NUR2203 - Nursing Care Patients With Complex Health Issues Assignment

Assignment Task

Task Description

This assessment requires students to plan, integrate and apply knowledge of safe nursing practice in the management of a patient with complex health conditions.

Rationale

The purpose of this assignment is to develop your critical thinking skills and clinical decision-making abilities in the care of a client with complex needs. In doing so, you are examining and applying the following standards for Registered Nurses for a patient's episode of care.

• Standard 1: Thinks critically and analyses nursing practice. Registered Nurses (RN) use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centered and evidence-based frameworks.
• Standard 2: Comprehensively conducts assessments. RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.
• Standard 3: Provides safe, appropriate, and responsive quality nursing practice. RNs provide and may delegate, quality and ethical goal-directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.
• Standard 4: Evaluates outcomes to inform nursing practice. RNs take responsibility for the evaluation of practice based on agreed priorities, goals, plans and outcomes and revises practice according to RN standards for practice Retrieved 

Course Objectives Measured

CLO 1. Evaluate the pathophysiological, pharmacotherapy and non-pharmacological management of acute exacerbation of illness, chronic diseases, and complex conditions.

CLO 2. Evaluate the principles of professional nursing practice for people with diverse health concerns within the Australian contexts, including a selection of regional, rural and National Health Priorities across the lifespan including the needs of culturally diverse, disadvantaged, and vulnerable groups with acute, chronic, and complex conditions.

Case Study:

Introduction

Clare Smith, a 63-year-old female, presented to the Emergency Department (ED) with a 3-day history of urinary issues. Signs and Symptoms: polyuria, dysuria, chills, febrile, nausea and vomiting, and malaise. Diagnosed with Pyelonephritis and admitted to the ward.

Background

Medical History:

• No allergies
• Early onset Dementia (diagnosed 1 year ago)T2DM GORD. recurrent UTI's urinary incontinence during UTI, chronic pain due to previous fractured ankle.
• Weight 75kg, Height 175cm.

Medications:

• Medications prehospital: Metformin 500mg BD; Esomeprazole 20mg daily, Paracetamol Osteo 1330mg Q8hr daily, Tramadol 100mg PRN, Multi vitamins 1 tablet daily, Fish Oil 2000mg daily.
• Medications on admission: Ampicillin 500mg Q6hr;
  Vancomycin 500mg Q6hr

Psychosocial:

• Clare lives at home with her husband Jim - lives on farm 1hr from town. Son (aged 33 years) - lives in a different state.

Assessment

On admission to the ward:

• Observations: temperature - 38.1°C; heart rate - 112bpm; blood pressure 145/72 mmHg; respiratory rate 22 bpm; Sp02 96% RA; pain - moderate as per Abbey pain scale; BGL 12.2mmoL.
• 18g peripheral intravenous cannula (PIVC) left cubital fossa in situ - VIP score 0, flushing well.
• MSU (mid-stream urine) results include WBC 22, Urea 3.7mmol/L, Creatine 65umol/L, Lactate 1.3mmol/L
• Blood cultures collected - awaiting results.
• Renal USS - no signs of calculi, obstruction, or abscess
• CT scan with contrast - positive for moderate parenchymal involvement.
• Kidney, ureter & bladder X-ray (KUB) - excludes obstruction.
• On examination: pain in the lower back and pelvic pain, left flank pain on urination..

Write an academic essay using the Clinical Reasoning Cycle (provided below).

Provide an Introduction

An introduction will provide clear scope about the direction of your assignment. This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.

Part A: Analyse the case to identify potential clinical issues and relevant nursing care

In this section of the assessment, you are required to:

• Discuss the pathophysiology of Pyelonephritis - include risk factors specific to Clare and her co-mobilities. Must be support by literature.
• Based on the case study presented above, identify and discuss two (2) priority nursing problems including rationales. Must be supported by literature.
• Discuss two (2) priority nursing interventions for each of the identified priority problems that you have discussed. Must be supported by literature.

Part B Discharge planning

• Develop and discuss discharge planning for either one of the following:
• Your discharge plan needs to consider Clare and her co-morbidities and incorporate family-centred care.
• Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan. 

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