NUR231 Task 3 Assessment

This assessment comprises two parts: Part A - The goal is to provide professional-focused information on a medication; Part B - The goal is to provide person-centred information on a medication. As a nurse, you will be required to interpret and use pharmacotherapeutic information and reliable clinical evidence to support your colleagues and patients in the quality use of medicines (QUM). You will interpret and use evidence to inform safe and comprehensive practice when designing professional-focused and person-centred medication information.

Assessment Information:

• Please use the Task 3 Response template when answering assessment questions.
• This is not an essay and does not require an introduction or conclusion.
• Use the third person in your responses, and all responses are to be written using the correct medical terminology (not in layperson’s language) (unless otherwise specified).
• Do not use bullet points in your responses. Use academic writing.
• Use font 11 font with 1.5 line spacing and a normal margin (2.54 cm).
• Approximate word counts have been provided to guide you in each section.
• Use APA 7^th edition referencing.
• References are to be placed in the section at the end as indicated, and the reference list always starts from a new page.
• References should not be older than 10 years, except when referring to historical information or landmark studies.
• The word count is 1500 words. A variance of +/- 10% of the specified word count is acceptable. The reference list is not included in your overall word count. Be aware that in-text citations are included in the word count.
• Part of the assessment for academic writing relates to being able to write concisely within the word limit provided. This may be a significant problem if you have included important information after the final word limit because the marker will cease marking when you have exceeded the maximum accepted word count of 1650 words.

Part A: The goal is to provide professional focused information on a medication

Consider the patient’s situation

Mrs Mary Barrett is a 52-year-old woman who has a diagnosis of type II diabetes mellitus. She has been receiving optimal metformin monotherapy for the last 7 years (1000 mg twice daily) and tolerates the treatment well. Mrs Barrett currently weighs 100 kg (height: 160 cm). Mrs Barrett is also on metoprolol 25 mg twice a day for her hypertension. She is on a disability pension (she had a severe back injury 2 years ago from a car accident) and lives with her husband in a regional city in Queensland. Her husband does occasional casual work. About 6 weeks ago, Mrs Barrett was diagnosed with rheumatoid arthritis and commenced on prednisone 5 mg daily. Over the last 2 months, Mrs Barrett has felt more thirsty than usual, often tired and weak, sometimes with blurred vision. She did not want to see a specialist as it would cost too much for her until the symptoms got worse.

Following her specialist appointment, Mrs Barrett is referred and admitted to the ward of a hospital for further medication management as her blood glucose level (BGL) is consistently above 28 mmol/L. The endocrinologist has prescribed a morning (breakfast) dose of intermediate-acting insulin (isophane [Humulin NPH, Protaphane]) at a dose of 30 units. On day 1 and day 2 of Mrs Barrett’s admission, her BGL was not well controlled, and by day 3, the endocrinologist had changed the insulin into a basal-bolus regime, including insulin aspart (Novorapid) before each meal and insulin glargine (Optisulin) at 2200 hours (both types in cartridge form).

Criterion 1: Application of pathophysiological concepts to justify clinical decision-making

Collect cues/information (approx. 250 words)

1. As a nursing student, your clinical facilitator has allocated you to care for Mrs Barrett. After the morning handover, you are asked to explain to the clinical facilitator the pathophysiology of type II diabetes mellitus, which is now requiring insulin. What is your response?
2. On admission, the patient’s HbA1C is 10%. What does this indicate?
3. What two life-threatening complications can occur because of hyperglycemia? Please provide a brief explanation of each complication.
4. How does lifestyle management, such as dietary intake and physical activity and exercise, help manage type II diabetes mellitus?

Criterion 2: Application of pharmacotherapeutic concepts to explain safe medication practice

Process information (approx. 350 words)

1. Mrs Barrett is disappointed that she has to administer two different types of insulin and continue to take metformin. Explain to your clinical facilitator how Mrs Barrett’s prescribed basal-bolus regime works to achieve glycaemic control.
2. Explain the dosage and administration of metformin and its common drug interactions with other medications Mrs Barrett takes, including metoprolol and prednisone.

Criterion 3: Evidenced based argument and justification of decisions

Identify problems/issues (approx. 150 words)

You commence a night shift at 2130, and the afternoon shift nurse has handed over to you that Mrs Barrett is due for her insulin at 2200 hours. You check Mrs Barrett’s BGL, which shows 3.2 mmol/L.

1. Apply one Principle from the Code of Conduct for Nurses, demonstrating your safe care to Mrs Barrett. You do not need to describe your actions but discuss how the immediate nurse responses could change outcomes in a time-critical, potentially life-threatening situation.

Take action (approx. 200 words)

As the student nurse, you decide to take action, notifying the clinical facilitator and offering Mrs Barrett fast-acting and slow-acting carbohydrates as per Diabetes Australia’s advice in managing hypoglycemia while checking BGL regularly.

2. After your actions, Mrs Barrett is feeling better and her BGL is 4.5 mmol/L at 2200. Explain how you will deal with the insulin at 2200 hours for Mrs Barrett and the rationale of your action.
3. Mrs Barrett’s blood test shows her creatinine of 180 umol/L (normal values: 45-90umol/L). Explain which medication may require a dosage adjustment and why.

Part B: The goal is to provide person-centred information on a medication

*Integrate the ACQHS Quality Use of Medicines principles into any of your responses below.

Mrs Barrett and her husband require information and education about diabetes and medication management before discharge. The endocrinologist has ceased insulin and commences Mrs Barrett on empagliflozin. Standard 3.2 of the NMBA Registered Nurse Standards for Practice requires nurses to ‘provide the information and education required to enhance people’s control over health’ (2016, p. 4).

Criterion 4: Application of social justice principles and the Quality Use of Medicines when describing mechanisms of action, adverse effects, benefits, risks and management of pharmacotherapy using person-centred approaches (approx. 550 words)

Take time to educate

1. Mrs Barrett is struggling to understand the rationale of adding this extra oral antihyperglycemic agent (OHA), empagliflozin, to her existing metformin. What information would you give her about the long-term benefits of having empagliflozin and metformin and closely monitoring her BGL?
2. What information would you provide to Mrs Barrett and her husband about taking these medications following discharge?
3. Identify one aspect that you would have to consider in relation to social justice, explain how this could impact Mrs Barrett’s ongoing health needs, and offer one potential evidence-based solution to address this.
4. Mrs Barrett comes to you saying that she really enjoys her walking group and wants to continue after discharge. She tells you her goal is to hike through some dense bush tracks near her home. What issues in relation to increasing her exercise do you need to discuss with Mrs Barrett? How will these affect her ongoing glycaemic control?

Note: You can use layperson’s language in third-person academic writing for questions under Criterion 4.