursing
education
through a dedicated education unit. Nurse education in practice, 17, 153-160.
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HLTENN015
TASK 3
Task 1- one paragraph: Nursing history (must also be observed by the facilitator 20-
30words)
A: Nursing History: The first known documents mentioning care as a profession were
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Student Assessment
written around 300 AD. During this time, the Roman Empire sought to build a hospital in
every city under its rule, which meant that nurses needed medical care in addition to the
doctors.
Task 2 – Physical assessment (must also be observed by the facilitator) (30-50 words)
A Physical Assessment: Registered Nurses perform assessment and details of
assessment and examination and document should be entered in the patient's medical
record.
Task 3 a) Develop a care plan identifying three nursing diagnosis (select a client with
confusion or Dementia) and three nursing interventions using respectful practices that
also support the person’s dignity and privacy (100-200 words)
A.Dementia is a disorder that affects brain and may cause a person to lose their ability to
self-reliance on a daily basis. Slowly a person affected with dementia may lose the
ability to learn new things and may affect decision making process. They find difficult to
communicate with other people becomes difficult.
The nurse should ensure that the patient's environment is trouble-free.. The nurse should
bring the patient closer to the nurses' station for constant monitoring. The nurse alerts
family members and asks if they can come and sit with the patient.
Task 3 (b) Explain/reflect (while implementing nursing interventions) how did you
Encouraged the person, family or carer to assist with the person’s self-care care as
appropriate (20-30 words)
A. The patient and family members should be encouraged by giving hope of recovery.
Family members should be educated about positive aspects of life, and the environment
should be designed to make the patient feel at home.
Task 3 c) reflect on how you planned and adjusted nursing interventions to assist the
person to meet their daily living activities. (20-30 words)
A.Based on patient histories, the patient's daily activities are listed. While most daily
requirements can not be met, some such as reading, watching TV, music, etc., patients
can be arranged to have the patient at home.
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Student Assessment
Task (d) reflect on how did you Identified and prioritised nursing interventions according
to the person’s needs (20-30 words)
A. Showing empathy is the main quality of a nurse. A description of empathy is "
creating an inner space with affection to accept the other person, thus helping them to
understand each other and not feel alone". (Cunico et al, 2012). Empathy is the necessary
component of relationships involving care. When empathy is missing, nurses become
mechanical and are not interested in understanding the patient's perspective, build trust,
and provide people-centered care (Griffiths et al ,2012).
Task 3e reflect on how did you monitored, evaluated and documented the person’s
response to nursing interventions and their progress toward primary health goals, and
reported findings to relevant interdisciplinary health care team (30-60 words)
A. We can improve patient outcomes by implementing strategies that respond to their
symptoms and needs. Strategies include the way we communicate with patients, make
small changes to the environment they are in, and act proactively with the support we
provide. The involvement of relatives and caregivers is crucial to the development and
implementation of effective, personalized care plans.
Task 4 Admission and discharge plan (30-40 words)
A.An emergency kit is prepared with legal documentation and up-to-date medical
information. This information should be available in an easily accessible place, such as
an envelope. A list of topical medications and allergies.
Copies of legal papers (eg will, instructions, proxy). Insurance information etc.
A medical note confirming the diagnosis should be made.
Task 5 Developmental stage through the lifespan of this client (Maximum 40 words)
A.Information on diagnosis, other illnesses or allergies with
The entire medical team is shared. Information about personal habits, eating habits or
other environmental needs, such as: For example, a private room that makes the
experience more enjoyable is documented.
Task 6 The impact and issues of hospitalization for the client (Maximum 30 words)
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A. Patient status at the time of hospitalization and progress of the client, all
environmental issues, the patient's pattern of behavior, and any issues arising from
interactions with close relatives are documented.
Task 7 – Age/gender specific health care needs (Maximum 30 words)
A. The age and sex of the patient as well as specific health care that can be continued
after discharge from the hospital should be documented.
Task 8 – Cross cultural issues (maximum 40 words)
A.The role of familyism as a cultural value, which was supposed to increase the role of
caregivers and lead to better mental outcomes for caregivers, should be explored.
Task 9 : effective decision-making- explain any two effective decisions you made and
initiated action based on results of clinical assessment and in collaboration with various
members of the interdisciplinary health care team (Maximum 40 words)
A. Maintaining a family culture, being affectionate to the patient, maintaining a close
relative whom the patient likes.
Task 10 Give one example where you Contributed to health policy in the primary health
care environment and participated in health education programs for the person and
community groups (Maximum 40 words)
A.I have contributed to health policy by proposing some changes such as infrastructure,
planning, documentation and training of health professionals.
Exercise 11 Explain how and give one example where you analysed health information
and the clinical presentation of 1 person in the workplace to reach a substantiated
conclusion about possible nursing interventions related to their primary health care needs,
in consultation with a registered nurse. (40-50 words)
A.Although not every disease has an environmental problem, almost everyone has a
health problem associated with an environmental hazard that is appropriate for evaluation
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Student Assessment
or advice on good nursing practice. In my opinion, the preservation of the environment is
the most important prerequisite for basic medical care.
Exercise - 12 Give 1 example where you reviewed and updated a plan of care for 1
person to address their specific primary health care needs. (40-50 words)
A.In a case where a person has suffered from severe allergic reactions, I have used my
expertise and identified the reason for it based on the patient's eating habits. My
observation was correct and after the necessary steps, the patient was fine.
REFERENCES :
Cunico, L., Sartori, R., Marognolli, O., & Meneghini, A. (2012). Developing empathy in
nursing students: a cohort longitudinal study. Journal Of Clinical
Nursing, 21(13-14), 2016-2025. doi: 10.1111/j.1365-2702.2012.04105.x
Griffiths, J., Speed, S., Horne, M., & Keeley, P. (2012). 'A caring professional attitude’:
What service users and carers seek in graduate nurses and the challenge for
educators. Nurse Education Today, 32(2), 121-127.
HLTENN005
TASK 4
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PART A
Question : You are required to perform following in your clinical placement and write a
500-word reflection on how you analysed, planned and evaluated the health care of 3
people using health information and clinical presentation to determine possible nursing
interventions, in consultation with a registered nurse
Answer : The training and the tasks with different case studies have given a deep insight
into my future profession. I have the excellent opportunity to work with senior medical
professionals during my training and assignments. I have a sense of nurturing while
senior health professionals care for many patients with expertise. This is a noble
profession because it is a service to the needy humanity. (Cherry & Jacob, 2016)
Sometimes we have encountered some moments that are critical in nature, and these
situations need to be handled with patience and mental power. In this reflection, I
examine the evaluation of the pain suffered by a 65-year-old patient, named Mrs. Alisa. I
also try to exchange my ideas that make this more general in terms of pain evaluation.
The actions of Ms. Alisa made me think about the sufferings of other patients which
helped me to analyze what I should do as a nurse to care patients.
This led me in particular to the question of how far I should recommend analgesia as a
nurse, by applying the knowledge I learnt about effective pain control. I had learned that
it is better to control the pain than to hunt.
In future, I like to be more actively involved to face such a situation, irrespective of my
role in the team or level of experience. This includes managing a patient with stress,
ensuring that whatever information is gathered is passed on to the appropriate authority,
and intervention if it leads to a risk to the health or mental well-being of the patient. In
addition to this , I will suggest the needs for change if any for betterment. I may adopt a
different communication method in case of need.
I do not think other employees should always be aware of personal needs and / or service
user triggers and I do not expect other employees to work fully in professional ways. I
will continue to reflect professionally regularly. I want to implement the National
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Student Assessment
League's policy and assessment for nursing consistently and safely, which refers to the
personal needs of the service users, such as: respecting the moral integrity and dignity
of each person without conditions or restrictions.(Shin et al., 2015)
People, reaffirm the uniqueness and differences between their ideas, values and ethnicity.
(National League for Nursing, 2017, N.D.). These are financed by the National Health
Service (NHS), which were made from standard that high-quality health care should be
available to everyone and should meet all individual needs
References :
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
NLN Education Summit 2017 - Home. (2019). Retrieved from
http://www.nln.org/conferences/summit-2017/home
Shin, H., Sok, S., Hyun, K. S., & Kim, M. J. (2015). Competency and an active learning
program in undergraduate nursing education. Journal of Advanced
Nursing, 71(3),591-598.
HLTENN011
TASK 1
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Question 2 : Enlist key principles of surgical nursing. Explain briefly following
surgical procedures/terminology. (30-40 words each) a) elective/emergency surgery
b) general, local, epidural and spinal anaesthetic and peripheral nerve block c)
amputation d) open reduction e) hip replacement f) craniotomy g) tonsillectomy h)
appendectomy i) laparotomy j) hysterectomy k) prostatectomy l) cataract extraction
m) internal bleeding due to trauma.
Answer to Q2
a) elective surgery / emergency surgery: elective surgery or elective surgery is an
operation planned in advance as it is not an emergency.
b) General, Local, Epidural and Spinal Areas: Aesthetic and peripheral nerve block:
Epidural anesthesia is a technique in which a local anesthetic is injected through a
catheter placed in the epidural space. An epidural delivers drugs outside the dura and has
its main effect on the nerve roots, leaving the dura at the level of the epidural cells and
not on the spinal cord itself.
C) Amputation : It is removal of limb by trauma, medical illness or surgery . As a
surgical procedure, it is used to control the limb pain or a disease process affected as
harmful or gangrene.
d) Open reduction: It is a type of surgery that fixes broken bones. After that, an internal
fixation device is placed on the bone. Since fractures are usually caused by trauma or
accident, ORIF surgery is usually an emergency procedure.
e.Hip Replacement: It is a method that removes a painful hip joint by means of surgical
operation and replaces it with an artificial joint, made of metal and plastic components.
This usually happens if all other treatment options fail to reduce pains.
f. Craniotomy: It is the surgical removal of part of the bone from the skull to expose the
brain. Special tools were used to remove the bone flap. The bone flap is removed and
reinstated after brain surgery.
g. tonsillectomy: It is a surgical operation to remove the tonsils. They are two small
glands in the back of neck. Tonsils may harbor white blood cells to fight infection , but
sometimes the tonsils become infected themselves.
h. Appendectomy: Surgically removal of the cecum.
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i..laparotomy: It is a surgical procedure involving a large incision through the abdominal
wall for gaining access to the abdominal cavity.
j.. Hysterectomy: is surgically removal of the uterus..
k. Prostatectomy: surgically removal of all or part of the prostate gland.
l. Cataract Extraction: surgical procedure to remove a clouded lens in the eye that affects
vision in the eye..
m. Internal bleeding due to trauma: It is one of the most serious consequences of trauma.
Internal bleeding may occur after a less severe trauma Some cases internal bleeding
stops by itself. But if it persists , surgery is needed.
Question 3 : Describe how a holistic care approach is applied to acute care environment
including nursing interventions and outcomes.
Answer Q3 Holistic care involves healing the body, mind and soul of our patients.
Question 4 : List two actual and potential health issues for a patient undergoing R) total
hip replacement. State the risk assessment needed to be done prior to ambulation
including patient’s stability on their feet
Answer Q4 Conditions that can damage the hip joint and sometimes require hip
replacement include: Osteoarthritis , rheumatoid arthritis. blood clots. Infection.
Question 8 : Explain strategies to manage post-operative pain
Answer to question 8
Analgesics that work through different processes and different receptor sites may meet to
provide connective or synergistic pain relief and it can reduce the cost of the opiate.
Medicines using nonopioid analgesics include: Paracetamol. Nonsteroidal anti-
inflammatory drugs (NSAIDs), including cyclooxygenase inhibitors.
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Question 11 : Outline emergency management protocol for following:
Any 2 first aid procedures
Cardiac arrest
Respiratory arrest
Answer to question 11
1. 2 first aid measures : Oxygen Therapy (Oxygen Mask) Defibrillator
Cardiac arrest: It is the most important medical procedure of all. If a person is in cardiac
arrest (the heart stops pumping blood) and no CPR is performed, that person dies. On the
other hand, performing CPR or using an automated external defibrillator (AED) can save
a life. (Saunders, 2014)
Respiratory arrest: Open the patient's airway and use a pouch mask for positive pressure
ventilation. In most cases, you can open the airway with the head-tilt chin lift method,
unless the patient has a neck or spinal cord injury. In the hospital, make sure your pocket
mask is attached to the oxygen meter and the oxygen is turned up completely.
Question 13 : List clinical manifestations of at least 6 acute disease states and illnesses
requiring complex nursing interventions. Explain briefly the nursing management for
each disease state and illness
Answer to Q13
In acute illness or injury, a sudden onset suddenly occurs. These conditions tend to
resolve quickly by themselves or with medical treatment. An acute illness can also work
so fast and be so severe that the patient does not survive. For example, a heart attack is
generally a fast onset, short-acting problem that either leads to death or can be stabilized
prior to treatment of the underlying cause. (Andersson & Lindgren, 2012)
In a chronic illness, the disease is slow and builds up over time and tends to be a long-
lasting problem. It can come back and forth between these two categories. For example, a
patient may develop a long-term chronic illness following a sudden injury. Likewise, a
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Student Assessment
chronic disease can increase the likelihood of a patient suffering an acute illness or
injury.
The term acute can be used to distinguish diseases or injuries from a chronic variation of
the condition. Acute can also be used in the general language to emphasize its suddenness
or severity.
Question 18 : Enlist at least 6 equipment used in acute care environments. Outline the
function and purpose of each equipment.
Answer to Q18.
2. Oxygen Therapy (Oxygen Mask)
3. Defibrillator
4. Adhesive defibrillator pads
5. Blood pressure monitor
6. ECG electrodes
7. Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol wipes,
tourniquets and cannula dressings
Question on Case Study
The case report should include:
1. Brief introduction (few lines)
2. Preliminary assessment of your patient in discussion with related multidisciplinary
team members.
3. Identify and explain two acute and two potential health issues of your patient
presenting with an acute health problem.
4. Presenting complaint and diagnoses
a. Include pathophysiology of patient’s acute health problem and its discussion with
patient, family or carer.
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5. Information gathered regarding past medical and health history including medications,
family and personal history and document on table 1 below. Write what changes in
conditions you report and to whom within multidisciplinary team. (Glen, 2017)
6. Impact of acute health problem on the patient, family and significant others
a. Include identification of actual and potential health issues
b. Physical and psychological impact on activities of daily living
7. Detail the patient’s acute care plan and interventions including:
a. therapeutic interventions (include pre-and post-procedure care) as per organisations
policy and procedure
b. how you contributed to the planning and delivery of care for the patient with registered
nurse and other members of the health team
c. Explain how you prioritized and modified nursing care using critical thinking and
problem-solving approaches to reflect changes in patient’s condition. List interventions
and number them as prioritized.
8. Discharge planning including:
a. Health education provided and how you contributed to the health education of the
patient to assist them to regain optimal function.
b. Psychological support identified and provided due to the impact of acute health
problems.( Aliakbari et al., 2015)
CASE STUDY 1
1. Brief introduction (few lines) :
Pneumonia is an infection which inflames one or both lung air lungs. The air
sacs may be filled with liquid or purse (purulent material), scandal or pulse,
fever, cold, and difficulty in breathing difficulties. Various types of
pneumonia, including bacteria, viruses and fungi, can occur
2. Preliminary assessment of your patient in discussion with related
multidisciplinary team members.
Mr. Baker aged 62 , male, was admitted to hospital.
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Based on the symptoms like fever, cough and cold, chest pain, sweating and
after discussion with seniors we came to the conclusion that the patient might
have been affected by pneumonia.
3. Identify and explain two acute and two potential health issues of your patient
presenting with an acute health problem.
The patient was having high fever, cough and cold and complaining about
chest pain.
4. Presenting complaint and diagnoses
Sudden appearance of symptoms and rapid illness escalation are associated
with bacterial pneumonias. The most common symptoms are cough,
Blood tests conducted to know whether there is an infection and to identify
the type of organism causing the infection..
X-Ray of chest . Patches observed showing infection because of pneumonia
and the entire chest was affected.. (Vaismoradi, et al., 2016)
5. Information gathered regarding past medical and health history including
medications, family and personal history and document on table 1 below.
Write what changes in conditions you report and to whom within
multidisciplinary team.
The past history of the patient indicated that the patient was affected with
pneumonia three years back and was cured by application of antibiotic
medicine. (Chuang, Levine & Rich, 2011)
Patient’s Map of life
Medical Diagnosis Suspected pneumonia
Past medical and health
history
The patient was affected with the same disease 3 years
back.
Sign and symptoms High fever, cough and cold, chest pain, sweating
Current medications Effective antibiotic treatments include respiratory
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Student Assessment
fluoroquinolones ; moxifloxacin is recommended.
Family History Wife and son. But both are in good health.
Personal history A retired teacher. Used to smoke during early ages. Left
smoking 20 years back. Financially well.
Impact of acute health problem on the patient, family and significant others
Since the patient is frequently affected by cough and cold, the family members are
worried about the recovery.
Discharge planning : After discharge from hospital the patient has to follow the health
care provider's instructions for home self-care. As the disease is not fully cured, the
medications have to continue at home as per instruction given.
It takes 7 to 14 days for recovery of cough.
Sleeping will be normal after three days.
eating will be normalized after one week.
Feel weak for another 14 days.
Rest is recommended.
References
Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories
application
in nursing education. Journal of education and health promotion, 4.
Andersson, I., & Lindgren, M. (2012). Perceptions of nursing care quality, in acute
hospital
settings measured by the Karen instruments. Journal Of Nursing
Management, 21(1), 87-93. doi: 10.1111/jonm.12011
Chuang, C., Levine, S., & Rich, J. (2011). Enhancing Cost-Effective Care with a Patient-
Centric Chronic Obstructive Pulmonary Disease Program. Population Health
Management, 14(3), 133-136. doi: 10.1089/pop.2010.0015
Glen, S. (2017). Problem-based learning in nursing: A new model for a new context.
Macmillan International Higher Education.
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Student Assessment
Saunders, M. (2014). Home Health Care Nurses’ Perceptions of Heart Failure Home
Health
Care. Home Health Care Management & Practice, 26(4), 217-222. doi:
10.1177/1084822314528938
Vaismoradi, M., Griffiths, P., Turunen, H., & Jordan, S. (2016). Transformational
leadership in nursing and medication safety education: a discussion
paper. Journal of nursing management, 24(7), 970-980.
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Student Assessment
CHCDIV002
Task 2
Case Study
Question F : F. Which other interpreters and colleagues as cultural brokers (Aboriginal
and /or Torres Islander) can you engage with, according to the situation needs?
Answer to F
Many Aboriginal and/or Torres Strait Islander people do not like to seek advice from
ordinary health professionals. They believe in a different kind of treatment involving
spiritual, emotional, social and cultural aspects.. In such a case we have to have GP in
shifts, so that people in general are not refused consultation or medical services.
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Student Assessment
HLTENN012
Question 20 List and describe the four components in the WHO chronic disease model of
care?
Answer to Q 20
1. Support a Paradigm Shift :
Guided by the ICCC Framework:
Policy: leadership ,advocacy and integrate policies
Organization: quality through leadership and incentives ensured
Organization: to organize and equip health care team
Community: to raise awareness and reduce stigma.
2. Manage Environment political in nature
Guided by the ICCC Framework:
Policy: leadership and advocacy
Health Care Organization: quality through leadership and incentives
Community: better outcomes through leadership.
3. Build Integrated Health Care
Guided by the ICCC Framework:
Policy: Integrate policies
Policy: Strengthen partnerships
Health Care Organization: Use information systems
Community: Mobilize and coordinate resources
4. Align Sectoral Policies For Health
Guided by the ICCC Framework:
Policy: Integrate policies
Policy: Strengthen partnerships
Question 24 : Identify two behavioral changes required for a client with chronic history
of diabetes mellitus overtime
Answer to Q24.
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Student Assessment
Diabetes is a chronic progressive metabolic disorder because of absolute or
relative deficiency of insulin. Approach is required for promoting self-care
practices among diabetic patients to restrict the food habits so that food items rich
in sugar has to be avoided. Moreover herbal medicines are available which
restricts diabetes to a great extent. (Shrivastava, Shrivastava & Ramasamy, 2015)
Question 25 : Identify two positive attitudinal and behavioural change that can be
established by a patient with chronic renal failure
Answer to Q 25.
The best treatment alternative for dialysis patients is kidney transplant. There is
no necessity typically for major behavioral changes except that intake of water
should be as per prescribed by the doctor. (Sieverdes et al., 2019)
Question 26 D “Nurses works with the multidisciplinary team in the management of
chronic and complex health care needs of clients. The multidisciplinary team may include
a Speech Pathologist, Dietitian, Physiotherapist, Occupational Therapist,
Gastroenterologist and Physician”.
Answer following questions considering above statement and the first web link
above.
Choose at least four of provided chronic and complex health care needs. Explain
for each condition/care need: its management, list what is considered by a nurse
during its (condition) management and which multidisciplinary members/people
will a nurse be working with in order to meet care needs of clients and why. (250-
300 words)
Conditions and care needs are: Management of Chest Infection / Aspiration
Pneumonia, Respiratory Health, Management of Type 2 Diabetes, Management of
Osteopenia and Osteoporosis, Management of chronic pain, Management of
bowel problems: Colostomy, Ileostomy.(Duncan,2013)
Answer to Q 26 D
Pneumonia: The treatment of pneumonia depends on the severity of pneumonia.
A person may need oral antibiotics and may be treated in the community, or in
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Student Assessment
more severe cases hospitalized and treated with intravenous antibiotics, oxygen
therapy and breast physiotherapy. (Moyle, Moyle & Moyle, 2019) Treatment for
Type 2 Diabetes: Health Ministry policies provide clear guidelines for healthcare
professionals to care for patients with diabetes. There is no known cure for
diabetes, however, the management of diabetes patients includes diet
management, physical activity, oral hypoglycemic agents and insulin regimens.
The care can also be complex, as some patients suffer from other long-term
illnesses, such as coronary heart disease.
Osteoporosis: A healthy diet rich in calcium and vitamin D help prevent collapse
of the skin, and exercise promotes blood circulation and healing. Exercise also
improves muscle strength around weak bones / joints and increase bone density to
reduce the risk of fractures.
Dealing with intestinal problems: high morbidity and death . Wounds healing
problems, including the formation of infection, ,dehiscence, evisceration and
fistula, can be significantly contributing to the disease and long-term problems. In
today's healthcare system, it will likely be admitted to the hospital after surgery.
Therefore, focusing on the treatment of wounds is outlined in care. (Mayor, 1986)
Question 26E: In regard to Person Centered Health Care Assessments and the
development of Health Care Plans Core Standard for Practitioners. Answer following
questions considering the third web link provided above.
Explain the purpose of Person Centered Health Care Assessments and the development of
Health Care Plans Core Standard for Practitioners. Explain what does this mean for in
your nursing practice.
Answer to 26 E.
This practice package is for multi-purpose use (Norton, Cordery, Abbenbroek,
Ryan & Muscatello, 2016)
Basis for self-directed learning
core standards learning
reference and clarification
induction of new staff
professional supervision
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Student Assessment
student nurses in placements
other professions and disciplines
It is part of the supporting resource material for the core standards program
developed by Clinical Innovation and Governance. (Wallcraft, 2010)
ASSESSMENT TASK 2 – CASE STUDY
Scenario One
Mrs. Paula Jones is a 68 year old lady who was admitted to the ward for a
left below knee amputation. Paula has Rheumatoid Arthritis and Type 1
Diabetes, insulin dependent who has had chronic leg ulcers on her left shin
for eleven months that are not healing. She has glaucoma and cataracts in
both eyes, leaving her with poor eyesight and peripheral neuropathy. Paula is
non-compliant with her diabetic diet, she eats what she likes and does not
regularly check her blood sugar levels.
Paula lives alone but is supported by her two sons who live nearby. Her
husband died four years ago. Her extended family live in New Zealand.
Paula is recovering in the ward post the amputation. She is very upset about
the amputation and not accepting of it. She is resistant to adhering to a
diabetic diet, despite the efforts of the dietician and nursing staff. Her BSL’s
fluctuate as a result and she is on her regular insulin with a sliding scale.
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Student Assessment
Paula is managing her pain with Paracetamol and Ibuprofen, which is
effective. Her left stump is bandaged and free from infection. She is not
sleeping well, making her tired during the day and reluctant to commence
physiotherapy.
Paula will be discharged to a rehabilitation centre to improve her
independence with ADL’s prior to going home.
Scenario 1: Part A
1. Develop a nursing care plan for her admission using the nursing process.
The care plan must contain at least 2 nursing interventions
Answer to Question 1
Mrs. Paula is aged and having multiple health problems and her left below
knee was amputated. The major health problem which will delay the post
amputation healing process is that she is affected by type 1 diabetes. There
will be problem with healing the wound because of diabetes. So the main
nursing process will be to control the insulin level so that she can be fit
enough to be admitted to a rehabilitation centre. ("Keeping up-to-date with diabetes
care and education", 2018)
The main nursing care plan at this moment will be to reduce and correct
patient’s risk factor.
Nursing Interventions Rationale
Clean and change
wound dressings as
indicated.
To prevent development of infections that
may be associated with poor wound care and
hygiene.
Administer and monitor
medication regimen
Administer and monitor medication
Review client’s current
diet and nutritional
Proper diabetic diet balanced with nutritional
needs is important in maintaining normal
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Student Assessment
needs. blood glucose levels. Stabilized blood
glucose levels ensure good blood flow
especially around wound site.
Educate client about
proper wound care
Persons with delayed wound healing are at
highest risk for developing further infection
which may result in further complications
around the amputated area.
2. Outline a health teaching plan for Paula that prepares her for discharge to
rehabilitation and then home.
The best way to cure a diabetic patient is to implement strict discipline in
diet and medication. So a teaching plan is to be in place prior to discharge to
rehabilitation.
Nursing Interventions Rationale
Ensure client is
knowledgeable about
using his own blood
glucose monitoring
device.
The blood glucose monitoring device is a
handy and accurate way of assessing blood
glucose levels. Proper usage of this device is
essential in detecting unstable blood glucose
levels.
Educate about
balancing food intake
with physical activities
Vital in preventing sudden increase or
decrease in blood glucose levels.
Educate about adjusting
home glucose
monitoring frequency
depending on client’s
risk factors like stress
and poor diet.
To quickly identify fluctuating blood glucose
levels for immediate correction.
Review and discuss Blood glucose levels greatly depend on
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Student Assessment
client’s carbohydrate
intake.
carbohydrate intake. It should be monitored
and controlled closely when stabilizing high
blood glucose levels.
Discuss how the client’s
anti-diabetic
medications work.
Essential in ensuring client’s understanding
of his treatment regimen to ensure his
compliance and adherence.
3. Explain the ways/strategies that you can implement to evaluate Paula’s
understanding of her chronic problems in consultation with interdisciplinary
health team.
Scenario 1: Part B
1. Identify and describe Paula’s condition and chronic health problems.
Research and describe the possible impact of at least two of the
identified conditions on body systems and explain how these can
affect a person’s ability to perform daily living activities.
Mrs. Paula is suffering from a multiple health ailments like type 1
diabetes, Rheumatoid Arthritis, chronic leg ulcers on her left shin for
eleven months that are not healing, she has glaucoma and cataracts in
both eyes, leaving her with poor eyesight and peripheral neuropathy.
The most serious of the ailments is diabetes which has resulted in
other ailments. So she should be properly educated as discussed above
to control diabetes. She is not able to see properly. After the insulin
level stabilized she can be operated upon to remove cataracts on the
eyes but in stages.
2. List and describe at least 2 clinical manifestations of diabetes and
rheumatoid arthritis and their long-term effects on the body’s systems.
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Student Assessment
Clinical manifestations of diabetes: Type 1 diabetes signs and
symptoms can appear relatively suddenly and may include: frequent
urination. increased thirst ,unintended weight loss , extreme hunger
irritability and other mood changes, fatigue and weakness and blurred
vision.
Clinical manifestations of rheumatoid arthritis : Signs and symptoms
of rheumatoid arthritis may include: Tender, warm, swollen joints.
Joint stiffness that is usually worse in the mornings and after
inactivity. Fatigue, fever and weight loss
3. Explain three available resources and support services available to
Paula upon her discharge from the rehabilitation centre to home.
Accurate, detailed information and records at discharge are available
for further consultations.
The patient, their family and carers are educated about proper
medication use.
Simplified medication supply and use.
Call center number of the clinic where she was admitted.
4. Discuss the physical, psychological, emotional, social and financial
impact Paula’s chronic health problems and recent amputation has on
her ADLs and her family
Mrs. Paula is suffering from multiple ailments which cannot be cured
like diabetes, arthritis etc. Moreover she has been amputated. All
these factors will create an adverse effect on herself and her family
members. She may recover from the wounds but she has to continue
medication and necessary exercise to keep her fit. Her family
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Student Assessment
members are also perturbed because of her health and moreover there
is bound to be financial stress on them. She cannot enjoy social
gatherings because of her strict dietary rules.
Scenario 2
Mr. Shane Gillespie is an 80 year old male, admitted to the ward via A&E
with exacerbation of COPD and abrasions to his left shin and elbow and a cut to
the forehead following a fall. Shane lives alone and up until now has managed
with the assistance of home help (cleaning services) and meals on wheels for
lunch. His wife has dementia and lives in a nursing home within walking distance
from his home. He has a two very supportive neighbors who visit daily, bring him
the newspaper and stay for a chat. He has one daughter who lives interstate and
another who lives 1.5 hours away.
Shane is emaciated and admits he does not like preparing meals and only eats the
lunch delivered by meals on wheels. He has a dosette box for his medication, but
he is increasingly forgetting to take them or mixing up the days and times. Shane
has recently found it difficult with activities like showering and dressing and
walking to the letter box due to experiencing shortness of breath. He has been
unable to visit his wife for a few weeks due to his increasing shortness of breath.
Shane is an ex-smoker of 25 cigarettes/day for 46 years, he stopped smoking 20
years ago. He has a history of chronic asthma (since childhood) and epilepsy.
On arrival his vital signs are:
RR – 30 bpm
HR – 100 bpm
BP – 190/100 mmHg
SpO2 – 87%
Temp – 38.3oC
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Student Assessment
1. Briefly describe Shane’s condition and chronic health problems
including chronic obstructive pulmonary disease and chronic
asthma.
Symptoms include breathing difficulty, chronic asthma cough, mucus (sputum)
production and wheezing. It's caused by long-term exposure to irritating gases
from cigarette smoke. Though he has left smoking but the bad effects are
troubling him.
2. List and describe five clinical manifestations of COPD and long-
term effects on the body’s systems.
Shortness of breath, especially during physical activities
Wheezing
Chest tightness
Having to clear your throat first thing in the morning, due to excess mucus in your
lungs
A chronic cough that may produce mucus (sputum) that may be clear, white,
yellow or greenish
Blueness of the lips or fingernail beds (cyanosis)
Frequent respiratory infections
Lack of energy
3. List three each and explain the role of other services and health
care workers who will be involved in his care.
Care member roles complement each other and contribute to the goal of providing
the necessary health services for this patient. Team members included nurses,
exercise specialists, social workers,
4. Discuss the impacts of chronic disease: physical, emotional, social and
psychological.
The long term impacts of chronic impact on a person's physical, emotional, social
and psychological are
1. Cannot lead a normal life.
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Student Assessment
2. Both the patient and family members will be depressed as the ailments are not
going to cure easily.
3. Psychologically the patient will lose confidence and feel himself a burden to the
family and the society.
TASK 3
CASE STUDY
You are required to discuss evidenced based nursing practice for TWO
patients, with chronic health problems, you cared for during your
professional practice.
You will be required to access the patient’s medical records to prepare for
your case report for both patients.
Please maintain patient’s anonymity at all times
Use a pseudonym name for the patients that is not identifiable and state this
in your case report
Be careful not to include any information that my identify the patient
including places, dates, time, events
The case report should include information related to only ONE patient
(word limit less than 70 words each):
DETAILED CASE STUDY
Mr. Jacob, a 65-year-old retiree, was admitted to the nursing home with Type 2
diabetes. The symptoms were increased thirst, dry mouth, frequent urination,
increased hunger (especially after eating), persistent headache, unexpected weight
loss (17 kg) 72 kg to 55 kg), tiredness, blurred vision. Since 2004, he has had this
problem in connection with blood sugar levels that have been reported to be 118
to 127 mg / dl, which he calls "borderline diabetes". At the time of the recording,
his condition was critical enough for recording. (Joo & Huber, 2014)
He was started with Glyburide (Diabeta), 2.5 mg, every morning, but had given
up on late afternoon due to dizziness, often accompanied by sweating and a slight
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Student Assessment
feeling of excitement. He has never tested his blood sugar level at home, although
he thinks the mirror is high. (Cold et al., 2019)
He said that when he was active, he had no such problem, but only after he
stopped working did the problem begin. He lives with his wife of 60 years and has
two married children. , Although both his mother and father suffered from Type 2
diabetes, Mr. Jacob had limited knowledge in managing the self-care of diabetes
and states that he does not understand why he suffers from diabetes since he never
uses sugar eats. In the past, his wife encouraged him to treat his diabetes with
herbal remedies and nutritional supplements, and she regularly scans the internet
for the latest diabetes medications.
His diet history shows excessive carbohydrate intake in the form of bread and
pasta. His regular dinner consists of 2 cups of cooked pasta with homemade sauce
and three to four slices of Italian bread. During the day he often has "one or two
slices" of bread with butter or olive oil. He also eats eight to ten fresh fruits a day
with meals and as a snack. He prefers chicken and fish, but is usually served with
tomato or cream sauce and pasta. His wife has offered to make him grilled meat,
but he finds her "tasteless". He drinks 8 ounces. red wine for dinner every
evening. He stopped smoking more than 10 years ago.
Physical Exam
A physical examination reveals the following:
Weight: 55 kg ; height: 5′2″; body mass index (BMI): 32.6 kg/m2
Fasting capillary glucose: 166 mg/dl
Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg
Pulse: 88 bpm; respirations 20 per minute
Eyes: corrective lenses, pupils equal and reactive to light and accommodation,
Fundi-clear, no arteriovenous nicking, no retinopathy
Thyroid: no palpable
Lungs: clear to auscultation
Heart: Rate and rhythm regular, no murmurs or gallops
Lab Results
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Student Assessment
Results of laboratory tests (drawn 5 days before the office visit) are as follows:
Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl)
Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)
Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)
Sodium: 141 mg/dl (normal range: 135–146 mg/dl)
Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)
Lipid panel
• Total cholesterol: 162 mg/dl (normal: <200 mg/dl)
• HDL cholesterol: 43 mg/dl (normal: ≥40 mg/dl)
• LDL cholesterol (calculated): 84 mg/dl (normal: <100 mg/dl)
• Triglycerides: 177 mg/dl (normal: <150 mg/dl)
• Cholesterol-to-HDL ratio: 3.8 (normal: <5.0)
AST: 14 IU/l (normal: 0–40 IU/l)
ALT: 19 IU/l (normal: 5–40 IU/l)
Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l)
A1C: 8.1% (normal: 4–6%)
Urine microalbumin: 45 mg (normal: <30 mg)
Assessment
Based on A.B.’s medical history, records, physical exam, and lab results, he is
assessed as follows:
Uncontrolled type 2 diabetes (A1C >7%)
Obesity (BMI 32.4 kg/m2)
Hyperlipidemia (controlled with atorvastatin)
Peripheral neuropathy (distal and symmetrical by exam)
Hypertension (by previous chart data and exam)
Elevated urine microalbumin level
Self-care management/lifestyle deficits
• Limited exercise
• High carbohydrate intake
• No SMBG program
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Student Assessment
Poor understanding of diabetes
Discussion
Mr. Jacob was affected with uncontrolled Type 2 diabetes and a number of
complex comorbidities that all needed treatment. The first task of the NP, which
took care of him, was the selection of the most urgent health issues and the
prioritization of his medical care.
The patient and his wife agreed that a referral to a nutritionist was their first
priority. Mr. Jacob admitted that little information was available about his diet to
achieve weight loss, and that his current weight was unhealthy and
"embarrassing" by reducing his portion size one-third the week before his dietary
consultation. Weight loss would also be an important first step to lowering your
blood pressure
The registered nutritionist (Mr. Arnold) was contacted to visit Mr. Jacob and
prescribe the diet table.
A first-line drug for this patient had to specifically improve the glucose control,
without contributing to weight gain
After reviewing these options and discussing the need for improved glycemic
control, the physician prescribed metformin, 500 mg, twice a day. Possible side
effects of the medicine and the need to avoid alcohol were a problem for Mr.
Jacob, but he agreed that medications were necessary and that metformin was his
best option. The doctor advised him to take the medication with food to reduce
the side effects of the medicine..
During the visit, Mr. Jacob and his wife learned to use a blood glucose meter that
has a simple two-step procedure. The patient agreed to use the meter twice daily,
both at breakfast and at dinner, while titrating the metformin dose. He understood
the need for blood glucose measurements to determine the choice of medication
and assess the effects of his diet, but he felt that it would not be "an eternal thing."
Summary
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Student Assessment
Experienced practice nurses are ideally suited to play a vital role in the education
and medical care of people with diabetes. The combination of clinical and
teaching and consulting expertise improves the delivery of care cost effectively
and effectively. The role of nurses in advanced practices is to understand the
shared responsibility for the outcomes of health care delivery. This partnership
between nurse and patient not only improves care, but also strengthens the role of
the patient as a self-manager
References
Cold, F., Health, E., Disease, H., Disease, L., Management, P., & Conditions, S. et al.
(2019). Symptoms of Type 2 Diabetes. Retrieved from
https://www.webmd.com/diabetes/type-2-diabetes-symptoms
Duncan, I. (2013). Health Care and Personal Responsibility. Population Health
Management, 16(4), 217-218. doi: 10.1089/pop.2012.1204
Joo, J. Y., & Huber, D. L. (2014). Evidence-based nurse case management practice in
community health. Professional case management, 19(6), 265-273.
Keeping up-to-date with diabetes care and education. (2018). Nursing, 48(10), 29-30. doi:
10.1097/01.nurse.0000546580.46691.e2
Moyle, S., Moyle, S., & Moyle, S. (2019). Pneumonia Symptoms, Signs and Treatment –
Ausmed. Retrieved from https://www.ausmed.com/articles/pneumonia/
Norton, S., Cordery, D., Abbenbroek, B., Ryan, A., & Muscatello, D. (2016). Towards
public health surveillance of intensive care services in NSW, Australia. Public
Health Research & Practice, 26(3). doi: 10.17061/phrp2631633
Shrivastava, S., Shrivastava, P., & Ramasamy, J. (2015). Saurabh RamBihariLal
Shrivastavaa, Prateek Saurabh Shrivastavab, Jegadeesh Ramasamy c. Türkiye
Halk Sağlığı Dergisi, 12(2), 136-136. doi: 10.20518/tjph.173094
Sieverdes, J., Raynor, P., Armstrong, T., Jenkins, C., Sox, L., & Treiber, F. (2019).
Attitudes and Perceptions of Patients on the Kidney Transplant Waiting List
toward Mobile Health—Delivered Physical Activity Programs.
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Student Assessment
Wallcraft, J. (2010). The person in health care policy development. Journal Of
Evaluation
In Clinical Practice, 17(2), 347-349. doi: 10.1111/j.1365-2753.2010.01588.x
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