NUR251 – Nursing Care of a Patient with a Medical Condition – Case Scenario

Topic: Nursing care of a patient with a medical condition

Assessment purpose

Learning objectives


Are developing the ability to locate, interpret, integrate, synthesize and apply nursing knowledge from NUR251 to a relevant nursing practice scenario in medical surgical settings


Are developing appropriate critical thinking, clinical reasoning and sound clinical decision-making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings


Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings


Are able to explain and justify or defend their nursing care decisions


Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context


Are progressing towards the level of professional written communication required for nursing practice in Australia


Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy.

Background:


Mary lives alone, in an assisted living facility. She is independent with her cares, she has a walking frame but she refuses to use it, she needs assistance with cleaning and laundry. She lives in a single storey home with her cat Gerald who keeps her company. She has been widowed for the last 10yrs and has a supportive son who lives locally, and he helps where possible. He is married with 2 teenage children. Mary sees her grandchildren every weekend.


She has an extensive past medical history including:


T2DM (on insulin), HTN, Hyperlipidaemia, chronic kidney disease stage 3 (Baseline eGFR 40 ml/min/1.73m2). She has been admitted previously due to syncopal episodes.


No known drug allergies (NKDA).


She is obese (BMI 35) she drinks 2-3 glasses of sherry each night.


Assessment:


Airway: Own, patent


Breathing: RR 23, O2 Sats 93% on RA.


Circulation: HR 68bpm, BP 165/85 mmHg.


Disability: GCS 14/15, she is drowsy and ‘I’m so tired, I can’t keep my eyes open, where’s Gerald?’.


Exposure: Temp 36.2 oC, BGL 3.5mmol/L


Mary looks unwell. She is restless and confused. Her urine is dark in colour and has an offensive smell. She has passed approximately 30ml of urine in 6 hours. She had 2 x IVC’s inserted to both ACF’s and is not tolerating any food due to nausea. She last attempted to open her bowels this morning and says ‘It was too painful’.


Recommendations/Read back:


Medical orders


Routine ward assessments and observations


Strict fluid monitoring


Administer Intravenous fluids as prescribed


MSU for MC & S


Diabetic diet and fluids as tolerated


TED stockings and DVT prophylaxis


IV Fluid orders


Intravenous compound sodium lactate (CSL) 500mls over 2 hours followed by:


Intravenous sodium chloride 1000mls/8 hourly.


Medication orders


Furosemide 20mg BD (IV)


Ramipril 10mg OD (PO)


Insulin Glargine 30 Units OD (s/c)


Nursing orders


Devise a plan of care for your patient


Written Assessment 2: Case scenario two


Identify: Mr Max Blue, HRN: 123567, DOB: 07/05/2001


Situation: Max is a 21-year-old indigenous male from a remote community in the NT. He has been admitted to the CDU medical ward due to Diabetic Ketoacidosis. He has a 3/7 history of feeling unwell, fatigue, and a fever. His Mum was worried as he has been complaining of increased thirst and passing large amounts of urine frequently. His Mum brought him to the emergency department (ED). He was treated for DKA in ED. He has been reviewed by the Endocrinology team and has been diagnosed with Type 1 Diabetes Mellitus (T1DM) and subsequently developed DKA. He has been transferred to the CDU Medical ward for continuing care.

Assessment:


Airway: Own, patent


Breathing: RR 30, Sats 97% on RA.


Circulation: HR 120 bpm, BP 90/55 mmHg.


Disability: GCS 15/15


Exposure: Temp 37.8 oCMax feels tired and anxious.


Max has 2 x IVC’s inserted to both ACF’s.


Max is refusing to eat, feels sad and tells you ‘Leave me alone, my life is ruined, I’ll never play sport again’


Venous Blood Gas attended shows Potassium 3.1mmol/L


BGL 27mmol/L


Ketones – 1mmol/L


Recommendations/Read back:


Medical orders


Routine ward assessments and observations


Strict fluid monitoring


Administer Intravenous fluids as prescribed


Commence Insulin sliding scale


MSU for MC & S


Diabetic diet and fluids as tolerated


TED stockings and DVT prophylaxis


IV Fluid orders


Intravenous compound sodium lactate (CSL) 500mls over 2 hours followed by:


Intravenous Potassium Chloride 40mmols/1000mls over 8 hours


Medication orders


Actrapid insulin (sliding scale) S/C


Insulin Glargine 10 Units S/C OD


Tazocin 4.5g IV TDS


Nursing orders


Devise a plan of care for your patient


Written Assessment 2: Tasks:


Using the template provided in the Written Assessment 2 folder and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following tasks.


Do not make up or assume information in relation to or about your chosen patient. Only use what you know from the information you received today.

Task 1: Assessment


Based on your chosen case scenario and in grammatically correct sentences identify:


Three (3) priority nursing assessments you would conduct at the commencement of your shift


AND


For each assessment you have identified explain:


Why it is necessary for the patient’s condition and nursing care?


What consequences can occur if this assessment is not completed accurately?


What chart or document could you use to assist with/record your assessments?

Task 2:


Based solely on the handover you have received and using the template provided, complete a nursing care plan for your patient. Your plan must address the physical, functional, and psychosocial aspects of care.


Three (3) nursing problems have been provided for you. For each nursing problem on your care plan you need to identify;


What it is related to?


Goal of care


Interventions


Rationales for intervention


Evaluation


Notes for Task 2 only


Dot points may be used in the care plan template


Appropriate professional language must be used – legally recognised abbreviations may be used in this task (care plan) but a KEY with full terminology must be provided after the assignment references – key will be excluded from word count tally


Goals need to be written using clear SMART objectives.


Interventions – 5 are required.

Task 3: Patient education


Discharge planning


An important aspect of nursing practice is to effectively and succinctly communicate relevant information related to ongoing disease management or prevention of reinfection or deterioration on discharge.


Patient education and discharge planning starts on admission and you need to provide your patient with education during your shift in preparation for discharge home.


Explain two (2) important points/topics you will need to include in your patient’s preparation for discharge to aid healing and prevent further illness.


For each education point identified provide:


One (1) strategy to assist your patient to implement the education into their daily routine.