CNC: Medical Surgical Nursing Care Reflection Report - Autumn 2019

This report reflects on a CNC (Complex Nursing Care) medical-surgical nursing assignment, focusing on three key learning activities. The first activity involves analyzing a case study of a patient with frequent falls, emphasizing the importance of patient-centered care and fall prevention strategies. The second activity centers on understanding blood transfusion protocols, including the recognition and management of transfusion reactions based on the National Safety and Quality Health Service Standard 7. The third activity involves analyzing case studies of patients with various conditions such as fall syndrome, obesity, cardiac failure, and cellulitis. The student reflects on the knowledge gained regarding disease management, medication administration, and the development of patient care plans. The report highlights the importance of communication skills, adherence to nursing standards, and the integration of theoretical knowledge with practical experience to enhance patient safety and clinical quality, particularly in elderly care. The student also identifies areas for improvement, such as enhancing communication skills and developing a deeper understanding of nursing policies.

Running head: COMPLEX NURSING CARE: MEDICAL SURGICAL
COMPLEX NURSING CARE: MEDICAL SURGICAL
Name of the Student
Name of the University
Author Note

1
COMPLEX NURSING CARE: MEDICAL SURGICAL
Description
In activity 1, we can see Mrs June with her frequent falling syndrome and the hospital
management on her disease control. However, hospital management was not very helpful, and it
led to her memory loss and depression. On the other hand, in activity 2, we can see the scorecard
refers to stopping transfusion of blood in cases of TACO, TRALI. It also refers to the bacterial
contamination, with or without hypotension, 1o temperature rise, and rash in 2/3 of the body or in
dyspnoea. In the case of activity 3, it has been three different case studies such as Mrs Grace
Case who experienced falls in the frequent interval and felt tired and light-headedness. On the
other hand, Mr Donovan Case, who has Congestive Cardiac Failure and feeling short, breathing,
cannot sleep flat along with oedema and obesity. Finally, in Mr Clarke's Case, who is a patient
with cellulites and ulcers in his feet, peripheral vascular disease, and he was prescribed IV
antibiotic.
Feelings
All these assessments of these activities help me learn about fall syndrome and other
diseases. The medication and disease management process also helpful factor in the knowledge
build up about nursing care (Sherrington et al. 2017, p.1753). However, based on activity 1, it
can be said that the patient needed patient centred care and the holistic approach would be
helpful as well. Inactivity 2 the documentation of nursing observation has been seen; however,
the vital sign record also needed to be added. Inactivity 3 if the factors of the case studies would
be combined with vital sign reports and medication management, then the document would be
more helpful for me to gather practical knowledge.

2
COMPLEX NURSING CARE: MEDICAL SURGICAL
Evaluation
In activity 1, we can be able to see the problems faced by the patient and her husband.
She faced improper care management, and that is the fact lead to her depression and memory
loss, and the frequency of fall never declined. The activity 1 helped me in the knowledge
gathering about how to improve elderly care and the approaches should be adopted (Fleig at al.
2016, p.117). Inactivity 2, the scorecard for the nursing observation was good in symptoms and
action plans on those symptoms; however, the vital sign report was missing; thus, the report was
incomplete. However, it helped me in learning about the preparation of the scorecard based on
the nursing assessment. The scorecard should be more discrete. The activity 3, on the other hand,
helps in learning about different cases including fall syndrome, obesity, oedema, cardiac failure
and other diseases and based on the symptoms and the doctor consent the medication
management As well. I learnt the needed step to be taken in these kinds of cases and the required
medication for the care of these patients. Also, the information should be collected about their
past medical condition for better assessment and care management. Three cases of activity 3, we
can be able to develop a fair knowledge about the medication management of the chosen
diseases (Bousquet et al. 2017, p.97).
Analysis
These activities helped me in developing insights about fall syndrome and the
management of different diseases. The visual documentation, the scorecard development and the
tasks on the medication management were the practical practices based on the theories (Blain et
al. 2016, p.649). Hence, all these help learn about different diseases management. As a nurse, I

3
COMPLEX NURSING CARE: MEDICAL SURGICAL
am very much thankful for the activities provided by my University as it helped me in the
knowledge development about medication management, along with knowing about the elderly
care process as well also (Yelvar et al. 2017, p.166). In the whole activity based task, I found
that fall syndrome is a critical factor in elderly care. I found it as a leading cause of different
severe conditions such as depression, memory loss and also the hypertension factor in the case.
On the other hand, activity 3 cases are the factors that helped me in the insight development
about fall syndrome medication management along with other cardiac and fluid retention
diseases. The factor of learning about these aspects would be helpful in my upcoming nursing
career development as well. These practical experiences and the theoretical knowledge helped in
the development of proper care management plans in elderly care. This includes the factors of
interactions and prioritises their needs, along with medication management. The visual
documentation helped me more efficiently in knowledge development about the fall frequency of
the elderly people (Hill et al. 2015, p.2593).
Conclusion
Based on the activities and above discussion, it can be concluded that I have learnt a great
aspect of elderly care and medication management in different diseases. I did not have the proper
knowledge about the fall syndrome among the elderly people and what are the factors that affect
this problem more and more. I now have the knowledge about the possible causes of the fall
syndrome along with how much frequent can it is. I also developed knowledge about the factors
of management of this disease and medication management as well. To prevent this disease
among the elderly people, the need for mental support and physical support as well will be
needed more efficiently. The knowledge about the cases of the fall syndrome and the common

4
COMPLEX NURSING CARE: MEDICAL SURGICAL
factor in all the diseases that is obesity and hypertension in present or past medical history
confirms the probable factors which influence this disease. However, my knowledge about the
observation and care management has been changed based on these activities. Now I have better
insight about the disease management in the elderly care facility, and it will be helpful in my
further development in the nursing career.
Action Plan
Based on all the activities, it can be said that my knowledge about fall syndrome
developed. I am thankful for the activities that helped me in the development of practical
knowledge, as well. Thus it helped me in my confidence development as well. I understand the
importance of elderly care and the management of fall syndrome for providing better care to the
patients (Ory et al. 2015, p.258). However, I need to develop my communication skills to
interact with the patients for knowledge development about their problems and needs. The
communication skills are one of the factors that help in the interaction and the person-centred
care providence (Tricco et al. 2017, p. 1697). The communication skill development would be
the factor that helped me in a more confident approach towards the patient centred care. To
provide proper care to the elderly people, I need to develop proper knowledge about the NSW
policies of nursing utilising reading about them and also need to focus on maintaining the
nursing standards of NMBA (Corken and McGreevy 2016, p.307). However, in elderly care unit,
I should be able to develop proper planning about the care management of the elderly people.
With the help of this activity and the insights, I have developed; I can be able to prevent the fall
syndrome of the patients. I also can help them in communication that could be the factor which
would ease them and help them prevent the stress and the depression as well. The patient centred

5
COMPLEX NURSING CARE: MEDICAL SURGICAL
care would be incorporated into the action plan for their treatment (Schneider and Beattie 2015,
p.194).

6
COMPLEX NURSING CARE: MEDICAL SURGICAL
References
Blain, H., Masud, T., Dargent-Molina, P., Martin, F.C., Rosendahl, E., van der Velde, N.,
Bousquet, J., Benetos, A., Cooper, C., Kanis, J.A. and Reginster, J.Y., 2016. A
comprehensive fracture prevention strategy in older adults: the European Union Geriatric
Medicine Society (EUGMS) statement. The journal of nutrition, health & ageing, 20(6),
pp.647-652.
Bousquet, J., Bewick, M., Cano, A., Eklund, P., Fico, G., Goswami, N., Guldemond, N.A.,
Henderson, D., Hinkema, M.J., Liotta, G. and Mair, A., 2017. Building bridges for
innovation in ageing: synergies between action groups of the EIP on AHA. The journal of
nutrition, health & aging, 21(1), pp.92-104.
Corken, R. and McGreevy, P.D., 2016. Organisations, people and policies: barriers to good
negotiation in the NSW planning system. Australian Planner, 53(4), pp.302-309.
Fleig, L., McAllister, M.M., Chen, P., Iverson, J., Milne, K., McKay, H.A., Clemson, L. and
Ashe, M.C., 2016. Health behaviour change theory meets falls prevention: feasibility of a
habit-based balance and strength exercise intervention for older adults. Psychology of
Sport and Exercise, 22, pp.114-122.
Hill, A.M., McPhail, S.M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, M.
and Haines, T.P., 2015. Fall rates in hospital rehabilitation units after individualised
patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised
controlled trial. The Lancet, 385(9987), pp.2592-2599.

7
COMPLEX NURSING CARE: MEDICAL SURGICAL
Ory, M.G., Smith, M.L., Parker, E.M., Jiang, L., Chen, S., Wilson, A.D., Stevens, J.A.,
Ehrenreich, H. and Lee, R., 2015. Fall prevention in community settings: results from
implementing Tai Chi: Moving for Better Balance in three states. Frontiers in public
health, 2, p.258.
Schneider, E.C. and Beattie, B.L., 2015. Building the older adult fall prevention movement–steps
and lessons learned. Frontiers in public health, 2, p.194.
Sherrington, C., Michaleff, Z.A., Fairhall, N., Paul, S.S., Tiedemann, A., Whitney, J., Cumming,
R.G., Herbert, R.D., Close, J.C. and Lord, S.R., 2017. Exercise to prevent falls in older
adults: an updated systematic review and meta-analysis. Br J Sports Med, 51(24),
pp.1750-1758.
Tricco, A.C., Thomas, S.M., Veroniki, A.A., Hamid, J.S., Cogo, E., Strifler, L., Khan, P.A.,
Robson, R., Sibley, K.M., MacDonald, H. and Riva, J.J., 2017. Comparisons of
interventions for preventing falls in older adults: a systematic review and meta-
analysis. Jama, 318(17), pp.1687-1699.
Yelvar, Y., Deniz, G., Çirak, Y., Dalkilinç, M., Demir, Y.P., Baltaci, G. and Kömürcü, M., 2017.
Impairments of postural stability, core endurance, fall index and functional mobility skills
in patients with patello femoral pain syndrome. Journal of back and musculoskeletal
rehabilitation, 30(1), pp.163-170.

8
COMPLEX NURSING CARE: MEDICAL SURGICAL
Appendices
Appendix 1
QUESTIONS PREVENTING FALLS AND HARM FROM FALLS
Consider your practice in Lab class week 4 or 5 (Simulation around Mrs Betty Graham,
who had experienced a fall at home):
ACTIVITY REPORT: PREVENTING FALLS AND HARM FROM FALLS (2-3 pages approx.)
1. Write a statement in your own words to demonstrate your understanding of Patient Safety:
For patient safety it is needed to focus on the patient's condition and interact with the patient and
family. The patient centered care is also needed and in this case the utmost priority would be fall
prevention through protecting the patient in terms of providing with bed cages and preventing mobility.
2. Patients should be screened for risk of falling on admission. List 4 other occasions when further
or repeat assessment should occur:
Patient’s depression assessment
Patient’s hypertension and blood pressure measure
Patient’s pain screening
Patient’s Body balance and muscular check up
3. Identify 3 risk factors Betty Graham has for fall now she is in hospital. Are these intrinsic or
extrinsic risk factors?
Her hypertension and low blood pressure level (intrinsic).
Body and muscle imbalance (intrinsic)
Higher beds without the prevention measures of fall (extrinsic)

9
COMPLEX NURSING CARE: MEDICAL SURGICAL
4. Identify three priority actions you can take as a nurse to minimise Betty’s risk of falling
Provide bed with bed cage.
Observe all her actions in a priority basis and prevent her mobility.
Provide the mental and physical support along with the proper medication.
5. What advice can you give Betty to minimise her risk of falling?
Focus on the movement and try not move but also think positively and interact with the nurses
for any kind of need.
Complete an ACTIVITY REFLECTION (1page) on your learning
What 3 key things did I learn?
Fall syndrome leads to different mental and physical problems.
Interaction with patient and motivate her would be the primary concern for the nurse.
Patient care management should be patient centered and prioritising the patient need in utmost
priority.
How will I apply this to my practice?
I need to assess and converse with the patient following her need and condition. I also need to
provide her with all the securities needed.
What do I need to do to continue to develop?

10
COMPLEX NURSING CARE: MEDICAL SURGICAL
I need to reflect and assess the cases to develop more. The primary focus should be on the
professional relationship build up by conversation.
Appendix 2
ACTIVITY REPORT: BLOOD AND BLOOD PRODUCTS (2-3 pages or approx.)
Complete an ACTIVITY REFLECTION (1-2 pages) on your learning
NB: Attach screen shot or certificate of completion - Transfusion Adverse Events eLearning
What 3 key things did I learn?
I learnt about the importance of the blood infusion.
In which cases the blood transfusion should be stopped.
The effects of different symptoms and the transfusion process
How will I apply this to my practice?
Based on the learning I can be able to understand the symptoms. I also can analyse them properly
and based on the analysis I can be able to decide whether to use transfusion of blood or not.
What do I need to do to continue to develop?
I need more practice to develop in the field and also need to develop more observation and
clinical practices.

11
COMPLEX NURSING CARE: MEDICAL SURGICAL
Appendix 3
Figure 1: Case study 1 score card

12
COMPLEX NURSING CARE: MEDICAL SURGICAL
Figure 2: Case study 9 score card

13
COMPLEX NURSING CARE: MEDICAL SURGICAL
Figure 3: Case study 13 score card