35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

Assessment Type: Case Study
Instructions to the student: This assessment comprises of two (2) parts.
1.Part A – Short answer knowledge-based questions relating to the attached case study.
2.Part B – Practical skills relating to caring for the patient in the case study.
During this assessment, you will be assessed on your ability to analyse the information you have been provided on your patient and use it to plan care and perform nursing interventions specific to the care of the person with complex needs.
35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

Part A – Short answer knowledge-based case study questions
You are required to read the case study background information on Ms Patricia Burn and use this information to answer the ten(10) questions attached related to her care. The answers you provide should be related to the patient information provided and all rationales of care should relate to
patients’ specific needs.

You are to:
1.Answer the questions from the perspective of a qualified Enrolled Nurse.
2.Use correct anatomical and medical terminology in your answers.
3.Reference your answers using the APA Edition referencing standard.

This part of the assessment must be completed prior to undertaking Part B – Practical skills.

Part B – Practical skills
The practical skills component of this assessment will take place on campus in the skills lab on the date outlined in your course timetable. A time will be arranged for you to attend your assessment.

The two (2) skills to be demonstrated as part of this assessment are as follows:
a.Skill 25.3 Incentive spirometry – page 213
b. Skill 6.1 Health teaching – page 3

The practical skills you will be assessed on will be conducted against the competency checklists provide in the textbook (unless indicated otherwise):

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

Koutoukidis, G. and Stainton, K (2017). Essential enrolled nursing skills for person- centred care. 7 th Ed. Sydney: Elsevier Australia.

The non-invasive skills will be simulated with one of your classmates representing the patient. The invasive skills will be simulated with a mannequin representing the patient.

During this part of the assessment, your educator will discuss with you, your rationales for your nursing actions and will ask clarifying questions to encourage you to think critically, problem-solve and identify the evidence that underpins your knowledge.

Deliverables for this assessment:
To gain a satisfactory result for this assessment, you will need to upload all the following documents into OpenSpace in one submission. Your OpenSpace assessment submission is to include:

  • This assessment, including your completed assessment coversheet, and
  • Part A – Your completed responses to the short answer questions relating on Ms Patrica Burn. (This will need to be submitted in a word doc format)
  • Part B – Copies of your two(2) clinical skills checklists of which you are to be demonstrated as part of this assessment.

Once all documents have been uploaded in OpenSpace,your educator will assess your assessment submission and provide feedback to you on the Assessment Evidence Checklist attached to this assessment.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

You will be given either a Satisfactory or Not Yet Satisfactory result. If your result is Not Yet Satisfactory, you will be given a due date for resubmission and feedback indicating what areas need addressing to gain a satisfactory result.

Case study background information – Ms Patricia Burn
Patricia Burn is a 58-year-old woman who has been living with Type 2
Diabetes Mellitus, COPD and Obesity. She has 2 adult children and 3
grandchildren all who live interstate, but she has regular phone contact with them.

Patricia divorced from her ex-husband 20 years ago now and is living in a
same-sex relationship with her long-term friend Andrea. Andrea is very
supportive of Patricia’s care needs but is compromised by her own
disabilities of advanced Rheumatoid Arthritis.

Patricia’s current & past medical history

a. T2DM
b. Obesity (BMI 33)
c. COPD for the past 14 years
d. HT
e. R) Foot ulceration
f. Peripheral neuropathy
g. Constipation
h. Hypertension
i. MI (10 years ago) 
j. PSH: Appendectomy 20 years ago 
k. PFH: Mother T2DM

Patricia’s current weight is 93kgs and as a result, her mobility and functionality has steadily decreased making her reliant on Andrea for
support and management.

Andrea has become concerned about Patricia today as she has rapidly
deteriorated, complaining of fatigue, listlessness, generally feeling unwell,
irritable, productive cough, shortness of breath on exertion. She is particularly short of breath walking to the bathroom. She has been sitting
in her reclining chair all day without any improvement.

Your observations of Patricia include:
Vital signs
1.Pulse: 142 beats per minute
2. BP: 175/98 mmHg
3.Respirations:32 breaths per minute
4.Temperature: 38.8oC
5.SP02: 93%

Visual observations
Slight cyanosis around lips. Patricia is needing to sit forward and lean on the table. She has increased anxiety as she is concerned about how Andrea is managing with her deteriorating health.

Current medications include:
1. PO Enalapril 10mg BD
2. PO Acarbose (Glucobay) 100mg TDS
3. Subcutaneous Lantus 18 units nocte
4. InhalationSalbutamol MDI 2 Puffs 4 hrly PRN
5. Inhalation Aclidinium Bromide 2 puffs BD
6. PO Coloxyl &Senna 2 BD
7. PO Movicol 1 sachet

Part A – Short answer knowledge-based case study questions

1.List three (3) strategies you could use as an Enrolled Nurse to help alleviate this patient’s anxiety.
To alleviate the anxiety of Patricia, as an Enrolled Nurse the following steps can be taken:

  • The recognition of anxiety is required with the assessment of the anxiety scale that is similar to the pain scale. The nurse will look for the non-verbal signals on the face of the patients to look for the facial expression. The following documents of increased heart rate, difficulty in concentration, gastrointestinal issues, trouble sleeping and difficulty in managing the pain has to be described.
  • The registered nurse has to listen to Patricia with full attention. There has to be open communication between the enrolled nurse and reviewing of the diagnosis is to be done. The delays are to be clarified by the nurse.
  • The enrolled nurse will prescribe medications ( medications such as Xanax or Valium can be introduced) and advise relaxation techniques (Leichsenring and Leweke,  2017). This has to be done with individualized patient interests with the governance of Andrea.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

2.Discuss at least six (6) observations you would include in your respiratory
assessment of this patient.
Six observations that can be included in the respiratory assessment  (with SPO2 VALUE 93%) of Patricia are as follows:

  • The pulse and blood pressure is to be assessed with the respiratory rates, and assessment of circulating blood volume and anaemia.
  • The nurse will use recognised physiological ” track and trigger systems’ ‘ such as the Modified Early Warning Scoring System (mEWS). This will verify if oxygen therapy is required or not (Stensrud et al. 2020).
  • The enrolled nurse will assess oxygen saturation as the “fifth vital sign” by using pulse oximetry and inspired oxygen concentration is to be assessed.
  • The arterial oxygen saturation is to be assessed to understand the blood gas measurements
  • The pH of carbon dioxide tension is to be assessed (pCO 2 )
  • Blood gas sampling is to be done to look for hypodermic conditions ( Lam et al.2017).

3.Discuss how Patricia’s comorbidities impact her health.
Patricia has T2DM, obesity and COPD for the past 14 years. The foot ulceration is due to the high diabetic conditions that have completely made her immobilize with the lacerations of the wounds. She has peripheral neuropathy and this is due to the diabetic condition. She will not be able to feel any senses and even can even feel no senses (Brali et al.2016). The comorbidity of constipation and hypertension have made Patricia
likely to develop the cardiac disorder in the present.  Patricia’s health is deteriorating and fatigue and listlessness are settling into the health conditions. She will develop irritability and productive cough due to COPD ( SPO2 saturation is 93%). There is shortness of breath and with these comorbidities, she might develop renal disorders, diabetic retinopathy, necrosis of the upper and lower limbs.  These will alter the walking
mechanisms of Patricia, there will be the development of lethargy, loss of appetite, loss of sleep and might lead to hypocapnia in the patients (Nowakowska et al. 2019).

4.Applying a critical thinking and problem-solving approach, discuss the education you could provide Patricia and Andrea regarding her managing exacerbations of her respiratory condition in preparation for discharge. Include a brief explanation on the use of incentive spirometry and peak flow.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

The stepwise decision-making and problem-solving approach that will be given to Patricia and Andrea regarding the management of exacerbating her respiratory conditions are as follows:

  • Andrea has to look for the cardinal symptoms of increased shortness of breath, increased sputum volume and increased purulence of sputum
  • Andrea has to look for cardiovascular signs ( such as abnormal pulse rate, peripheral oedema and wheezing with absent breath sounds). The learning of PEFR( Peak Expiratory Flow rate) has to be checked so that the forced expiratory volume in 1 second can be used for the clinical manifestations (Rhodes, 2020). The optimum dosage of the medication has to be done so that the patient can maintain stable conditions. The parents have to be kept away from air pollution as the aetiology of the patient will increase over time. The peak expiratory flow test should be around 300-500 litres per litre.  The patients have to be looked for any regions of cyanosis and if the patients are unable to control the breathing problems and there is certain application observed. The patient must be rushed to the hospital or there should be permission for oxygen therapy for the patients. Andrea has to keep good eyes on Patricia (Brockwell,  2019).

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

5.Discuss the procedure for obtaining a sputum specimen, and the test this would be sent off for.
In order to collect the sputum from the patients, the clean cup is to be collected and the sputum of early morning is to be collected before drinking water or brushing the teeth.The patients have taken deep breaths and hold the air for 30 seconds and then slowly breathe out. The patients have taken deep breaths and cough hard so that the sputum comes to the mouth. The sputum will spit into the plastic cup. At least 5ml of sputum has to be sent to the lab for testing (Churchyard et al. 2015). The cup has to be covered
properly so that there is no further contamination. The sputum test will help in the understanding of the COPD conditions of the patients. From the sputum, change in the neutrophil and neutrophil activation products such as proteases, elastase and myeloperoxidase are to be checked (Pedersen et al. 2021).

6.As you are attending to other patients in the ward, Patricia indicates she is
increasingly short of breath while lying in the bed. Her respiratory rate has
increased to 33 breaths per minute, and her pulse is 112 beats per minute. List your four (4) immediate nursing actions in priority for the management of her acute dyspnoea, and include the rationale for these nursing actions.

The four nursing actions that are required to take by the nurse to manage Patricia’s acute dyspnea are as follows:

  • Obtaining intravenous access and help in the assistance of ABC management (Emergency Airway management, emergency breathing management and emergency circulation management of the patient are to be done with immediate care (Nestor, 2020).
  • The vital stats are to be checked with temperature, blood pressure, heart rate (to treat symptomatic bradycardia and tachycardia via the ACLS guidelines). There has to be a checkup of respiratory rate and oxygen saturation tests
  • There has to be immediate triage is to be set to test the hypotension, altered level of consciousness, hypoxia, arrhythmia, stridor and unilateral breathing patterns are to be checked. The respiratory rates are to be checked in regular internal and the oxygen ventilation therapy is to be administered
  • There has to be consideration of noninvasive positive pressure ventilation is to be done with the application of inhaled bronchodilators (Gardner, 2020).

7.Reflecting on your previous clinical placement experience, discuss an area of clinical practice that you have observed. Make at least one (1) recommendation for a change to that practice that would result in improved quality of the patient experience.

The clinical practice that I have observed in my previous placement is based on the hemodialysis unit that I was working on. The department deals with dialysis of patients with chronic kidney failure. I have observed the patients are provided with intensive care and provided with good food after the dialysis is done. The patients have to lie over 4 hours to run the entire dialysis process. The process painful and the aortic clamping is
done with was by the pain management is not within the framework of the dialysis unit. If were to practice dialysis, I could look into the person -hood based pain management and provide them with psychological and mental boost so that they could be relieved after their entire dialysis procedure. It is crucial to include pain management and the psychological elegance of the patients.

8.Patricia would like you as her nurse, to explain to Andrea what T2DM is. Outline below how you would explain T2DM to Andrea.
T2DM is a lifelong disease that keeps the body from utilizing insulin. People with T2DM become resistant to insulin. This can affect any person at any time of their lifetime. This is one of the largest pandemic diseases that is predominant on the earth. The population that is affected by T2DM is more than 2 billion and people are living with prediabetes conditions over 4 billion. The blood sugar levels increase with hypertension (Bhansali et al. 2020). There many comorbidities that are associated with the diseases such as ulceration of hind limbs, DIABETES RETINOPATHY AND NEUROPATHY, renal disease, cardiac diseases and musculoskeletal disease. The cause
for this disease is due to the malfunction of beta cells of islets of Langerhans that are unable to produce insulin. Therefore, sugar in the body is not broken down into glucose and the energy is not converted. Instead, this glucose remains in the blood. This can be due to genetic problems, extra weight and metabolic syndrome, breaking of glucose by the liver, bad communication between the cells and broken beta cells. This is a disease
that has to be taken care of so that the form can be tackled with high efficiency (Campbell et al. 2020).

9.Discuss four (4) complications of T2DM.
4 complications that are associated with T2DM are as follows:
1. Heart and vascular diseases associated with blood vessels 
2. Neuropathy and other nerve damages and hind limb ulcerations 
3. Kidney disease such as chronic kidney failure
4. Eye damage especially retinal diabetopathy

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

35814/03 Contribute to nursing care of a person with complex Assignment- Open Colleges School Of Health Australia.

10.Discuss two (2) health professionals you could refer Patricia to in the community setting to assist with her ongoing management of her Diabetes.
The first health professional that Patricia is to be sent to is the pulmonary and lung medicine professionals so that she can deal with her COPD conditions. This will help in uplifting her conditions and she will be able to live her life independently. The oxygen therapy is to be considered regularly with the use of bronchodilators that will help Patricia to deal with her conditions. The community-based help will give the assistance
and support that she requires with the management of the pain. this would her with the correct use of dosage of her medications.

the 2nd health professional that Patricia should visit is a psychologist who can help with her anxiety and depression that is undergoing due to her comorbid conditions. The community-based health care will help Patricia to deal with her conditions in more intensive care with the support and assistance of the community members who are going through a similar problem.

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