NURS90130 \u2013 Nursing Assessment and Care \u2013 End of Year Take Home Examination – 2020
\nDue Date: Thursday 2nd July 2020 by 1000 hours
\nWeight: 40%
\nSubmission: Online via Canvas, through the link in this subject.
\n**3000 words \u00b1 10% limit (excluding references).
\nNote penalties apply for words in excess or under word the limit.
\nAssessment Outline:
\nThis take-home exam consists of 5 case separate studies. Each one contains questions that you are required to answer.
\nIntroductions and conclusions are NOT required; go directly into answering each question.
\nTake-home exam must be typed using double spacing and size 11 or 12 font and text left justified.
\nThe assignment must be typed in accordance to the American Psychological Association (APA) style.
\nAll pages must be numbered consecutively from the title page.
\nThe title page should include the Department, University, Course name, Student number, Subject name and Subject code.
\nInsert your student number and subject code as a footer.
\nIt is important to present your ideas in paragraph form with linked sentences to establish the flow of ideas. There should be no single sentence paragraphs. Use single spacing between paragraphs. Dot point format is to be avoided unless you are told to do so. Dot point format may be used for question 1f, 1g, 2a, 2i, 3c,
\n4d and 5c only.
\nReference your work carefully and include a Reference List at the end. https:\/\/library.unimelb.edu.au\/recite\/apa
\nCarefully check your grammar \/ spelling before submitting, also that you have answered the question \u2013 written on task.
\nPenalties:
\nYou may lose up to 5% of the total marks for non-compliance with referencing requirements, including in-text citations and Reference List.
\nYou may lose up to 5% of the total marks allocated to the assessment component for errors or inaccuracy in spelling\/grammar and sentence construction.
\nWord Limit and penalties:
\nAny piece of work which is over or is under the stipulated word limit by more than 10% will result in the deduction of 5% of the total marks allocated for the assessment for each 10% over the word limit. The maximum penalty that a student can receive is 50% of the mark for that piece of work.
\nFailure to submit an assignment by the required deadline will result in a penalty of the deduction of 10% of the total marks allocated to the assessment component for each day that the assignment is late.
\nAssignments submitted later than 5 working days after the due date will not be marked and will receive no marks.
\nThe Board of Examiners may offer supplementary assessment to a student in special circumstances. Students should refer to the assignment submission and return guidelines under the \u2018Policies, forms and resources\u2019 link for further information. www.nursing.unimelb.edu.au
\nCASE STUDY ONE: Mr Dan Smith
\nMr Dan Smith is a 42-year-old mechanic who sustained a minor head injury and fracture of his Right distal tibia and fibula in a motor bike accident. He was brought into University Hospital last night by ambulance where he has been admitted to Ward 1B at University Hospital. He is awaiting an open reduction and internal fixation (surgical repair) of his fracture.
\nSocially, Dan loves riding his motor bike and is a regular at the Australian MotoGP. He owns his own business and lives with his 7-month pregnant partner.
\nHis has an unremarkable past history, does not take any regular medications other than paracetamol for the occasional headache, and has no allergies. Dan is a 30-packet-per-year smoker and likes to meet his mates at his local pub every Friday for a couple of drinks.
\nYou and your buddy nurse have just received handover from the night shift nurse and note that the surgical registrar has requested hourly neurovascular observations be performed on Mr Smith until he undergoes surgical repair.
\nQuestion 1a (approx. 80 words)
\nDiscuss how you would perform neurovascular observations on Mr Smith and outline how the nurse would recognise a compromise in the neurovascular status of Mr Smith.
\n(2.5 marks)
\nDan is now Day 1 post surgery and is tolerating diet and fluids well. His pain has been well controlled via a Patient Controlled Analgesia (PCA) which was taken down this morning and he has been charted for oral analgesia in its place. At 1000, Dan buzzes his call bell and asks for Helpance to have a wash as his partner will be visiting soon and he wants to look presentable. As a MNSc student, you understand that the extent with which the nurse may need to help with personal hygiene will depend on the patient\u2019s physical abilities, health problems and the degree of hygiene required, however, there are a number of governing guidelines that nurses should follow when providing hygiene to their patients.
\nQuestion 1b (approx. 150 words)
\nOutline six (6) of these guidelines and discuss how you would implement them in your nursing care while Helping Dan with personal hygiene.
\n(3 marks)
\nIn preparation for Helping Dan with personal hygiene, you question Dan about his level of pain, as you understand that movement may cause additional pain. Dan reports a current numerical pain score of 7\/10 and indicates he would like to take some additional pain relief prior to having a wash. You discuss this with your buddy nurse and together you agree on the most appropriate medication to administer.
\nQuestion 1c. (approx. 70 words)
\nUsing the chart below choose the most appropriate medication to be administered. Provide a rationale for the use of this medication.
\n(1 mark)
\nQuestion 1d. (approx. 10 words)
\nCalculate how many tablets you would need to administer to Dan.
\n(1 mark)
\nQuestion 1e. (approx. 30 words)
\nUnder what name and classification should a medication be prescribed by the physician? Provide a rationale for your answer
\n(1 mark)
\nQuestion 1f. (approx. 70 words)
\nPropose when it would be safe to discharge Dan home
\n(2 marks)
\nQuestion 1g. (approx. 50 words)
\nIdentify which referrals you would make to ensure that Dan is safely discharged and has the Helpance he needs.
\n(3 marks)
\nCASE STUDY TWO: Ms Eliza Evans
\nMs Eliza Evans is a 78-year-old woman who has just been admitted to University Hospital Ward 1B. Ms Evans is alert and orientated with a Glasgow Coma Scale (GCS) of 15. Despite having a slight visual impairment for which she needs glasses, Ms Evans lives by herself in her own home. Ms Evans has been having 3rd daily dressings to a laceration on her right anterior tibia which was caused by a fall in her house one week ago.
\nFiona, the community nurse who reviewed Ms Evans, called the ambulance due to vertigo, urinary frequency, fever and observed that Ms Evans appeared to be uncharacteristically confused to the day and date. Fiona also noted significant weight loss.
\nYou are on an afternoon shift in Ward 1B and are waiting for Ms Evans to be admitted to the ward via ED. The morning shift nurse advises you of the following:
\nMs Evans has been admitted to hospital for investigation of weight loss, urinary frequency and vertigo.
\nHer past history includes: Chronic Heart Failure (CCF), Hypertension (HT) Tinnitus, Glaucoma, Anxiety, Depression, Urinary Tract Infection (UTI) and Rheumatoid Arthritis (RA).
\nMs Evans is on several medications, including Atenolol 50mg, Aspirin 100mg, Frusemide 40mg BD and Alprazolam 1mg BD. She has an allergy to shellfish.
\nMs Evans normally mobilized with the aid of a walking frame, however, she would not let the ambulance officers bring it with her to hospital, stating \u201cthe last time I was in hospital the lady in the next bed stole my walker and I had to buy a new one!\u201d
\nQuestion 2a. (approx. 40 words)
\nIdentify six (6) patient characteristics outlined in the profile above that would place Ms Evans at an increased risk of having a fall whilst in hospital.
\n(3 marks)
\nQuestion 2b. (approx. 75 words)
\nOutline four (4) nursing interventions that would Help in reducing the risk of Ms Evans a fall whilst in hospital.
\nProvide a rationale for each intervention.
\n(4 marks)
\nQuestion 2c. (approx. 250 words)
\nDiscuss how you would perform an assessment of conscious state in this case.
\n(6 marks)
\nQuestion 2d. (approx. 10 words)
\nUsing the Neurological Observation conscious state form in appendix A at the end of this exam paper, correctly fill out the following GCS results of your assessment of Ms Evans.
\n\u2022 Eyes open to speech
\n\u2022 Is confused to time and day but is aware of location
\n\u2022 Able to follow commands
\n\u2022 Pupils are equal and reactive and measure 4mm
\n\u2022 You feel a mild weakness in her left arm, normal strength right arm
\n\u2022 Equal strength in both lower limbs
\n\u2022 Vital signs: Temp 365C, PR 89 regular, RR 16 no accessory muscles being used, Sp02 96% RA, BP 190\/94
\n\u2022 Is complaining a severe headache and has reported 8\/10 pain on a numerical pain score
\n(3.5 marks)
\nOn completing your assessment and reviewing the observations as well as the Medication Administration Record (MAR) you note new upper limb weakness, an elevated blood pressure and a pain score of 8\/10. You note that she has had her antihypertensive this morning however she has been nauseous. When questioned Ms Evans indicates that she vomited into the toilet after breakfast. You discuss your concern with your buddy nurse who suggests making a RAPID call to Ms Evans doctor and request a review of the patient.
\nQuestion 2e. (approx. 300 words)
\nUsing the ISBAR framework outline how you would report to Ms Evans doctor to request a review.
\n(5 marks)
\nQuestion 2f. (approx.100 words)
\nProvide a summary the correct way to receive a phone order for a medication.
\n(1.5 marks)
\nQuestion 2g. (approx. 10 words)
\nUsing the MAR below correctly fill out a phone order for Atenolol 25mg.
\n(1 mark)
\nQuestion 2h. (approx. 10 words)
\nCalculate how many tablets you would need to administer to Ms Evans with a stock strength of 50mg per tablet. Ensure that you include your calculation in your answer.
\n(1 mark)
\nQuestion 2i. (approx. 80 words)
\nUsing the MAR below list elements of validity in ensuring safe administration of medications to Ms Evans.
\n(3.5 marks)
\nCASE STUDY THREE: Mrs Lucy Edwards
\nMrs Edwards is a 70-year-old lady who has been admitted to University Hospital Ward 1B University Hospital after a mechanical fall at home. She has been diagnosed with a fracture of the right neck of femur.
\nPrior to this accident, Mrs Edwards was fit and well. She lives with her husband of 50 years and together they enjoy playing lawn bowls four times a week at their local club. She has 4 children and 6 grandchildren, all living within a 10-minute drive.
\nShe has a history of Hypertension (HT) which is treated with Hydralazine 50mg q.i.d and Indapamide hemihydrate 2.5mg daily. Mrs Edwards has no known allergies (NKA).
\nHer clinical course has been uncomplicated and includes undergoing a R) Total Hip Replacement (THR).
\nIt is now day four after Mrs Edwards\u2019 surgery, she can mobilise slowly around the ward with the Helpance of a gutter frame and one (1) nurse. However, Mrs Edwards does this reluctantly, as she is still experiencing a lot of pain.
\nQuestion 3a. (approx.200 words).
\nUsing this information above, and using a COLDSPAA framework, provide a summary of how you would ascertain Mrs Edwards\u2019 level of pain.
\n(5.5 marks)
\nQuestion 3b. (approx. 50 words)
\nIt is now 1230 and after performing a comprehensive pain assessment, Mrs Edwards indicates to you on a numerical pain scale a pain score of 4\/10. Using the medication chart below, identify the most appropriate course of action to manage Mrs Edwards\u2019 level of pain. Provide justification for your choice.
\n(2.5 marks)
\nQuestion 3c. (approx. 150 words)
\nUsing the MAR below identify the 10 rights of medication administration and discuss how you would ensure the safe administration of medications to your patient within the frame of your existing scope of practice.
\n(5 marks)
\nQuestion 3d. (approx. 50 words)
\nAfter 15-30 minutes, you visit Mrs Edwards to assess if her pain medication has worked. However, Mrs Edwards now appears in greater pain. When asked, she evaluates her pain at 9\/10. Discuss what your next nursing intervention would be in this situation.
\n(1 mark) Question 3e. (approx. 75 words)
\nIt is now 0800 and your buddy nurse has asked you to review Mrs Edwards MAR below and identify any medications due for 0800.
\n(1.5 marks) Question 3f. (approx. 50 words)
\nWhat assessments should you perform prior to administering Mr Edwards mane medications? Provide justification for your decision.
\n(1 mark) Question 3g. (approx. 30 words)
\nCalculate many tablets should be given of each medication using the following stock strength. Ensure that you include your calculations in your answer.
\n\u2022 Hyralazine – stock strength 25mg
\n\u2022 Indapamide hemihydrate – stock strength 2.5mg
\n(2 marks)
\nOver the next two days, Mrs Edwards has noticed that she feels bloated and has not used her bowels for six (6) days. She tells you that she has been straining upon defecation and has only passed a small hard dry stool (1 on Bristol chart).
\nQuestion 3h. (approx. 200 word)
\nBeing aware of this information, propose what assessments and which nursing interventions would be appropriate in this case.
\n(3.5 marks)
\nQuestion 3i. (approx. 100 words)
\nWhat impact might her age have on Mrs Edwards\u2019 bowel function?
\n(2 marks)
\nQuestion 3j. (approx. 10 words)
\nUsing the information above, and using a NANDA framework, develop one (1) actual nursing diagnosis related to Mrs Edwards\u2019 constipation.
\n(1 mark)
\nCASE STUDY FOUR: Mr Graham
\nMr Graham is 75-year-old male and has been admitted to University Hospital Ward 1B University Hospital for Congestive Heart Failure (CCF).
\nHe has a past history of CCF, Hypertension (HT), diabetes mellitus and he is obese. He has a family history of CCF
\nRegular medications include: Metformin 750mg BD, Ramipril 10mg mane, Frusemide 40mg BD. Mr Graham has no known allergies (NKA)
\nSocially, Mr Graham is divorced and lives alone, though his daughter visits weekly. He is estranged from his 2 sons. Mr Graham is a 50-pack-a-year smoker and is a heavy drinker.
\nOn receiving handover from the ED nurse you note that Mr Graham is VRE+ (Vancomycin-resistant Enterococci positive) and requires isolation. Your buddy nurse asks you to prepare Mr Graham\u2019s room prior to his arrival.
\nQuestion 4a. (approx. 150 words)
\nDiscuss four (4) clinical scenarios when the nurse must implement standard precautions and don PPE. In your answer identify the type of precautions you should initiate for Mr Graham and explain what PPE a nurse would apply when entering Mr Graham\u2019s room. Provide a rationale for your choice.
\n(4 marks)
\nOn admission, you perform an assessment including vital signs. You note the following:
\n\u2022 Weight gain of 3kg in the past month
\n\u2022 Blood cholesterol 320mg\/ml
\n\u2022 High-density lipoprotein (HLD) 28mg\/dl
\n\u2022 Blood pressure 186\/116
\n\u2022 Radial Pulse Rate 76bpm (you believe it to be irregular)
\n\u2022 Respiratory Rate 21 and obvious use of accessory muscles
\n\u2022 Sp02 95% RA
\n\u2022 Oral temp 363 C
\n\u2022 BGL 8.9mmol\/L
\n\u2022 Diminished visual acuity
\n\u2022 Decreased bladder tone
\n\u2022 Weakness and dizziness
\n\u2022 Glasgow Coma Scale (GCS) score of 12 (E3, V4, M5)
\nWhen reporting these findings to your buddy nurse, she asks you to perform an apical pulse assessment to confirm the suspected irregular heart rate (HR).
\nQuestion 4b. (approx. 300 words)
\nIdentify the following traditional areas of cardiac auscultation on the the picture below and explain which part of the heart you are listening to when auscultating at each of those anatomical regions. Explain the process an RN shoud undertake when auscultating the apical pulse and explain why is it important to auscultate the heart when suspecting an irregular radial pulse.
\n6
\n7
\n1
\n2
\n3
\n4
\n5
\n(6.5 marks)
\nDuring your AM shift, Mr Graham\u2019s condition deteriorated, and he was admitted to CCU at University Hospital for cardiac monitoring. After 4 days, he returns to Ward 1B. You perform another admission assessment and note the following:
\n\u2022 Glasgow Coma Scale (GCS) score of 15 (E4,V5,M6)
\n\u2022 Blood pressure 130\/90
\n\u2022 Radial Pulse Rate 76bpm regular
\n\u2022 Respiratory Rate 16bpm
\n\u2022 Sp02 97% RA
\n\u2022 Oral temp 363C
\n\u2022 BGL 5.3mmol\/L
\nMr Graham still describes
\n\u2022 Diminished visual acuity
\n\u2022 Weakness and dizziness
\nQuestion 4c. (approx. 60 words)
\nUsing the information above and using a NANDA framework, develop one (1) actual nursing diagnosis related to Mr Graham\u2019s current situation.
\n(2 mark)
\nMr Graham has just pressed his call bell and told you that he feels nauseous and has asked for you to administer something to \u201cmake it feel better\u201d. You speak with your buddy nurse and together you review Mr Graham\u2019s MAR and note that he has a prescription for antiemetic therapy on the MAR.
\nQuestion 4d. (approx. 50 words)
\nUsing the MAR below, identify the components of a valid order and propose whether you can administer medication as it is currently prescribed. Propose a resolution to the situation and provide rationale for your solution.
\n(2.5 marks)
\nCASE STUDY 5: Ms Olive Brown
\nOlive Brown is a 4-year-old girl who has been admitted to University Hospital Ward 1B with a chest infection.
\nShe is accompanied by her mum and grandmother and a younger sibling.
\nOlive\u2019s mum informs you that she is normally a bright and curious child who does not stop asking questions. However, over the last 3 days, she has become increasingly lethargic and is not interested in her normal activities. Olive\u2019s mum indicates to you that she has lost her appetite and it has been difficult to get Olive to drink anything.
\nOlive has no past history but is allergic to peanuts.
\nYour buddy nurse asks you to perform a set of vital signs, however, before entering Olive\u2019s bedspace you remember that the hands of health care workers are the most common way that bacteria-causing infections are transmitted between patients in hospitals.
\nQuestion 5a. (approx. 150 words)
\nOutline the five (5) moments of hand hygiene and discuss the need for each moment.
\n(2.5 marks)
\nAfter completing hand hygiene, you perform a set of vital signs and note the following:
\n\u2022 Blood pressure 95\/60
\n\u2022 Radial Pulse Rate 153bpm regular
\n\u2022 Respiratory Rate 29bpm
\n\u2022 Sp02 94% RA
\n\u2022 Oral temp 389C
\n\u2022 She appears flushed and is hot to touch
\nQuestion 5b. (approx. 50 words)
\nUsing the track and trigger vital signs form at the back of this exam, correctly document these vital signs. Based on your assessment, what should your next action be?
\n(2 marks)
\nWhile you are performing Olive\u2019s vital signs, her Grandmother Jenny asks why you are using a tympanic thermometer, stating, \u201cI\u2019ve always used a thermometer that goes under the tongue, I\u2019m sure what you\u2019re using isn\u2019t as accurate.\u201d
\nQuestion 5c. (approx.70 words)
\nTo educate Jenny on the use of tympanic thermometers, you engage in a discussion on the advantages and disadvantages of tympanic thermometers. List six (6) advantages and six (6) disadvantages of the tympanic temperature measurement that you might highlight when speaking with Jenny.
\n(3 marks)
\nOlive\u2019s condition remains stable and she appears to be more engaged and has even managed to eat and drink something for dinner. However, Olive now appears to be developing a productive cough and you notice a respiratory wheeze. You speak with your buddy nurse regarding this change, she asks you what you think your next step should be. You reply that prior to escalating to Olive\u2019s doctor, you would like to perform a respiratory assessment.
\nQuestion 5d. (approx. 300 words)
\nDiscuss how would you perform a focused respiratory assessment in this case. Provide justification for each element and performing a respitratory assessment.
\n(9.5 marks)
\nQuestion 5e. (approx. 10 words)
\nOlive has now been prescribed 360mg Amoxycillin oral suspension twice a day for a chest infection. Using the diagram below calculate many mls of Amoxycillin you will administer.
\n(1 mark)
\nEnd of Examination<\/p>\n
Appendix One: Neurological Observation Conscious State Form
\nAppendix Two: Track and Trigger observations chart<\/p>\n","protected":false},"excerpt":{"rendered":"
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