Acute practical skills scenario:Analyse health information on the patient scenario and contribute to planning nursing care and interventions specific to the care of the person with acute health needs

Assessment 1: Acute practical skills scenario 1 – Gordon

Instructions to the student – During this assessment, you will be assessed on your ability to:

Analyse health information on the patient scenario and contribute to planning nursing care and interventions specific to the care of the person with acute health needs.

As your patient will be a real person with as simulated disease. It is important you familiarise yourself and read the scenario below and analyse the information given to you.

This assessment will take place in the clinical skills lab at a predetermined time arranged with your educator.

All nursing documentation required for this scenario is attached to this assessment and will need to be pre-printed and bought into the simulated environment for assessment.

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

On completion of this assessment you will be provided with constructive performance feedback by your educator and you will be graded with a satisfactory or not satisfactory result.

Scenario 1 – Gordon

Gordon is 72 years of age and presents following a 12 hr history of 'droopy eye' which his GP diagnosed as ptosis. On neurological examination, the GP noted that his L) pupil was sluggish to respond to light and he was hypertensive 172/98 on assessment.

Neither of these symptoms was present in Gordon's recent history so suspecting a neurological event the GP sent Gordon to the local hospital for an MRI and further assessment by the neurological team. Now in hospital Gordon complains of a sudden intense headache and visual disturbance.

Question 1 – What observations will you conduct and what is your rationale?

Question 2 – Perform these observations on your patient and document your findings.

Question 3 – What likely changes in Gordon's neurological and vital sign status are you going to see as his condition deteriorates? Explain the rationale for them.

Gordon becomes unconscious 2½ hrs following the commencement of his headache.

The CT Scan confirmed he has had a ruptured cerebral aneurysm leading to a large subarachnoid hemorrhage on the R) side of his brain. Given the seriousness of his condition Gordon has a PICC line inserted (peripherally inserted central catheter) for maintenance of hemodynamic status and medication access.

Question 4 – Anita, his wife has become understandably very distressed about Gordon's sudden deterioration. How would you explain to Anita what an aneurysm is and what is happening?

Question 5 – It is decided that Gordon requires an emergency craniotomy to relieve the increasing intracranial pressure caused by the aneurysm. Outline 8 key nursing interventions and the rationale required to prepare Gordon for surgery.

Gordon undergoes successful surgery and is being closely monitored in the High Dependency Unit (HDU). He has returned to HDU with an IDC in-situ (indwelling catheter), a redivac wound drain, PICC line with Total Parental Nutrition (TPN) running @ 80mls/hrly, and a SCUD device in-situ.

Question 6 – Outline the nursing care and rationale for the management of Gordon's situation.

Question 7 – As his condition improves post-operatively what risk assessment tool would you use to assess his safety with mobilizing?

Assessment 2: Chronic health conditions case study

Instructions –

Purpose of the assessment – To demonstrate your knowledge, critical thinking and clinical reasoning of the content covered in nursing people with chronic conditions.

Task –

This assessment consists of 3 scenarios with related information. To be deemed satisfactory in this assessment you are required to complete all the sections of this assessment. Once you have completed all the sections of this assessment you are required to upload your assessments into the open space platform as instructed in the module.

Read each of the detailed scenario's pertaining to Anna, Frank and Shirley.

Answer all the related questions to each scenario satisfactorily, with the correct responses.

You must complete all the responses unassisted by the assessor or other individuals, but may refer to reference materials or resources as needed.

The question responses section is the only resource required for this written assessment to be completed. A pass mark of 85%, of the completed questions, correctly completed is required, to gain a satisfactory grade for this assessment.

Scenario 1 – Anna

Anna is a 49-year-old lady who lives with her husband and 2 sons. She is a personal care worker and works in a low care facility part time. Some of Anna's complaints at present are that she is living with asthma and arthritis which impact on her ability to work.

Anna described to you that she had been experiencing significant joint pain, mainly in her wrists and has been diagnosed with rheumatoid arthritis.

She experiences acute, severe lumbar pain and tenderness that radiates to her right hip and lateral thigh after falling and landing on her buttocks last week. Walking and bending increases her pain, she sustained a stress fracture in her wrist 5 months ago. She has a history of osteoporosis. She has been taking corticosteroids and mineral corticoids for the past 6 years for Addison's disease. She drinks two glasses of wine every evening and she dislikes dairy products and due to her pain issues does not part take in any physical exercise.

She is 167cm tall and weighs 52.7 kg. Diagnostic studies included:

Bone mass /density test- showed decreased bone mineral density at the spine and hip.

Lumbar spine X-ray reveals a slightly displaced L4 compression fracture

Biochemistry shows: Normal Serum calcium, phosphorus and increased alkaline phosphate

1.1 Provide a summary of the pathophysiology of Rheumatoid arthritis including signs and symptoms.

1.2 Provide a brief discussion on the expected actions for each of the following medications used provide an example of a drug from each category. Include the drug classification for each.

NSAID's

Steroids

Disease -modifying antirheumatic drugs (DMARD'S)

To help manage her pain, Anna has been taking Naproxen for years. She has subsequently been experiencing: tiredness, loss of appetite, headaches, itchy skin and irritability. After discussion with her GP, she was sent for a blood test. The results of one of the blood tests indicated that Anna had an eGFR (estimated Glomerular Filtration Rate) of 48, indicating stage 3, chronic kidney disease. She asks you what may have happened to her if she didn't see her GP.

1.3 List 3 long term complications of chronic kidney disease?

1.4 To help Anna stay healthy, identify 3 main aims in managing chronic kidney disease.

1.5 Not that she is anywhere near requiring dialysis, she is however curious and asks you what dialysis is. Provide a description of 2 types of dialysis available for the treatment of CRF.

1.6 Whilst you are talking to Anna she becomes short of breath, can only speak short sentences and has an audible wheeze. Indicate your 4 immediate nursing actions you would take in this situation to provide Asthma First Aid.

1.7 List one type of inhaler medication for each category available for managing asthma?

1.8 List the factors that increases Anna's risk for osteoporosis.

1.9 What are the priority teaching needs for Anna?

1.10 How might you assist Anna in increasing her intake of calcium?

1.11 Why would regular exercise be important to Anna?

1.12 Bases on the assessment data presented, what are the priority nursing care problems? Are there any multidisciplinary problems that you can identify?

1.13 In the table below complete the comparison of rheumatoid arthritis and osteo arthritis according to the listed parameters.

The overall goals for a patient with Rheumatoid arthritis are:

1. Satisfactory pain management

2. Minimal loss of function of the affected joints

1.14 Explain how you would conduct a pain assessment on Anna, indicate which method you would use and record your findings correctly in her progress notes. (See the last page of this assessment for the progress notes template).

1.15 Discuss the nursing interventions and care you would undertake and implement under the following headings, for Anna's Rheumatoid arthritis:

a. Acute intervention at flare -up

b. Ambulatory and Home care

c. Joint protection

d. Alternative therapies

e. Psychological support

Scenario 2- Frank

Frank is a 73-year-old widowed gentleman. He has a history of Parkinson's disease, TIA's, congestive cardiac failure, HT and unstable angina.

He has a supportive family consisting of 4 daughters and a son. They all live close by. Frank spends a lot of time at the Italian club, but deeply misses his wife who only passed away 3 years ago.

You are the visiting nurse who is doing a general review of Frank's care needs. You notice that he has Parkinson's Disease in the early stages. He has slight hand tremors and his gait is a little shuffle. He tells you that he is taking a medication called Sinemet to help this condition. He confides in you however, that he is not even sure what Parkinson's Disease is, and isn't even sure why this medication has helped.

2.1 How would you describe Parkinson's disease to Frank? (100 words)

2.2 Based on your understanding of Parkinson's disease, provide the following information on the drug “Sinemet” and what is its primary function?

Generic name

Trade name

Action

Contra indication

Side effects

2.3 List 5 nursing care considerations to support Frank in relation to his Parkinson's Disease and provide a rational for each?

2.4 After talking to Frank for a while he tells you that he is experiencing some chest discomfort. You are aware that he suffers from unstable angina. Describe the pathophysiology of myocardial infarction from onset of injury to the healing process.

2.5 You notice that he is becoming pale, sweaty, short of breath and clutching his chest. List the 3 most immediate nursing actions you would undertake and the rationale for each in sequence of priority (consider the domiciliary care environment).

2.6 If you could administer oxygen to Frank, what mask and flow rate would you commence? Provide a rationale for your decision and indicate why oxygen would be helpful.

Frank's chest pain has resolved, after taking his prescribed GTN and he mentions to you that this happens on and off. He tells you that every time he sees his Dr, he checks his blood pressure and does a heart trace, 'to keep me on track'.

2.7 What is your understanding of hypertension? Provide a brief explanation outlining the pathophysiology related to hypertension.

2.8 Explain why GTN was indicated and how it helps Frank's angina?

2.9 Identify 5 risk factors for coronary artery disease and your nursing role in the promotion of therapeutic lifestyle changes in patients at risk?

2.10 List 2 types of anti- hypertensives and include, generic name, trade name, indication, action and contraindication and side effects for each.

2.11 What do you imagine the 'heart trace' is that Frank's GP is performing and what does this test indicate, explain?

2.12 Hypertension are classified as primary hypertension or Secondary hypertension, Explain your understanding of the two and list 2 causes for each. (500 words).

2.13 What is the main differences between a TIA and a CVA? List 3

2.14 Define and discuss the term “hemiparesis”?

Scenario 3 – Shirley

Shirley is a 79-year-old widowed lady with a past medical history of COPD, bronchitis and hypertension. She has also developed dermatitis of her left lower leg. With all of her coughing she is also prone to having 'small accidents' i.e. – passing small amounts of urine when she coughs.

She is becoming increasingly depressed and isolated, becoming too embarrassed to leave the house.

3.1 What type of incontinence do you suspect Shirley is living with?

3.2 List 5 continence management strategies that you could suggest, helping Shirley manage her incontinence? And give a rationale for each.

During the time, you are spending with Shirley, she starts coughing and becomes very short of breath. This may be secondary to her COPD.

3.3 What is COPD? Provide a brief but accurate description and include the pathophysiology associated with COPD and list 4 symptoms.

3.4 You are required to undertake a Peak flow, test for Shirley.

1. Define spirometry

2. What does a peak flow measure and what are the expected normal ranges for an adult and a child?

3.5 Which nursing interventions would you apply to assist Shirley while she is experiencing this significant episode of shortness of breath? List four and give a rationale for each.

3.6 Shirley has had a steroid cream prescribed for a significant flair up of some dermatitis on her left lower leg. Why do you think a steroid cream has been prescribed? Describe the action and rationale.

3.7 List and describe 3 signs of depression in older people.

3.8 What are the most common organisms that cause UTi's – List 2

3.9 Discuss the nursing strategies that you could implement to assist Shirley with her depression and isolation due to the impact of her chronic disease, include possible referrals in the community to assist her.

Assessment 3: IV Therapy and IV Bolus Medication Practical Skills

Instructions to the student – During this assessment, you will be assessed on your ability to:

Safely administer IV Therapy and IV bolus medication to your simulated patient scenario.

Demonstrate knowledge and use of a medications handbook (i.e./ MIMS) and identify potential nursing considerations of the medication in use.

Demonstrate 100% accuracy in drug calculation of IV fluid rates and dosage of medication in the simulated scenario.

Identify nursing considerations in administering the prescribed medication to your simulated patient scenario.

This assessment will take place in the skills lab at a predetermined time arranged with your educator lasting approximately 20 minutes and will be done in pairs or as stipulated by your Educator.

As your patient will be a real person with a stimulated simulated disease, it is important to familiarise yourself with the scenario below and analyse the information given to you.

On completion of the assessment you will be provided by with constructive performance feedback by your educator and will be graded as satisfactory or not satisfactory result.

Once this assessment is completed and resulted, ensure you save a copy for your own records and upload a copy into open space for evidence.

Resources for the student –

All nursing documentation required is attached to this assessment and will need to be pre-printed and bought into the simulated environment for this assessment.

Cannulation Documentation Chart (VIPS Scale)

Medication Authority and administration chart

Intravenous Therapy Orders

Patient scenario 4 –

Joel is a 17-year-old man who has been at a summer 'Rage' concert and has presented in A&E with the following symptoms:

Nausea

Ataxia

Headache

Tachycardia

Hypotension

He is diagnosed promptly as being dehydrated and the RMO on Duty authorises on a Medical Authority that you commence IV hydration of an Isotonic solution 1000mls in 6 hrs for rehydration and replacement of electrolytes. Included on the Medication Authority is an order for IV Metocloperamide of 10mg 4/24hrly PRN and a 'stat' dose of paracetamol PR 1gm which you are required to administer.

Question 1 – Prior to commencing IV therapy what nursing considerations do you need to undertake?

Question 2 – He has been prescribed an isotonic solution for infusion, please give an example of what this could be?

Question 3 – Demonstrate correct calculation of mls per hour and drops per minute at the prescribed rate of infusion that will be required for you to set an electronic pump up.

Question 4 – What is the Generic and Trade name of the anti-emetic drug ordered and what routes of administration can this medication be given by?

Question 5 – Calculate the volume to be drawn up and administered as per outline of a medication handbook.

Question 6 – Is the Medical authority an acceptable dosage for an adult of metoclopramide?

Question 7 – How would you administer this medication IV? Discuss how you would administer the paracetamol medication.

Question 8 – Demonstrate a correct technique of checking the IV cannula site providing rationale for the observations you are undertaking.

Question 9 – List at least 4 observations required for an IV cannula check.

Question 10 – Which tools could you use to clarify the location and nature of his pain/discomfort?

Question 11 – How would you evaluate the effectiveness of the pain relief given?

Question 12 – What complimentary strategies could you implement to assist him with his pain management?

Question 13 – Where would this be documented?

Question 14 – Should this patient have an anaphylaxis reaction to the paracetamol what signs and symptoms would you observe?

Question 15 – List three immediate nursing actions.

Questions 16 – State the three main side effects of paracetamol?

Question 17 – How would your nursing considerations change if he was having the Isotonic solution via subcutaneous route?

Attachment:- Assignment Files.rar

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