NURS90155: Nursing of Acute Health Conditions – End of Semester 1 Take Home Examination 2023: Exam 1
Due Date: Monday 8th May 2023, 1000 hours
Weight: 20%
Word Count: 2000 words
Submission: Online via Canvas, through the link in this subject.
Assessment Outline: This take-home exam consists of one case study, containing questions that you are
required to answer.
Introductions and conclusions are NOT required; go directly into answering each question.
Take-home exam must be typed using double spacing and size 12 font and text left justified.
The take-home exam must be presented in accordance with the American Psychological Association (7th ed APA) style.
All pages must be numbered consecutively from the title page.
The title page should include the Department, University, Course name, Student number, Subject name, and Subject code.
Insert your student number and subject code as a footer.
You do not have to present your work in paragraph form (except where directed to do so). Dot points and/or tabled format can be used where you are specifically directed to do so.
Provide citations in your responses wherever you have used ideas or information from other sources (texts, journal articles, websites). Reference your work carefully and include a reference List at the end. https://library.unimelb.edu.au/recite/apa
Penalties: You may lose up to five (5)% of the total marks for non-compliance with referencing requirements, including in-text citations and Reference List.
You may lose up to five (5) % of the total marks allocated to the assessment component for errors or inaccuracy in spelling/grammar and sentence construction.
Word Limit and penalties: Any piece of work which is over or is under the stipulated word limit by more than 10% will result in the deduction of five (5)% of the total marks allocated for the assessment for each 10% over the word limit. The maximum penalty that a student can receive is 50% of the mark for that piece of work.
Failure to submit an assignment by the required deadline will result in a penalty of the deduction of 10% of the total marks allocated to the assessment component for each day that the assignment is late.
Assessments submitted later than 5 working days after the due date will not be marked and will receive no marks.
The Board of Examiners may offer supplementary assessment to a student in special circumstances.
Students should refer to the assignment submission and return guidelines under the ‘Policies, forms and resources’ link for further information. www.nursing.unimelb.edu.au
I
Keith Griffiths| D.O.B. 12/09/1948| Male (he/him) |NKA| Full Resuscitation
S
Keith was admitted to the hospital yesterday after visiting his general practitioner (GP) 2 days ago with increasing shortness of breath, reduced appetite and feeling hot. His GP diagnosed him with community acquired pneumonia and commenced him on oral antibiotics, but in the 2 days since, Keith has continued to deteriorate.
O
Observations at 0530 hrs
Alert & Orientated; Temp 38.4 OC, HR 104 irregular, RR 24; BP 120/60 Sp02 91% on Room Air; BGL 10.6 mmol/L
Keith had an IVC inserted into his L) hand (22g) yesterday, which is clean and patent with no signs of infection
B
Worked as a carpenter/builder before retiring at 60 years after being diagnosed with asbestosis and moving to Melbourne to live with his daughter and her family. His daughter reports that he sleeps poorly, has few social contacts in Melbourne, and rarely leaves the house.
Smoker since aged 17 years. 30 cigarettes per day recently reducing to 5 per day.
Phx: Diagnosed with asbestosis and emphysema at 58-yrs old, Coronary Artery Bypass Grafts x2 at 55 yrs Hypertension; Type 2 Diabetes; asbestosis, emphysema, coronary artery disease
Current Medications: Aspirin; perindopril; metoprolol; atorvastatin; metformin; amoxicillin
A
Admitted to Medical unit
Investigations: ECG – 12 Lead; Bloods: FBC; U&E’s; Blood cultures; Chest X-Ray; Urinalysis Sputum specimen
Fluid Balance Chart (FBC)
R Current nursing problems:
Risk of Delirium
Altered breathing pattern Risk of infection
Question 1
Excluding the three problems identified in the handover, identify one (1) actual and one (1) potential problem. For each problem, provide a rationale using data from the case study and relevant literature or practice guidelines.
(3 marks)
Question 2
For each of the three problems identified in the handover:
i. Identify one independent nursing intervention and one collaborative intervention
ii. For each intervention, provide a rationale using relevant literature or practice guidelines
iii. For each, write a SMART goal and describe how you would evaluate the outcomes Present your responses in tables as shown below:
Problem 1: Risk of Delirium
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
Problem 2: Altered breathing pattern
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
Problem 3: Risk of infection
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
(8 marks)
Question 3
It is now 0800 and Keith is due to be administered the following medications:
• Metoprolol 25 mg
• Metformin 750 mg
• Amoxicillin 1 gram
For each medication:
i. explain why Keith requires the medication, with reference to his medical diagnoses and assessment data ii. describe the assessment(s) you would undertake prior to administering the medication (excluding checking the patients’ name, number, and date of birth against the prescription)
(3 marks)
Question 4
Keith’s medical team decides to commence him on a short-acting beta agonist (salbutamol) and long-acting betaagonist/inhaled corticosteroid (salmeterol/fluticasone), both via metered dose inhaler (MDI).
Describe two (2) important points about taking these medications via MDI that you will need to provide Keith with education about prior to discharge. Support your response with relevant literature or practice guidelines.
(2 marks)
Question 5 (400 words)
One of the aims of the Comprehensive Care Standard is to “…ensure that risks of harm for patients during health care are prevented and managed” (p 44, ACSQHC, 2021), research paper writing service including actions for preventing harm related to delirium.
In a short essay response, discuss why screening for delirium and implementing preventative care is important for preventing harm associated with healthcare. Support your response with reference to the standards, other relevant literature, and the case study,
Present your ideas in your own words, in paragraph form with linked sentences to establish the flow of. There should be no single sentence paragraphs. Use double spacing between paragraphs. Reference your work carefully and include a Reference List at the end. https://library.unimelb.edu.au/recite/apa
Reference
Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Health Service Standards. 2nd ed. – version 2. Sydney: ACSQHC
Rubric (Question 5)
Criterion 2 marks 1 mark 0 mark
Applies standards, relevant literature and policy to Keith’s case in discussion of importance of delirium screening and prevention.
Supports responses with appropriate references
Presentation (spelling, language, grammar, referencing)
(4 marks)
_______________________________________
Question 1
In addition to the three problems identified in the handover, Keith is also at risk of falls and pressure injuries.
Falls: Keith is at risk of falls due to his age, multiple medical conditions, and medications. He is also likely to be feeling weak and tired as a result of his pneumonia.
Pressure injuries: Keith is also at risk of pressure injuries due to his age, immobility, and reduced sensation in his skin.
Rationale
Falls: Older adults are more likely to fall than younger adults due to changes in their balance, strength, and coordination. Keith’s multiple medical conditions, medications, and fatigue can all increase his risk of falls.
Pressure injuries: Pressure injuries are areas of skin damage that can occur when pressure is applied to the skin for a prolonged period of time. Keith is at risk of pressure injuries due to his age, immobility, and reduced sensation in his skin.
Relevant literature or practice guidelines
Falls: The National Safety and Quality Health Service Standards (NSQHSS) for Aged Care Quality and Safety (ACQS) state that “people are supported to maintain their mobility and independence and to reduce their risk of falls” (Australian Commission on Safety and Quality in Health Care, 2021, p. 11). The Australian College of Nursing (ACN) also has a position statement on falls prevention in older adults, which recommends a number of interventions to reduce the risk of falls, such as:
Regular assessment of fall risk
Interventions to improve balance and strength
Environmental modifications to reduce the risk of falls
Pressure injuries: The NSQHSS for ACQS state that “people are supported to maintain their skin integrity and to reduce their risk of pressure injuries” (Australian Commission on Safety and Quality in Health Care, 2021, p. 11). The ACN also has a position statement on pressure injury prevention, which recommends a number of interventions to reduce the risk of pressure injuries, such as:
Regular skin assessment
Use of pressure-relieving devices
Good hygiene practices
Question 2
Problem 1: Risk of Delirium
Nursing intervention: Provide frequent orientation to the environment, including the person’s name, location, and date.
Rationale: Delirium is a common and serious complication of hospitalization, especially in older adults. It is characterized by a sudden onset of confusion, disorientation, and agitation. Frequent orientation can help to reduce the risk of delirium by helping the person to understand their surroundings and stay calm.
Collaborative intervention: Consult with the doctor about the possibility of using medications to treat delirium.
Rationale: There are a number of medications that can be used to treat delirium. The doctor will need to decide which medication is best for the individual patient.
SMART goal: Keith will be oriented to his surroundings and will not exhibit signs of confusion or agitation.
Assessment: The goal will be met if Keith is able to identify his name, location, and date, and if he is not confused or agitated.
Problem 2: Altered breathing pattern
Nursing intervention: Encourage Keith to take deep breaths and cough regularly.
Rationale: Keith’s breathing pattern is altered due to his pneumonia. Encouraging him to take deep breaths and cough regularly will help to clear his lungs and improve his breathing.
Collaborative intervention: Administer oxygen as prescribed by the doctor.
Rationale: Oxygen can help to improve Keith’s breathing and reduce his risk of complications.
SMART goal: Keith will have a regular and effective breathing pattern.
Assessment: The goal will be met if Keith’s breathing is regular and effective.
Problem 3: Risk of infection
Nursing intervention: Maintain a clean and safe environment.
Rationale: Keith is at risk of infection due to his hospitalization. Maintaining a clean and safe environment will help to reduce the risk of infection.
Collaborative intervention: Administer antibiotics as prescribed by the doctor.
Rationale: Antibiotics will help to treat Keith’s pneumonia and reduce the risk of infection.
SMART goal: Keith will not develop any new infections.
Assessment: The goal will be met if Keith does not develop any new infections.
Question 3
Metoprolol
Explanation: Metoprolol is a beta-blocker that is used to treat high blood pressure, heart failure, and chest pain. It works by slowing down the heart rate and reducing the force of the heart’s contractions.
**Assessments
