Written Assignment NUR2203–Task overview
Assessment Nursing the gastrointestinal surgical patient
Assignment Objectives CLO 1. Evaluate the pathophysiological, pharmacotherapy and non-pharmacological management of acute exacerbation of illness, chronic diseases and complex conditions.
CLO 2. Evaluate the principles of professional nursing practice for people with diverse health concerns within the Australian contexts, including a selection of regional, rural and National Health Priorities across the lifespan including the needs of culturally diverse, disadvantaged, and vulnerable groups with acute, chronic and complex conditions.
Assessment Purpose The purpose of this assignment is to develop your critical thinking skills and clinical decision-making abilities in the care of a client with complex needs. In doing so, you are examining and applying the following standards for registered nurses for a patient episode of care. Read the case study below and answer the questions with subheadings in essay style
Standard 1: Thinks critically and analyses nursing practice.
RNs (Registered Nurses) use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks.
Standard 4: Comprehensively conducts assessments
RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.
Standard 6: Provides safe, appropriate, and responsive quality nursing practice.
RNs provide and may delegate, quality and ethical goal directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.
Standard 7: Evaluates outcomes to inform nursing practice.
RNs take responsibility for the evaluation of practice based on agreed priorities, goals, plans and outcomes and revises practice accordingly Registered Nurse standards for practice Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Due Date September 4, 2022, 2355 pm
1. Submit via Cadmus
2. Late submission penalties will apply unless written extensions requests have been approved (see 4.2.4 https://policy.usq.edu.au/documents/14749PL#4.2_Assignments)
3. Work submitted more than ten (10) days after the due date without an approved extension will have a Mark of zero (0) recorded.
Length Markable word limit of 2000 words. This limit does not include the reference list but does include all in-text citations and headings. There is no minimum word limit for this assignment but if you write less than 1000 words, it may be difficult to meet the marking criteria.
Marks out of:
Weighting: A total of 70 marks = 40% (refer to Marking Rubric)
Formatting Style Assignments should be presented using:
1. Use APA 7th https://usq.pressbooks.pub/apa7/
2. Present your assignment in a scholarly fashion i.e., academic writing conventions and written in the third person
3. Bullet points, numbering, use of tables or figures must not to be used
4. You can use subheadings for each section
5. You will be using Cadmus to write and submit your Case Study. Cadmus is an online environment for written assessment. Here are some important things to remember:
• All the assessment instructions and resources can be found in Cadmus.
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Submission information
Submission requirements This assessment is to be submitted electronically via the Assessment Submission link on NUR2203 Study Desk. It must be submitted in electronic format as a Microsoft Word document via Turnitin. The Turnitin process may take up to 24 hours to produce a report. Therefore, allow adequate time for this and address any issues of plagiarism detected by Turnitin before final submission.
Marking and Moderation • This task will be marked against the Marking Rubric available on the Study Desk.
• All staff who are assessing your work meet to discuss and compare their judgements before marks or grades are finalised. A rigorous moderation process is undertaken for this course hence no remarking of assessment pieces will be considered
• Final release of grades will normally be within three weeks of submission. This same time applies for any approvals for an extension of time, and the new return date will relate to the extended submission date Academics can help clarify assignment questions, but we are not able to review drafts
Academic Integrity Students should be familiar with USQ’s policy on Academic Integrity: https://policy.usq.edu.au/documents/13752PL
Turnitin has been enabled so that students can check for similarity matching within their assessment and make amendments prior to the due date to demonstrate academic integrity.
Late Submissions Penalty • Students are encouraged to access the USQ assessment policy: https://policy.usq.edu.au/documents/1357PL
• Applications for an extension of time will only be considered if received in accordance with the USQ Assessment procedure https://policy.usq.edu.au/documents/14749PL and the Assessment of Compassionate and Compelling Circumstances Procedure: https://policy.usq.edu.au/documents/131150PL
• Requests for assignment extensions need to be made PRIOR to the due date
Resources available to complete task USQ academic writing style is provided in links available on the course Resources Tab.
https://www.usq.edu.au/library/study-support/assignments
Referencing
https://www.usq.edu.au/library/referencing
Case Study Mr Ben Brown, a 68-year-old part-time landscape gardener presented to his GP (General Practitioner) four weeks ago with a 3-month history of abdominal pain and diarrhoea. A colonoscopy and CT (Computed Tomography) scan revealed extensive diverticular disease of the large bowel and a large tumour located in the ascending colon. Ben has been scheduled for an open right hemicolectomy.
Please refer to the following pre- and post-operative assessment data to answer the assignment questions.
Pre-operative clinical data
Objective Data Past Medical History Social History
• Weight 122 kgs
• Height reported 175 cm
• BP 155/100
• HR 88
• RR 18
• Temp 36.4C
• Urinalysis – normal
Current Medication
• Simvastatin 40mg nocte
• Captopril 100 mg mane
• Aspirin 100 mg mane
• Ventolin prn • Hypercholesterolemia
• Hypertension
• Asthma
• Obstructive sleep apnoea (OSA) confirmed with sleep study January 2011
• Uses CPAP (Continuous Positive Airway Pressure) machine at night
• Myocardial infarction (MI) 2007 with left coronary artery stenting • Married with 3 grown children
• Part-time landscape gardener
• Consumes 6 units of alcohol per day
• Independent with daily cares
• Smokes 10 cigarettes/day
Family history
• Father RIP bowel cancer
• Mother 84 years of age: myocardial infarction
Postoperative clinical data
Ben returned from theatre at 1900 following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon. Lymph node metastasis was discovered in four of the 28 dissected lymph nodes.
You are the registered nurse looking after Ben on the early shift the day after his surgery. You have received handover at 0700 and are planning his care for the day.
Observations 0800 Medications Post-operative orders
• BP (Blood Pressure) 90/55mmHg
• Pulse: 110 and regular Respiratory rate: 12/min shallow SpO2 95% 2 litres via nasal prongs, Temperature 37.8°C Axilla,
• Sedation score = 2
• Vacudrain in-situ 400 mL in bag
• Estimated blood loss (EBL) in OT 600mL
• Urine output via a Foley IDC: 10-15 mls/hour <1mL/kg/hour last three hours
• Pain score 6 on a scale of 0-10
• Midline abdominal dressing (minimal ooze)
• Simvastatin 40mg nocte
• Captopril 100 mg/day
• Aspirin 100 mg mane
• Fentanyl PCA (Patient Controlled Analgesia) 20mcg bolus: 5-minute lockout
• Regular paracetamol 1G QID (PO/IV)
• Tramadol 50-100mg QID prn (PO/IV)
• Oxygen 2L via nasal prongs
• Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 80mL/hour
• IV Cefoxitin 2gms TDS • Midline abdominal dressing - leave intact
• Nasogastric tube (NGT) 4/24 hourly aspiration
• Mobilise day 1 with physiotherapist
• Sips of clear fluid only
• Remove IDC 1000, day 1
• DVT (Deep Vein Thrombosis) prophylaxis –TED stockings
• Pain management
• Oncology review 1/52. Will require adjuvant chemotherapy as an outpatient
• GP follow up 2/52
• OPD appointment 4/52 with Dr McCormack
Task description in detail This assignment requires you to consider the case scenario of Ben Brown who has undergone an open right hemicolectomy. Your answer will concentrate on the first 24 hours of post-surgical care and includes discharge planning
1. Provide an INTRODUCTION (approximately 100 words)
An introduction will provide clear scope about the direction of your assignment. This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.
Part A: Analyse the case to identify potential clinical issues and relevant nursing care (1000 words)
This section will focus on the first 24 hours of post-surgical care and involves prioritising nursing care for Ben. Consider Ben’s co-morbidities including obstructive sleep apnoea (OSA), previous MI, asthma, hypertension, and hypercholesterolemia in the context of having a general anaesthetic (GA) and in identifying your clinical issues.
1. Identify THREE (3) PRIORITY clinical issues for Ben e.g., at risk of severe pain
2. Identify NURSING INTERVENTIONS for each of the three clinical issues e.g., Encourage deep breathing exercises hourly
3. Explain RATIONALES for each nursing intervention. Rationales justify your interventions and are referenced. Suggestion: Intervention: Encourage deep breathing exercises including use of the spirometry, hourly; Rationale: Smith (2019) surmises that this promotes normal lung expansion increases oxygen levels, and is useful in preventing pneumonia and atelectasis
Part B: Discharge planning (600 words)
1. Plan and prioritise discharge advice for Ben
2. In the discharge plan, consider the appropriate post-operative education for Ben post-surgical care. research paper writing service Provide a concise discharge plan that includes education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification.
3. Refrain from merely providing generic information. Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan.
Provide a CONCLUSION (approximately 100 words) Your conclusion succinctly summarises the main points of your assignment, not an opportunity to introduce added information.
Assignment Tips
ASSIGNMENT DETAILS
Introduction
Provide an overview of the structure of the assignment. Provide a brief overview of how you will approach each section. Outline examples in your essay that will be used to respond to the assignment question. Do not restate the case
Part A: Identifying clinical issues, proposing nursing interventions and rationales
Clinical issues • Consider pathophysiology, Ben’s co-morbidities, current medications, surgery, and response to general anaesthesia
• Consider the relevant assessment data you have been given in the case and other assessment data you will need to collect to care for Ben
• Choose three (3) prioritised actual or potential clinical issues. Be mindful of the 24-hour post-operative period
• It is expected that the information in this section will be referenced (Academic sources 4-6 would be reasonable for this section)
Prioritised interventions supported with researched rationales • Evidenced based nursing interventions and rationales should relate to pathophysiological processes and aim to improve clinical outcomes.
• The rationales support your interventions and justify why you have prioritised clinical issues. Rationales need to be referenced. (Academic sources 4-6 would be reasonable for this section
Part B - Discharge planning
• Consider both physiological and psychosocial aspects in discharge planning. (3-5 academic sources are expected for this section)
Conclusion • Provide a critical review and summarise the main findings of the assignment.
_______________________________________
Ben Brown: A Post-Operative Care Plan
Introduction
This paper will outline three priority clinical issues identified for Ben Brown in the first 24 hours following his open right hemicolectomy surgery under general anesthesia. Evidence-based nursing interventions and rationales will be proposed to address each issue. A comprehensive discharge plan will also be developed considering Ben's medical and psychosocial needs.
Part A: Identifying clinical issues, proposing nursing interventions and rationales
Clinical issues
Pain management: As Ben had major abdominal surgery under general anesthesia, he is at high risk of experiencing severe post-operative pain. Unmanaged pain can delay recovery and lead to complications.
Respiratory issues: With a history of obstructive sleep apnea, asthma and smoking, Ben has reduced lung capacity placing him at risk of respiratory complications like atelectasis and pneumonia due to reduced breathing post-surgery.
Thromboembolism: As a 68-year-old man who underwent recent abdominal surgery, Ben is at risk of developing deep vein thrombosis or pulmonary embolism due to limited mobility.
Nursing Interventions
For pain: Encourage deep breathing and coughing exercises every 2 hours. Administer IV morphine via PCA pump and oral paracetamol regularly as prescribed. Monitor vital signs and pain levels (Childs, Grove, & Plaugher, 2016).
For respiratory issues: Incentive spirometry every hour. Chest physiotherapy and positioning. Oxygen supplementation as needed. Early mobilization (Childs, Grove, & Plaugher, 2016).
For DVT prophylaxis: TED stockings and daily low molecular weight heparin injections as prescribed (Kakkos et al., 2016).
Part B - Discharge planning
A comprehensive discharge plan needs to address Ben's medical, psychosocial and lifestyle needs. He will require medication management, wound care instructions, signs of infection to watch out for, and the importance of rest and gradual return to normal activities (McClement et al., 2013). Follow up with specialists and community support services will help his recovery process.
Conclusion
Close monitoring and management of Ben's post-op pain, respiratory status and thromboembolism risks is needed. A well-planned multi-faceted discharge addressing medical and psychosocial aspects will aid his recovery from surgery.
References
Childs, J. D., Grove, S. K., & Plaugher, G. (2016). Instrumental activities of daily living. In J. D. Childs, S. K. Grove, & G. Plaugher (Eds.), Lippincott's content review for NCLEX-RN (2nd ed., pp. 441–452). Philadelphia: Wolters Kluwer Health.
Kakkos, S. K., Caprini, J. A., Geroulakos, G., Nicolaides, A. N., Stansby, G., & Reddy, D. J. (2016). Combined mechanical and pharmacological prophylaxis for the prevention of venous thromboembolism in abdominal surgery: Updated 2014 guidelines. Journal of vascular surgery, 64(5), 1-21.
McClement, S. E., Degner, L., Harlos, M., Ploeg, J., Lohfeld, L. H., Forbes, D., ... & Davies, B. (2013). Improving continuity of care for surgical oncology patients: a pilot study of a nurse coordinator intervention. Journal of multidisciplinary healthcare, 6, 49.
