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


NUR251 Assessment 2
Nursing care of a patient with a medical condition

Week 10, Friday 2ndOctober, 2020, 23:59hrs (ACST)

2000 words ± 10% + 100 words to account for the headings in the template. Markers will stop reading at the maximum allowable word count. This word count includes the text in the template provided to you.

Contribution to overall grade:40%

Assessment purpose Learning objectives
Assessment 1 is the only written academic assignment in NUR251 for students to demonstrate they:

•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 adheringto the University’s academic integrity standards and plagiarismpolicy

This assessment addresses the unit learning outcomes; 1, 2, 3, 4 and 5

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S1 2020

Preparation

•Timely completion of study materials including modules 1, 2, 3, 4 and 5 with participation or review of online collaborate sessions, pre-recorded lectures or internal classes.

Presentation Guidelines

  • On the Assessment 1 template located in the Assessment 1 folder on NUR251 Learnline
  • As a computer generated document in Word format.
  • 1.5 spaced using Arial or Calibri font in size 11 or 12
  • In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia
  • Using appropriate professional terminology
  • Contents page, title page, introduction and conclusionareNOT required
  • Unless otherwise indicated, no acronyms, abbreviations and/or nursing jargon
  • Unless otherwise indicated, grammatically correct sentences and topic paragraphs are required. Dot points only accepted in the nursing care plan.
  • No more than 10% over or under the stated word count. Marking will cease at the 10% over mark.

    oNote:Headings, any task information copied in and in-text citationsare includedin the word count. 100 words have been included in the word count to account for the headings within the nursing care plan template.

  • Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice

    Referencing

    Students are reminded of their academic responsibilities and professional nursing practice requirements when using the work of others in assignments.

    Remindermarks are allocated for academic integrity. See the marking criteria for Assessment 1 for full details. Breaches of academic integrity will be lodged on the University system and may have serious consequences for students.

    • All information is to be interpreted and restated in your own original words demonstrating your ability to interpret, understand and paraphrase material from your sources
    • CDU APA 7threferencing style is to be used for both in-text citations and end of assessment reference list.
    • All resources for NUR251 assignments should be from quality, reliable and reputable journals relevant to nursing practice and the Australian healthcare industry.Please DO NOT use patient information leaflets or websites.
    • All resources must be dated between2010 and 2020
    • There must be at least 10 peer-reviewed journal articles and/or evidence-based

      practice guidelines cited in your assignment.

    • Do not use any health facility or local health service policies or procedures
    • Only 1 current Australian medication textbook and 1 current Australian medical surgical

      nursing textbook to be referenced.

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 2

Shift handover:

Please complete the assessment task on the next page.

Assessment 2: Case scenario one

Identify: Mr Dennis Black, HRN: 123456,DOB: 26/01/1945
Situation: Dennis is a 75 year old Caucasian man from Darwin. He has been admitted to the CDU medical ward following a cerebrovascular accident. He has a 2/7 history of confusion, fatigue, and headache. HisCTscanshowedthathehassufferedathromboticstroke. He has now been transferred to the CDU Medical ward for continuing care.
Background: Dennis lives in an aged care facility. His daughter lives close by and visits him occasionally. He needs assistance with his ADL’s,including feeding and showering.
He has an extensive past medical history including:

T2DM (on insulin), AF, HTN, Hyperlipidaemia, chronic kidney disease stage 3 (Baseline eGFR 40 ml/min/1.73m2), previous R) sided stroke with mild L) sided hemiparesis, anxiety. No known drug allergies (NKDA).

He is obese (BMI 30) and drinks 1 small glass of whiskey every night.

Assessment: Airway: Own, patent
Breathing: RR 22, O2 Sats 94% on RA.
Circulation: HR 96 bpm, BP 105/65 mmHg.
Disability: GCS 14/15, feels tired and‘a bit worried’.
Exposure: Temp 37.2oC
Michael looks unwell. He is restless and pleasantly confused. His urine is dark in colour. He has urinated 50 ml into a urine bottle in 8 hours. Hehad 2 x IVC’s inserted to both ACF’s andhas been tolerating a diabetic diet. He last opened his bowels this morning. He is currently nil by mouth, awaiting speech pathology review.

Pathology(on admission)

WBC 11.0 x 109/L(4.0-11.0)
Urea 9 mmol/L(3.0-8.0)
Serum creatinine 110µmol/L(60- 100)
eGFR 30 mL/min/1.73 m2(90-120)

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 3

Recommendations/Read back: Medical orders

  • Routine ward assessments and observations
  • Strict fluid monitoring
  • Administer Intravenous fluids as prescribed
  • Diabetic diet and fluids as tolerated (following speech

    pathology review)

  • 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
  • Spironolactone 10mg BD (PO)
  • Rivaroxaban 20mg OD (PO)
  • Insulin Actrapid 10 Units TDS (s/c)

    Nursing orders

•Devise a plan of care for your patient

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 4

Shift handover:

Assessment 2: Case scenario two

Identify: Mrs Lily Orange, HRN: 123567,DOB: 10/02/2005
Situation: Lily is a 15 year old Indigenous female from Katherine. She has been admitted to the CDU medical ward due to Diabetic Ketoacidosis. She has a 2/7 history of feeling unwell, fatigue, and a fever. She became increasingly dyspnoeic, so she presented to the emergency department. She was treated for DKA in ED, and she has now been transferred to the CDU Medical ward for continuing care.
Background: Lily lives with her parents. She is independent with her cares.
She was diagnosed with type 1 diabetes when she was 6, she is not always compliant with her insulin regimen; this is her 3rdpresentation with DKA.
Her past medical history:
T1DM (on insulin); last HbA1c: 13.2 %
No known drug allergies (NKDA).
Assessment: Airway: Own, patent
Breathing: RR 24, Sats 96% on RA. Circulation: HR 106 bpm, BP 95/65 mmHg. Disability: GCS 15/15
Exposure: Temp 37.4oC
Lily feels tired.
Lilyhad 2 x IVC’s inserted to both ACF’s. She is refusing to eat, and she feels sad.

Pathology(on admission to the ward)

WBC 13.0 x 109/L(4.0-11.0)
Potassium 2.4 mmol/L(3.0-8.0)
Sodium 128 mEq/L. (135-145)
BGL 12 mmol/L

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 5

Recommendations/Read back: Medical orders

  • Routine ward assessments and observations
  • Strict fluid monitoring
  • Administer Intravenous fluids as prescribed
  • MSUforMC&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
  • Actrapid Insulin (sliding scale) S/C
  • Insulin Glargine 30 Units S/C OD

    Nursing orders

•Devise a plan of care for your patient

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 6

Assessment 2 Tasks:

Using the template provided in the 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 informationin 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)prioritynursing assessments you would conductat the commencement of your shift

AND

For each assessment you have identified explain:

  • Why it is necessary forthe patient’scondition 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?

    (Approximately 500 words)

    Task 2: Care Plan

    Based solely on the handover you have received and using thetemplate 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 interventions
  • 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

  • Rationales must be appropriately referenced (Only rationales need referencing in the

    care plan)

    (Approximately 500 words)

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 7

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 inyour 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.

(Approximately 500 words)

Task 4: Medication

  • Calculate the hourly rate of the compound sodium lactate and the sodium chloride infusions. List the formula that you used.
  • Choose two (2) medications that your patient has been prescribed (one (1) from their IV fluid order and one (1) from their medication order) and include the following in your discussion:

    Describe the pharmacokinetics of the fluid/medication?
    Why has your patient been prescribed this fluid/medication? Discuss any side effects that could affect the patient.

    (Approximately 500 words)

    Your assignment must include a reference list after the completion of the tasks and a key if you have used abbreviations in task 2.

NUR251 Medical Surgical Nursing 2: Assessment 2 Topic and Tasks S2 2020 8

NUR251 Assessment 1 Marking Rubric S1 2020

5-7.5 Excellent

3-5 Satisfactory

0-3
Needs Development

Criterion:

Task 1: Assessment

Demonstrates excellent safe practice knowledge for assessment. Explains clearly, succinctly and specifically how to conduct the relevant assessments and explains their relevance to the patient.

Demonstrates satisfactory knowledge of patient assessment.
Rationales demonstrate satisfactory ability to conduct the relevant assessments and explain their relevance to the patient.

Demonstrates a limited knowledge of assessment. Does not demonstrate safe practice, knowledge of the relevant assessmentsand/orexplain their relevance to the patient.

Criterion:

Task 2: Care planning

Develops individualised, comprehensive nursing care plan relevant to the case study using the clinical reasoning cycle. All rationale is referenced. Demonstrates strong critical thinking skills.

Develops individualised, comprehensive nursing care plan relevant to the case study using the clinical reasoning cycle. Most rationale is referenced. Demonstrates emerging critical thinking skills.

Care plan has been completed using the clinical reasoning cycle, but it is not individualised or comprehensive. There is a discourse between the sections of the care plan. No critical thinking skills displayed.

Criterion:

Task 3: Discharge planning

Demonstrates a high-level ability to provide relevant and comprehensive patient education. Provides specific patient education discussing two topics with an implementation strategy.

Demonstrates a satisfactory ability to provide relevant and comprehensive patient education; discussing two topics with an implementation strategy. Discussion lacks detailand/oris not person centred

Poor interpretation of taskorEducation is provided but it is not specific to the patient. No implementation strategy is identified.

Criterion:

Task 4: Medication

Provides excellent, relevant and specific discussion about medications. Side effects are discussed. Demonstrates strong critical thinking skills.

IV fluid calculations and formula are correct.

Provides a satisfactory discussion about medications. Discussion is not specific. Side effects are discussed. Demonstrates emerging critical thinking skills.
IV fluid calculations are correct and/or some minor errors in formula.

Provides a limited discussion about medications. Side effects are not discussedand/orDiscussion is not specific to the case study. No critical thinking skills displayed.

IV fluid calculations are missing or incorrect.

Referencing

4-5

All ideas supported with in- text citations and there is a complete and accurate reference list.
No errors detected in CDU APA 7thformat. Referencing guidelines met.

2-3

Some ideas supported with in- text citations and there is a complete reference list.
A few errors detected in CDU APA 7thformat. Referencing guidelines met with errors.

0-1

Many references are missing and there are many errors in CDU APA 7THformat. Referencing guidelines not met.

Presentation

4-5

No errors with grammar, syntax, sentence and paragraph structure. Presentation guidelines met.

2-3

Some number of errors with grammar, syntax, sentence and paragraph structure. Presentation guidelines met with errors.

0-1

Many errors with grammar, syntax, sentence and paragraph structure. Writing lacks cohesion. Presentation guidelines not met.

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