NSB132 Integrated Nursing Practice - Clinical Case Study - Research Project - NMBA - Nursing Assessment Answer

NSB132 Integrated Nursing Practice - Jacob Muray Case Study - Nursing Assessment Answer

Assessment Task:

Learning Outcomes:

1. Apply and integrate the knowledge of the key NMBA Registered Nurse Standards for Nursing Practice, National Safety and Quality Health Service Standards, and National Health Priorities to enable effective clinical decision making, planning and action.

2. Apply the underpinning knowledge of anatomy, physiology and pathophysiology to support evidence-based decisions for planning and action.

3. Apply clinical reasoning and decision-making frameworks and beginning level communication skills to the development of foundational person-centred care plans for individuals across the lifespan.

Task description:

Developmental and chronological age, gender, life experiences, support, and health status are just a few things that can impact how a person responds to injury and illness. This assessment requires you to compare and contrast the current literature around evidence-based practice related to meeting the individual care needs of the cases in relation to ONE priority nursing problem.

What you need to do:

Select ONE priority problem (from the list below) relevant to the case scenarios (go to page 5 of this document). Priority health problems: (choose 1 only)

1. Experience of substantial pain related to bone fracture OR

2. Falls risk due to altered mobility OR

3. Potential for impaired skin integrity related to altered circulation.

Using current and relevant peer-reviewed evidence, write an academic essay to discuss the research related to the following points:

a) From John and Jacob’s case study explain how the underlying pathophysiology of the presenting injury causes the problem you have chosen.

b) Considering the chronological and developmental age of the cases, describe how you would comprehensively assess John and Jacob to identify their care needs and modifiable risk factors related to the problem you have chosen.

c) Both cases are being sent home. Define what the goal for care related to the chosen problem would be (use the SMART framework to write the goal).

d) Choose TWO evidence-based interventions (one must be a nurse initiated intervention) that you would instruct Jacob’s mother and John’s wife to implement while at home to address the goal for care.

Tip: The interventions must consider the context of the cases and you must justify your choice by critically analysing the current evidence.

e) Compare and contrast the similarities and differences in methods to evaluate the effectiveness of the interventions.

f) In relation to the effectiveness of the intervention, discuss the instructions you would give Jacob’s mother and John’s wife related to evaluating signs and symptoms to observe for that would indicate that the intervention had not been effective.

Case Studies

Scenario 1: Jacob Murray

Situation

Jacob Murray is a 7-year-old boy being treated in the emergency department for a fractured left tibia.

Background

Jacob was bought to the emergency department by his mother Fiona. Jacob was climbing on the kitchen table trying to reach an ornament on a shelf and he fell. Following the fall Jacob started to cry and was inconsolable. He has not walked since the fall. Mum states that there were no other injuries.

Assessment

Jacob has no previous medical history and is up to date with his immunisations. In the emergency department, an X-ray was taken and showed an undisplaced spiral fracture of the left tibia. Jacob has been teary and holding his mother while in the ED and screams when moved (FLACC score 8).

Assessment data on admission: Temperature 36.5 0 C, BP 105/70, HR 96, R 22, SpO2 100% on room air, weight 26kg, alert and follows instruction, able to wiggle toes but is unable to weight bear, a limb is warm with normal sensation.

The left lower leg is swollen with an inflamed area on the anterior mid shaft 5cm x 3cm. No deformity is evident.

Jacob was given Paracetamol 390ml liquid and plaster of Paris back slab was applied.

Pain score 60 minutes after treatment was FLACC score 6.

Recommendations

Jacob is to remain non-weight bearing until reviewed in 7 days. Please provide Jacob’s mother with information about Jacob’s ongoing care and make an appointment for him to attend the fracture clinic in seven days to have a below-knee fibreglass cast applied.

Scenario 2: John Ridges

Situation

John Ridges is a 72-year-old man being treated in the emergency department for a fractured right tibia.

Background

John was bought to the emergency department by his wife and daughter using private transport. John was using a ladder to reach kitchen cabinets when he fell from a height of 2 metres. His lower right leg was trapped in between the rungs of the ladder when he fell. He has been experiencing severe pain in his right leg mid shaft since and is not able to weight bear. John states that he was amazed that he didn’t do any other damage.

Assessment

John has a history of osteoporosis with no active treatment for this. He is usually well and is up to date with his immunisation. In the emergency department an X-ray was taken which showed an undisplaced transverse fracture of the right tibia. John stated that his pain was 7/10 and he grimaced whenever he was moved. John stated ‘I’ll be right, just give me a couple of panadols’.

Medications: Nil others

Assessment data on admission: Temperature 36.50 C, BP 120/80, HR 90, R 22, SpO 2 100% on room air, Weight 85kg, alert and orientated, able to wiggle his toes but is unable to weight bear, a limb is warm with normal sensation.

The right lower leg was swollen; bruise 7cm x 4cm anterior mid shaft. No deformity is evident.

Paracetamol 1000mg oral was given and plaster of Paris back slab was applied.

Pain score 60 minutes after treatment was 5/10.

Recommendations

John is to remain non-weight bearing until reviewed in 7 days. Please provide John’s wife with information about his ongoing care and make an appointment for him to attend the fracture clinic in seven days to have a below-knee fibreglass cast applied.

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