Student name:
\nStudent number:
\nNURS2101
\nINSTRUCTIONS
\n1. This assessment consists of four (4) scenarios, each with five questions.
\n2. There are six (6) pages
\n3. Total number of questions is twenty (20). Marks available for each question are provided.
\n4. The total marks for this assessment are 50.
\n5. Please save the document to your computer and then type your answers directly under each question using the heading ANSWER.
\n6. The word limits for questions are the maximum words required.
\n7. Dot points can be used
\n8. Please provide in-text referencing for any source material used to answer the questions. In-text referencing is not included in the word limits.
\n9. Every answer must have an intext reference to gain maximum marks
\n10. Provide a Reference List of all source material at the end of the document, using APA referencing style.<\/p>\n
Scenario 1 (Total 15 marks)
\nYou are a new graduate registered nurse working in a small local hospital emergency department.
\nMr Gary MacDonald is a 52- year-old businessman. McDonald has a very stressful position, and as a coping mechanism he drinks quite heavily. Mr McDonald has been feeling increasingly unwell lately but has been too busy to go to the doctor for a check-up. His abdominal girth has increased, his ankles are a bit swollen and he gets short of breath on exertion.
\nMr McDonald was attending a business meeting when he began to vomit quite a lot of bright red blood.
\nOn arrival at the Emergency Department of the local hospital he has a vomit bag with about 350 mL of bright red blood. He is pale and complaining of feeling dizzy and appears confused as to what is happening to him and where he is. His immediate vital signs are:
\nBlood pressure 80\/50mmHg, Pulse 130bpm, Respiratory rate 28, Oxygen saturation 91% on room air, Temperature 36.1 Celsius, Glasgow Coma Score (GCS) 13.
\nQuestion 1: Maximum word limit 100 words. (2 mark) (Reference not required for this question)
\nBased on your A-G assessment identify two (2) areas that are your highest priorities and express then as Nursing Diagnoses with \u201cRelated to\u201d and \u201cEvidenced by\u201d statements.
\nQuestion 2: Maximum word limit 150 words. (4 marks)
\nThe doctor makes an initial medical diagnosis of bleeding oesophageal varices due to alcoholic cirrhosis. Explain the pathophysiology that caused his bleeding oesophageal varices.
\nQuestion 3: Maximum word limit 200 words. (4 marks)
\nBased on Mr McDonald\u2019s current condition, and NSW Health SAGO chart and DETECT policy requirements, outline four immediate nursing actions and their rationales within your scope of practice (as RN new graduate).
\nQuestion 4: Maximum word limit 150 words. (3 marks)
\nBriefly discuss the current best medical practice recommendations for the treatment of bleeding oesophageal varices including likely intravenous fluids, medications, and procedures.
\nQuestion 5: Maximum word limit 150 words. (2 marks)
\nFollowing treatment, Mr McDonald\u2019s bleeding varices settled, and he was discharged home on the following medications: Lactulose orally 20 mL BD, Spironolactone 50mg mane. Explain the reason for each of these in relation to his underlying disease process.<\/p>\n
Scenario 2 (Total 11 marks)
\nYou are a new graduate registered nurse working in the paediatric ward of your local hospital.
\nSam Nicolaides is a nine-year-old boy who until recently has been in good health. Sam lives with his mother and father and two siblings. Following a respiratory virus a few weeks ago he has been slow to recover, lacking in his usual energy. He has been hungry and thirsty all the time, and has recently begun wetting the bed, which he has not done for many years.
\nSam presented to the Accident and Emergency department two day ago with nausea, abdominal pain and feeling generally unwell. His observations taken on admission were:
\nBlood pressure 80\/50mmHG, pulse 140, respiratory rate 28 deep and sighing with an unusual sweet smell to the breath, oxygen saturation 100%, temperature 37.2 degrees Celsius. Urinalysis SG1025, pH 5, sugar++++ ketones+++ no other abnormalities. BGL 28mmol\/L.
\nA medical diagnosis of Diabetes type 1 with keto-acidosis was made.
\nQuestion 6. Maximum word limit 120 words (approximately 30 words per section) (2 marks)
\nBriefly explain the pathophysiology causing the following symptoms Sam was experiencing on admission:
\na) Glycosuria
\nb) Thirst
\nc) Ketonuria
\nd) Kussmaul breathing
\nQuestion 7. Maximum word limit 50 words. (2 marks)
\nList four (4) ongoing nursing assessments, other than vital signs, that will be required to monitor Sam\u2019s fluid status and ensure safe fluid replacement therapy over the next 48 hours.
\nQuestion 8. Maximum word limit 150 words. (3 marks)
\nExplain the concept of family centred care and why this is important to the physical and psychological care for Sam.
\nQuestion 9. Maximum word limit 150. (2 marks)
\nFor the ongoing management of type 1 diabetes, current best practice recommends an intensive insulin therapy regime called multiple dose insulin (MDI) or basal\/bolus regime. Explain:
\na) What this insulin regime involves and
\nb) Discuss why this is considered best practice management for type 1 diabetes.
\nQuestion 10. Maximum word limit 150 words (2 marks)
\nExplain what the HbA1c test is and why it is important in the management of patients with diabetes.
\nScenario 3 (Total 11 marks)
\nYou are a Practice Nurse in a small rural medical centre.
\nMr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.
\nMr Murray presents to his local medical centre saying he was not feeling well. Mr Murray\u2019s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered.
\n\u2022 His blood pressure is 167\/95mmHg, pulse 92bpm, respiration rate 24.
\n\u2022 Blood biochemistry reveals: Sodium 132 mmol\/L, Chloride 92 mmol\/L, Potassium 5.7 mmol\/L
\n\u2022 Bicarbonate 20 mmol\/L, Urea 27.6 mmol\/L, Creatinine 428 umol\/L, Hb 82g\/L, eGFR 20
\n\u2022 HbA1c 8.6%
\nQuestion 11. Maximum word limit 20 words. (1 mark)
\nYou are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.
\nQuestion 12. Maximum word limit 20 words. (1 mark)
\nList the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.
\nQuestion 13. Maximum word limit 10 words. (1 mark)
\nBased on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?
\nQuestion 14. Maximum word limit 300 words. (5 Marks)
\nMr Murray\u2019s doctor prescribes the following dietary modifications and additional medications.
\n\u2022 Sodium bicarbonate tablet 500mg tds
\n\u2022 Calcium carbonate tablets 600mg tds
\n\u2022 Erythropoietin injection 40,000 units SC weekly
\n\u2022 1500 mL fluid restriction
\n\u2022 Low potassium and 70-gram protein diet
\nAs the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.
\nQuestion 15. Maximum word limit 150 words. (3 marks)
\nThe doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go.
\na) What cultural concerns may be raised for Mr Murray by this possibility?
\nb) Briefly describe strategies that could be implemented to help maintain Mr Murray\u2019s autonomy.
\nc) Briefly describe strategies that could be implemented to help maintain Mr Murray\u2019s cultural safety.
\nScenario 4 (Total 13 marks)
\nA new graduate nurse is working in a surgical ward of the local hospital. She has been allocated to care for Mrs Beverly Smith, a 70-year-old woman admitted for a hemicolectomy for stage 2 bowel cancer. Mrs Smith has a history of hypertension and stage 2 Chronic Kidney Disease (CKD). Mrs Smith had her surgery yesterday and is reported to have been stable overnight. She has a midline incision closed with staples, one Belovac of with minimal haemo-serous drainage, IV 4% Dextrose in 1\/5 Normal Saline running at 85mL\/hr and a PCA of Morphine sulphate 100mg in 100mL Normal Saline set to deliver 1mg with each press. She has an indwelling urinary catheter draining an average of 60mL\/hr.
\nWhen the nurse assesses Mrs Smith at the beginning of the shift, she appears distressed and complains of pain rated 7 out of 10 in her abdominal area. Her observations are blood pressure 140\/85 mmHg, pulse 90 bpm, respiratory rate 12, oxygen saturation 92% and temperature 36.2 degree Celsius. She is unwilling to sit up in bed and has difficulty taking a deep breath.
\nThe nurse explains to Mrs Smith the importance of pressing the PCA button regularly. She then checks her medication chart for any orders for \u201cbreakthrough\u201d medication. Mrs Smith has an order for oxycodone (Endone) 10mg oral PRN, so the RN asks the endorsed EN to accompany her to the locked medication cupboard, check out the dose of Endone, and administer it to Mrs Smith, checking all the \u201c5 rights\u201d of medication administration.
\nThe RN continues to give care to her other patients. When she returns to the room, she notes that Mrs Smith is sleeping peacefully. Because she had a poor night, she decides not to wake her for observations and charts \u201csleeping\u201d on her PCA chart. The nurse then goes to morning tea.
\nWhen she returns from morning tea, she notes that Mrs Smith is slumped down in the bed and looks very pale. She does a set of observations and notes the following:
\nPatient is semi-conscious, rousing to voice, unable to give a pain score, PCA history delivered dose 15 times in the last 2 hours, blood pressure 90\/60mmHg, pulse 70 bpm, respiratory rate 4 breaths per minute and shallow, oxygen saturation 84%.
\nQuestion 16. Maximum word limit 50 words. (1 mark) (Reference not required for this question)
\nExpress the immediate priority patient problem indicated by this situation as a Nursing Diagnosis with a \u2018Related to\u2019 and \u2018Evidenced by\u2019 statement.
\nQuestion 17. Maximum word limit 200 words. (4 marks)
\nList four immediate priority nursing actions that are required in this situation to address the identified problem and a rationale for each.
\nQuestions 18. Maximum word limit 200 words. (3 marks)
\nDiscuss what you believe were the main patient factors and nursing or system errors, that led to this occurrence.
\nQuestion 19. Maximum word limit 150 words. (2 marks)
\nFollowing treatment by the medical and nursing team, Mrs Smith is significantly improved by the time her daughter visits later.
\nDescribe the actions required following this incident as part of NSW Health and hospital policy to address issues of patient safety and standards of care.
\nQuestion 20. Maximum word limit 200 words. (3 marks)
\nWhat are the legal requirements for a Tort of negligence? Do you believe that the new graduate RN was negligent in this situation? Justify your answer.
\nEND OF ASSESSMENT<\/p>\n","protected":false},"excerpt":{"rendered":"
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