NUR331 Assignment 2 Complex Care Case Study

Subject Code & Title :-  NUR331 Complex Care Case Study
Assessment name: Complex Care Task 2 Case study
Length :- 2500 words
Weighting :- 50%
Individual/Group :- Individual
Formative/Summative :- Summative
How will I be assessed :- 5-point grading scale using a rubric. See the rubric on Canvas.
NUR331 Assignment 2 Complex Care Case Study

Presentation requirements :-
This assessment task must:
 Be a written academic case study containing headings
 Times New Roman size 12 and 1.5 line spacing
 Use APA 7 th referencing for citing academic literature
 Be submitted in electronic format as a word document via Turnitin

Task description :-
The goal of this case study is for you to use the template provided in a separate document to present a response to a clinical scenario in which you demonstrate evidence-based principles for the assessment and care of a patient who suffers from complex health problems.

What you need to do:

Download the Task 2 Response Template. You will use this template to complete five (5) parts of the assignment.

1.Complete the body system secondary assessment identify necessary investigations and the rationale for them and explain the pathophysiology of the abnormal findings.
2.Explain the pathophysiology of the abnormal results of patient investigations being sure to use supporting academic resources.
3.Explain the implementation and the evaluation of two high priority interventions and the actions to ensure care is patient- centred.
4. Apply the NSQHS standards to a later episode of poor-quality care that the patient experienced. Although the NMBA practice standards are identified in the marking criteria you do not need to apply the NMBA standards in this assignment. You only need to apply the NSQHS standards.

Considerations:
1.Make sure you draw on the best available evidence to support your assessment.
Peer-reviewed journal articles must be no older than 5 years old unless it is seminal research. Textbooks should be no older than 7 years old.
2.Make sure you use references from credible peer reviewed sources which are applicable to the patient
human the pathophysiological condition and the topic nursing.
3.Use the databases available from the library.
4. This is a short answer written piece written in academic language:
you should write using third person language.
5. Make sure you use correct terminology and accepted abbreviations with in your assessment.

The case study assignment is an individual assessment Task. You may work collaboratively with other students to understand concepts in this course but your answers must be your individual research interpretation and application of the materials.’

Case Scenario :-
Case Scenario
Identification
Mrs. Rhonda McKenzie, 75 years old.

Situation
Rhonda is in the emergency department, presenting with shortness of breath and discomfort in the upper back.

Background
Allergies: – glyceryl trinitrate
Medications: metformin 500mg BD, aspirin 100mg OD, atenolol 100mg OD, sliding scale actrapid
before meals (the dose is dictated by the BSL reading).
Past history: stable angina, type 2 diabetes mellitus
Last ate & drank: last night, cold pizza

Events:
Rhonda presented to the emergency department at 4am as she was feeling short of breath had pain between her shoulder blades, and could not sleep. She was triaged a category 4 and has only now been brought through to a bed.

NUR331 Assignment 2 Complex Care Case Study

Assessment
Temperature = 36.2°C
Pulse rate = 125 beats per minute
Respiratory rate = 30 breaths per minute
Blood pressure = 105/80 mmHg
Oxygen saturation = 90% on room air
GCS = 15, fatigued, light headed
BGL = 12.5 mmol/L
Rhonda weighs 95kgs, and she is 163cm tall.
Inspection – pale facial colouring, clammy skin
Palpation – slight peripheral oedema, delayed capillary refill (4 seconds)
Percussion – no dullness or hyperresonance in the lungs
Auscultation – air entry equal into both lungs

NUR331 Assignment 2 Complex Care Case Study

Subjective information :-
Rhonda lives in her van with her dog Max. The van is parked at the beach, and she ran out of petrol a week ago. Rhonda is recently homeless as her landlord sold the house she was renting and she cannot afford to rent another place locally as the costs have gone up. Rhonda has received multiple parking fines and has not had money to pay for her medications and she also ran out of her atenolol, aspirin, and actrapid last week. Two years ago Rhonda left her husband Mike as it was an abusive relationship. She has no children or immediate family available to support her. Rhonda is a recipient of the aged pension; she has no superannuation. Rhonda is anxious about Max (her dog) as he is in the van.

Recommendations
Please complete the required investigations for the patient, and a doctor will be around after the hand over.

Please refer to NUR331 Task 2 Response Template for the detailed questions that you need to answer.

Part 1
This part presents a series of questions to respond to in a short answer format. Completing these short answer questions will lead to the completion of the body systems assessment of the patient and an identification of the pathophysiology of the patient’s condition. Additionally questions guide an assessment of the lifestyle and social factors of the patient and their patterns of healthcare use.

The Unfolding Scenario
Investigations
The RN captured an electrocardiogram (ECG) from the patient (Figure 1). The RN interprets the ECG on the way to showing it to the Emergency Consultant. The RN identifies ST elevation in leads V2, V3, V4, and V5.

Part 2
In this part of the assignment, you are required to explain the pathophysiology of the patient’s condition as indicated by the information in the patient ISBAR handover (above) and the ECG (Figure 1).

Immediate Management
Fortunately there is a cath lab in the hospital to perform a percutaneous coronary intervention. The patient will require treatment to stabilise while waiting for transfer to the cath lab.

Part 3
In this part of the assignment, you are to explain one high priority intervention:
1. RN actions to implement intervention
2. RN actions to evaluate the intervention
3. Evidence that the intervention is safe and effective
4. RN actions to create patient-centred care through adherence to the social justice framework

NUR331 Assignment 2 Complex Care Case Study

Part 4
In this part of the assignment you are to explain a second high priority intervention:
1. RN actions to implement intervention
2. RN actions to evaluate the intervention
3. Evidence that the intervention is safe and effective
4. RN actions to create patient-centred care through adherence to the social justice framework

Patient critical event
After the PCI the patient was transferred to the coronary care unit (CCU) for monitoring. The CCU RN Nurse Busy seemed distracted during the handover, as there was one of her patients who was deteriorating and had to be MET called. This was nurse Busy’s first shift as a new graduate without the clinical coach supporting her. These are the notes taken by Nurse Busy during the handover:

Identification – Bed 13
Situation – PCI – one stent
Allergies – nil known
Medications – aspirin, nitrolingual spray, metformin, actrapid
Social – homeless
Assessment – vital signs stable, no complaints from the patient
Plan – continue to monitor, and social worker involvement for
discharge planning

For the next 2 hours Nurse Busy had the deteriorating patient.
The nurse working alongside Nurse Busy announced that she was going to dinner and told Nurse Busy to keep an eye on her patients. Nurse Busy was over whelmed but had not had an opportunity to speak with the Team Leader as they were on the other side of the unit orienting a new staff member. As it was after hours the clinical coach had gone home.

NUR331 Assignment 2 Complex Care Case Study

At 5:30pm the patient complained of discomfort and shortness of breath. Nurse Busy grabbed the nitrolingual spray and directed the patient to open their mouth. Nurse Busy then sprayed 2 x pumps of nitrolingual spray under Rhonda’s tongue and left to get the ECG machine. On returning, Rhonda was pale tachycardic and had a hoarse voice and audible wheezes. Panicked, Nurse Busy pressed the MET button and called the Team Leader over to help. The patient was intubated and transferred to ICU for further management.

Part 5
In this part of the assignment, please consider the NSQHS standards and answer the provided questions to:

i. identify how Nurse Busy compromised the medication safety,
ii. identify the factors that contributed to the compromised medication safety,
iii. identify what actions were required by Nurse Busy to ensure safe medication administration, and
iv. identify how other team members could have helped to ensure safe care.

Figure 1
ECG print out for Rhonda McKenzie