Briefly explain how Clive?s health issues are likely to have had an impact on his weight and nutritional status in the last twelve months.
This assessment requires you to respond to a series of questions within given clinical scenarios and support all your answers with contemporary literary evidence. Consider the relevant contextual factors within the given scenario when developing your responses to the questions. Check the required style and examples in Black board before you start. You will submit this assessment online via Turn it in. Look for the Turn it in tip sheets and links that are in the assessment pages of this unit for further information.
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Marking: Each mark is awarded for a key point in your response that is correct, responds closely to the focus on the question and is supported with a valid academic resource / reference. Partial marks are used. Please check the examples provided on blackboard to further clarify expectations before you begin this assessment.
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Jamie is a 29 year old male admitted to hospital 6 hours ago with severe asthma. Jamie recently started a new job in the coal mines in central Queensland (3 weeks on 1 week off) and two days ago started his days off at home in Brisbane. Last night he was out partying with mates in the Valley and became very breathless and had an acute exacerbation of asthma symptoms. He was brought in by ambulance. Apart from having asthma since childhood Jamie reports he has good health and an active lifestyle. He usually takes an inhaled preventative medication daily and a reliever (salbutamol) when he experiences asthma symptoms. He hasn?t taken his preventer medication recently as he forgot to take it with him when he went on shift at the mine.
Currently he is lying on his side flat in bed and has oxygen 6 litres a minute delivered via nasal a face mask. He looks pale and has pink lips. Peripheral capillary refill time is 3 seconds. Respirations are deep, through the mouth, slightly laboured and chest expansion is equal left and right. He had an inspiratory wheeze audible with a stethoscope. He has a frequent cough. Jamie?s skin is warm, with no evidence of central or peripheral cyanosis. Vital signs / observations are BP 130/85 mmhg, pulse 96 b/min, respiratory rate 32 r/min, temperature 36.8C and oxygen saturations 92%. On arrival in the ward for a morning clinical practice shift you are allocated to look after Jamie, supervised by your buddy nurse.
Answer the following questions referring to the above scenario of Jamie [16 marks]
1. Consider the person and contextual information in the scenario and select two points of information that could be relevant to Jamie?s current acute asthma diagnosis and oxygenation problem. Briefly explain why you think these could be relevant. [2 marks]
2. Jamie currently has an oxygenation problem. Select three pieces of patient data related to this problem and for each briefly explain your understanding of the underlying pathophysiology of how each piece of data indicates an oxygenation deficit. [3 marks]
3. Briefly explain two advantages of delivering oxygen via a face mask as compared to the use of nasal prongs? [2 marks]
4. Briefly explain what changes in Jamie?s physical assessment data (excluding vital signs) would justify the nurse changing current oxygen therapy from a non-rebreather oxygen mask to nasal prongs? [2 marks]
5. Identify changes in vital signs that would indicate substantial deterioration in Jamie?s condition [1 mark]
6. Identify three questions you will ask Jamie about his symptoms to elicit data relevant to his current oxygenation and condition [3 marks]
7. Identify three changes Jamie would report to you that may indicate substantial deterioration in his condition. [3 marks]
Mrs Adams is an 84 year old lady transferred from the acute surgical unit to the rehabilitation unit for intensive physiotherapy and occupational therapy to assist her in regaining her mobility in preparation for discharge in 5 days. Mrs Adams is a slight lady who is approximately 150cm tall and says she weighed 48kg before coming to hospital. She had a right total hip replacement 5 days ago following a fall in the bathroom of her home when she fractured the neck of her femur. Her surgical wound is clean and dry with staples intact under a dry dressing. She also has an area of redness on her right heel. She is taking paracetamol and codeine tablets 6th hourly for pain. She is also ordered heparin 5000 units subcutaneously. She is wearing compression stockings on both legs (with the right heel protected). Mrs Adams is able to weight bear on her right leg, was transferred to the rehabilitation unit on a trolley and was assisted to walk a few steps from the trolley to the bed by a nurse supporting her elbows on either side. Mrs Adams has been transferring from the chair to the bed under supervision with 1 nurse assisting today and has walked to the bathroom using a walking frame and had a shower sitting on a chair. The physio has also taken her for a short walk using the walking frame and she will need to mobilise twice more today with nursing staff. The physio notes in the chart say that Mrs Adams was hesitant but completed her walk satisfactorily.
Prior to this hospitalisation she was generally well, mobile and didn?t use any mobility aids. She has a history of being a smoker and has osteoporosis and osteoarthritis. She lives with her husband Mr Adams who is 90 years old.
You are working the afternoon shift with a buddy registered nurse. Mrs Adam?s current pain is 2 on a scale of 1 (no pain) -10 (worst pain). Mrs Adams is refusing to get out of bed for a walk with you and the buddy RN saying ?I?ve done it once today that is enough?. The buddy nurse has a short discussion with Mrs Adams and determines she is afraid of falling again.
(case adapted from Crisp and Taylor, 2011)
Walking frame Compression stockings
Area of redness on right heel
Answer the following questions referring to the case of Mrs Adams above (14 marks)
8. Identify two factors in the scenario of Mrs Adams that increase her risk of falls. Briefly explain how each increases risk. [2 marks]
9. Identify two factors in the scenario of Mrs Adams that increase her risk of skin integrity problems. Briefly explain how each increases risk. [2 marks]
10. The nurse documents the characteristics of Mrs Adam?s heel injury in the relevant form /chart used at this health service. Describe the characteristics or information that should be documented at this time by the nurse caring for Mrs Adams. [3 marks]
11. Briefly discuss three nursing interventions nursing staff could use to prevent Mrs Adam?s heel injury from deteriorating further. [3 marks]
12. Briefly discuss two nursing interventions the nurse could implement to assist Mrs Adams to mobilise safely to the bathroom. [2 marks]
13. Briefly discuss two likely short term health complications of Mrs Adams not mobilising using the walker and staying in bed. [2 marks]
Clive is a thin and pale looking 46 year old man who has a history of cardiac failure and severe cardiomyopathy. Clive lives alone in a small unit, receives a disability pension and community nurses visit weekly. Clive is oxygen dependant, uses nasal prongs on 2 litres per minute at all times and has been on the waiting list for a heart transplant for almost 12 months. He uses an extension cord from his oxygen concentrator to the nasal prongs to allow him mobility. Clive takes many medications to manage his chronic illness symptoms. Clive has been advised to limit his fluid intake to 1000mls per day due to his cardiac failure. To manage his chronic disease and the medications he takes he needs to self-monitor his signs and symptoms of fluid balance and contact his health management team if he notices problems. Despite his health issues Clive manages to live independently getting through all his self care and household tasks by spreading them throughout the day and taking frequent rests and naps.
Answer the following questions referring to the case of Clive above. [10 marks]
14. Briefly explain how Clive?s health issues are likely to have had an impact on his weight and nutritional status in the last twelve months. [2 marks]
15. If you suspected Clive was dehydrated identify and describe two pieces of observed data you would look for that would contribute to your assessment of his hydration status? [2 marks]
16. If Clive?s hydration status reflected he was overloaded, identify and describe two pieces of observed data that you would expect to find that would indicate this. [2 marks]
17. Identify what disease related diet recommendations Clive is likely to be following given the scenario information. [1 mark]
18. What simple and economical food options would you recommend to Clive that will meet his nutrition needs and not exacerbate his disease? [3 marks]
End of questions
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