NRS73005 : Portfolio skills – Emerging Practitioner - Medical Science Assignment Help

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Assessment 2 (60%): Portfolio skills NRS73005 – Emerging Practitioner

This assessment is designed to support students to understand how to build a portfolio using experiences from practice. A beginning portfolio is built based on this assessment as students work through how they best meet the requirements and standards of a registered nurse graduate. This assessment uses case studies to facilitate the understanding of how everyday practice can be applied to demonstrate meeting Professional Nursing Standards and the selection criteria applicable to graduate nurse.

Select two case studies from those supplied below. Follow the instructions provided and address all the following three section (A, B, C and D) in your assignment. You may use this workbook or complete in a word document. Either way, your document or workbook must be submitted through turnitin as a PDF.

Section A (1000 words: 500 per case study)

Consider the nursing management of two patients (out of the four case studies provided in Section A at the end of this workbook) and address each under headings provided below each case study. You will be required to provide references to support your nursing thoughts/actions.

Case study A: Community care

You are working in a community health clinic in Dubbo. George, 47, has presented with shortness of breath and high blood sugar. He has a history of hypertension, diabetes and smoking. He is overweight and has a sedentary lifestyle.

George has a large family who reside with him in social housing. This includes grandchildren and cousins. George does not have high literacy levels, is 47 years of age and has a great sense of humour. He is a gentle caring man and proud of his ATSI heritage and his family.

1. Identify primary concerns re: the risks/complications that could arise from the patient’s associated condition and your nursing thoughts/actions.

2. Discuss the potential impact of the patient’s condition/situation on the patient and significant others and your nursing thoughts/actions.

500wds

Case study B: Emergency Department

Rupa Deepak, 37, presents to your emergency department with small scratch on her left wrist from a rusty nail. The wound appeared inflamed and Rupa tells you that she and grandfather-in-law were sorting through an old crate of junk that was to be sold at a vintage fair when she injured her wrist on the nail. Thinking nothing of it she put a band aid on the injury and continued sorting the crate. In the days that followed, Rupa’s husband reported that she has developed a cold, it got rapidly worse, and when he returned home late after working he found her sick in bed and as "cold as ice". At first, he thought she had "pneumonia or something".

On examination, you note that Rupa was also experiencing shivering and muscle pain, her skin was a bit mottled, her speech had become a bit slurred and she did appear confused at times.

3. Identify primary concerns re: the risks/complications that could arise from the patient’s associated condition and your nursing thoughts/actions.

4. Discuss the potential impact of the patient’s condition/situation on the patient and significant others and your nursing thoughts/actions.

500wds

Case study C: Paediatrics

Jasmine is a 9-year-old girl who is under your care on the Paediatric Ward. Jasmine has just been admitted to back the ward, following an open reduction, internal fixation of a fractured forearm. Jasmine is otherwise healthy, fully vaccinated and has no significant medical history. Jasmine is sharing a room with another 6-year-old girl, who was admitted for the treatment of aspiration pneumonia resulting from chronic reflux. After being settled in the room, Jasmine’s mother notices that the child in the other bed is coughing and sounds unwell. Jasmine’s mother approaches you in the corridor, and loudly demands that you move Jasmine to another bed right now - away from ‘sick people who could make her sick’. Jasmine’s mother loudly complains that the last thing her daughter needs is a cough or cold, and that if Jasmine is not moved now, she will personally go and find the doctor to complain.

You are a New Graduate nurse, and have not dealt with this before. You ask Jasmine’s mother to wait while you speak with the nurse in charge about the situation. Jasmine’s mother stands near the Nurse’s station watching as you approach the RN in charge, occasionally looking down to type something on her phone. The ward is very busy, and there are no other beds currently available. The RN in charge confirms that the other child in Jasmine’s room is not considered infectious and that Jasmine will need to stay there. The medical plan for Jasmine is that she needs to stay in hospital overnight for vascularity observations, pain relief and IV antibiotics.

The RN in charge asks you to explain this to Jasmine’s mother, and to let her know if there are any further problems. You approach Jasmine’s mother, who stands with her hands on her hips during your explanation. She shakes her head and says ‘really not good enough’ before turning and going back into the room with Jasmine. You follow her to check on both Jasmine and the child in the bed next to Jasmine. Jasmine complains that her arm is hurting, and appears to have been crying. Jasmine’s mother is talking on her phone and has her back to you and to Jasmine. Jasmine’s observations are within normal limits, and she is lying quietly in bed. She tells you that her arm is hurting ‘quite a bit’. Her vascularity obs appear normal.

Upon reviewing Jasmine’s medication chart, you note that Jasmine is written up for both regular and PRN pain medications. While you are reading, the RN in charge announces that it is time for your tea

break, and that she will take over the care of your patients for 20 minutes while you have your break. You hand over to the RN in charge that Jasmine is in pain and is written up for pain medications, which she has not been given. You also confirm that you spoke with Jasmine’s Mum about the unavailability of a different bed, and that she didn’t seem happy.

When you return from your tea break, you do a quick routine check of your patients. You note that Jasmine is sleeping, and that her Mum is not in the room. You check Jasmine’s records and see that while you were on your tea break, two other nurses on the ward have given Jasmine her prescribed Paracetamol as well as her PRN pain relief. You sit down to read through notes from the surgery, and discover that paracetamol was given intraoperatively less than 2 hours ago. This was charted in the surgical notes but not on the mediation chart. Jasmine’s mother walks past the nurse’s station and back into Jasmine’s room, looking back at you over her shoulder on her way past. Your four patients are all due for observations, and two of your patients are due for IV medications. The RN in charge is not present at the nurses station, nor are the other two nurses on your team.

1. Identify primary concerns re: the risks/complications that could arise from the patient’s associated condition and your nursing thoughts/actions.

2. Discuss the potential impact of the patient’s condition/situation on the patient and significant others and your nursing thoughts/actions.

500wds

Case study D: Aged Care

Mary is a 91 year old female residing in your nursing home. She was born overseas and speaks both English and Italian. She has mild dementia related symptoms, PMR (Polymyalgia rheumatica), is doubly incontinent and experiences episodes of anxiety. Mary is also deaf in her right ear and has significant macular degeneration. Mary’s weight is 47kgs and she is of small stature at 5ft, 2 inches (157cms). She has both upper and lower dentures, moderate kyphosis, and requires a walking frame to ambulate over short distances. A wheelchair is preferred for long distances or on outings.

Her advanced care directive is to remain in the nursing home unless a surgical repair (fracture or sutures) are required or IVI antibiotics are to be administered. Although she has five children, they are estranged and do not get along with each other. Her daughter Joan is the person responsible and the primary contact for Mary in emergency only. She is not be contacted overnight, unless her mother has passed away.

Mary requires full care including assistance with showering, toileting, dressing and the cutting up of meals. Her anxiety exacerbates when she is rushed or has new staff attending to her. Her poor eyesight and deafness contribute to her anxiety if she cannot understand what is going on. She will also frequently to be confused to time and place. Her favourite things to do are to listen to the news, particularly the Italian radio channels, be outside in the garden and to participate in concerts provided at the home. She is an early riser at 0430hours and enjoys and afternoon nap after lunch. Mary is generally a quiet person who keeps to herself and apart from her anxiety, does not exhibit aggression. She does, however experience pain from her PMR and requires a titration of cortisone to address this

from time to time. She also becomes embarrassed if she is faecally incontinent. Mary has urgency and ASB (asymptomatic bacteria) and as such needs to be toileted shortly after meals.

Mary’s is allergic to Sulphate and her medications are as follows:

· Cortisone 5mg daily

· Coloxyl with Senna 2 tabs at night

· Pan codeine BD · Lorazepam 2mg at night

· Fentanyl patch 25micrograms (change third daily)

· Frusemide 40mg daily

· Prolia injection every 6 months · Ranitidine 150 mg daily

· Cortisone 5mg daily PRN as directed by physician for increased pain from PMR.

· Movicol 1 sachet PRN · Lorazepam 2mg PRN (maximum dose 6mg per day)

You are working on a night shift as the solo RN with 4 personal carers, one of whom is a certificate IV. The nursing home is 60beds and the dementia unit of 10 residents has been particularly busy during the evening with adverse events of aggression between two male residents, one of whom was recently admitted. As a consequence, your handover included some extra tasks of documentation and stocking and counting of the S8 cupboard and preparing clinical trolleys for the next day. You have two residents on end of life care with syringe drivers insitu and one resident in acute care due to a recent fall. Mary has been anxious all evening and difficult to settle.

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