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NUR250 Medical Surgical Nursing 1

Question

Answered

Question:

Case scenario one

Shift handover:

Identify: Mr James Blue, HRN: 123456, DOB: 26/03/1958

Situation: James is a 61 year old Indigenous man from a remote community.

He has been admitted to the CDU medical ward with chest pain. He has a 6/24 history of central crushing chest pain. His ECG shows that he has suffered from and inferior NSTEACS (NSTEMI).

Background: James lives in a single story home with his wife, 4 children and 2 grandchildren. He is independent with his cares.

He has an extensive past medical history including:

T2DM, smoker (10 per day), HTN, hyperlipidaemia, rheumatic heart disease and mitral valve regurgitation.

No known declared allergies (NKDA).

Assessment: Airway: Own, patent

Breathing: RR 22, Sats 94% on RA.

Circulation: HR 96 bpm, BP 160/95 mmHg.

Disability: GCS 15/15, 4/10 central chest pain, feels tired and a bit worried.

Exposure: Temp 37.0 oC

Recommendations/Read Medical orders

back: • Repeat ECG

  • Pain management
  •  TED stockings and DVT prophylaxis

Medication orders

New medications:

  •  GTN sublingual spray 400mcg PRN
  •  Paracetamol 1g PO QID
  •  Aspirin 300mg PO STAT
  •  Clopidogrel 300mg PO STAT

Usual medications:

  •  Metformin XR 1gm BD
  • Ramipril 10mg OD
  • Simvastatin 20mg OD

Case scenario two

Shift handover:

Identify: Mrs Amity Purple, HRN: 123678, DOB: 19/02/1962

Situation: Amity is a 57 year old Caucasian lady from Darwin. She has been admitted to the CDU medical ward with exacerbation of COPD. Shehas a 2/7 history of dyspnoea, productive cough and a fever.

Background: Amity lives in a two story home with her husband. She is independent with her cares.

She has a past medical history of:

T2DM, smoker (20 per day), HTN, hyperlipidaemia and obesity.

No known declared allergies (NKDA).

She is obese (BMI 30) and drinks 1 bottle of wine every night.

Assessment: Airway: Own, patent

Breathing: RR 26, Sats 89% on RA.

Circulation: HR 89 bpm, BP 160/95 mmHg.

Disability: GCS 15/15, 2/10 sharp chest pain on inspiration

Exposure: Temp 38.6 oC

Recommendations/Read Medical orders

back: •  Chest X-ray ordered

  •  Administer medications as charted
  • Pain management
  •  TED stockings and DVT prophylaxis

Medication orders

New medications:

  •  Paracetamol 1g PO QID
  •  Ceftriaxone 1g IV BD
  •  Amoxycillin 1g PO TDS

Usual medications:

  •  Metformin XR 1gm BD
  • Simvastatin 20mg OD
  •  Salbutamol MDI 100 mcg PRN
  •  Seretide MDI 1 puff BD

Tasks:

Choose from one of the patients handed over to you.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 tasks.

Task 1: Consider the patient

Based on the case scenario and in academically sound sentences/paragraphs:

  • Define the patient’s presenting disease (NSTEMI or exacerbation of COPD)
  • Discuss the pathophysiology of the disease.
  • How does the condition link with the patient’s past medical history?

Task 2: Care plan

Based solely on the handover you have received and using the template provided, complete a nursing care plan for your chosen patient. Your plan must address the physical, functional and psychosocial aspects of care.

Three (3) nursing problems have been provided for you. For each nursing problem on your care plan you need to complete the following sections:

  • What it is related to?
  • Goal of care
  • Interventions
  • Rationales for interventions
  • Evaluation

Task 3: Patient education

Discharge planning

An important aspect of nursing practice is to effectively and succinctly communicate relevant information related to ongoing disease management or prevention of reinfection or deterioration on discharge.

Patient education and discharge planning starts on admission and you need to provide your patient with education during your shift in preparation for discharge home.

  • Explain two (2) important points/topics you will need to include in the patient’s preparation for discharge to aid healing and prevent further illness.

For each education point identified provide:

  • One (1) strategy to assist the patient to implement the education into their daily routine.

Task 4: Medication

Choose two (2) medications that your patient has been prescribed (one (1) from their new medications list and one (1) from their old medications list) and discuss the following:

How does the medication work?

Why has your patient been prescribed this medication?

Are there any red flags/drug interactions that could affect the patient?

Use the clinical guidelines provided to support your claim.

NUR250 Medical Surgical Nursing 1

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