EXPLAIN THE SPECIFIC UNDERLYING CAUSE/S (AETIOLOGY) OR REASON/S FOR EACH OF THE NURSING PROBLEMS ABOVE.
CARE PLANNING IN ADDITION TO THE NURSING PROBLEMS ABOVE, YOU ALSO RECOGNISE THAT NEVILLE REQUIRES FUNDAMENTAL NURSING CARE TODAY AND YOUR ROLE AND RESPONSIBILITY AS THE NURSE CARING FOR NEVILLE TODAY IS TO KEEP HIM:
Assessment 1: Nursing care of a person with a respiratory problem Meet Neville You will be caring for him today Shift handover: Neville is a 62 year old man with moderate, established chronic obstructive pulmonary disease (COPD) and a long history of smoking. He was admitted 2 days ago with worsening dyspnoea, cough and increasingly purulent sputum production. He reports he developed a cold a few days before admission but his usual preventative medications didn’t relieve symptoms and he is now unable to take more than a few steps before having to rest. Since admission, his upper respiratory symptoms have improved but he reports his dyspnoea and shortness of breath on exertion have not yet returned to what is normal for him. He remains tachycardic and his blood pressure is slightly elevated. Nasal prong oxygen remains in place. Medical orders are for nasal prong oxygen @ 2L/min to maintain oxygen saturations 88-92%; spirometry before and after nebulisers; high protein, high carbohydrate diet; push oral fluids, fluid balance chart, food chart and second daily weighs. Current medications are ipratropium bromide and salbutamol nebulisers, oral prednisone, oral amoxicillin, prn paracetamol and coloxyl. Pneumococcal and flu vaccines have been ordered to be administered before discharge once his condition has improved. Neville has tried to stop smoking on a number of occasions. He has cut down to 10 cigarettes per day but is having difficulty stopping completely. He lives with his wife who continues to be very supportive. NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2017 5 Assessment 1 Tasks: 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 5 tasks. Do not make up or assume information in relation to or about Neville, the photo is not an indication of his age or appearance. Only use what you know from the information you received today. Note: Students are expected to demonstrate • Person-centred care • That they have read beyond the set texts to prepare their responses and, • Can apply and integrate knowledge to practice and a specific case. Reliance on text books alone is no guarantee that your information is current and reliable evidence for practice. However, set texts are a good place to start to identify key points and to develop search strategies to locate appropriate journal articles. A reminder to use the Assessment 1 tips in the Assessment 1 folder on NUR250 Learnline. Task 1: Understanding nursing problems After handover you consider and plan the nursing care that Neville requires today. You recognise that there are 5 key nursing problems for Neville today: • Ineffective airway clearance • Impaired gas exchange • Risk of impaired ventilation • Imbalanced nutrition: less than body requirements • Risk for infection In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice • Explain the specific underlying cause/s (aetiology) or reason/s for each of the nursing problems above. (300 words, 10 marks) NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2017 6 Task 2: Care planning In addition to the nursing problems above, you also recognise that Neville requires fundamental nursing care today and your role and responsibility as the nurse caring for Neville today is to keep him: • Safe • Clean and dressed • Warm and comfortable • Fed • Hydrated • Rested • Mobile • Toileted Based solely on the handover you have received select five (5) fundamentals of care from the list above and develop a plan of care for each one identifying: • The related nursing problem • The underlying cause or reason (ie, what the problem is related to) • Goal of care • Specific bedside nursing interventions you will do • The rationales for your nursing interventions and actions • Indicators that your plan is working Information is to be in dot point form on the nursing care plan template on the required Assessment 1 template. (800 words, 30 marks) Task 3: Medication management Three important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications, the nursing responsibilities associate with administering each medication and how to monitor the patient to ensure they are responding to prescribed medications as they should. In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice, • Briefly explain why Neville has been prescribed: o Oral prednisone o ipratropium bromide via nebuliser o Oral amoxicillin AND • Identify and explain o The specific nursing responsibilities associated with administering each medication and monitoring Neville for expected, side and adverse effects (350 words, 10 marks) NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2017 7 Task 4: Patient teaching During Neville’s hospital admission, it is part of the nurse’s role to review his current knowledge and understanding related to his condition and to update or provide new information. Topics that need review/updating or new information are: • How to effectively use a metered dose inhaler (MDI) and spacer • Why he needs to stop smoking • Early indicators that his COPD is deteriorating that require medical review •