Part One
This scenario introduces you to John Tack a 66 year old retired builder. John is an ex-smoker (10 years) and drinks 3-4 beers per night. He is slightly overweight. He is married to Jan (his second marriage) and has 2 children and 5 grandchildren. John and Jan live in a two story home on two acres about 45mins from Brisbane. Jan works part-time (2 days per week) at the local primary school as a librarian.
John presented to his GP clinic 6 months ago due to feeling fatigued, light headed as well as occasionally having -a funny feeling in his chest-. The doctor has ordered an ECG which showed Atrial Fibrillation. It is suspected that John may have had a TIA. The doctor prescribed John Amlodipine 5mg once daily. At his last appointment his BP was 150/90 and he had started taking his dog for a walk every day and trying to lose weight.
John has now experienced a left-sided thromboembolic stroke resulting in right hemiplegia, dysphagia, and expressive aphasia. He is NPO (nothing by mouth) and fed through a recently inserted nasogastric tube. John also has an IDC in for urinary incontinence and has been placed on a bowel regime. He is admitted to inpatient rehabilitation after 7 days in the acute care hospital.
On arrival his vital signs are as follows:
1. Height 1.67 metres
2. Weight 118.6 Kgs
3. Blood Pressure 185/95
4. Temperature 36.8 degrees centigrade
5. Pulse rate 88 beats/min and regular
6. Respiration rate 18 breaths/min and regular
During the first week in rehabilitation, John attends physical, occupational, and speech therapy. The therapists have identified rehabilitation goals focusing on: John's ataxic gait, visual impairment and limb incoordination. The Occupational Therapist (OT) has provided splints for John's hand and foot. The Physiotherapist has provided mobility aids and outlined what other general physiotherapy interventions he may require including passive ROM exercises. A falls risk assessment, waterlow assessment are conducted and John has Sequential Compression Devices insitu.
You noticed when you were assisting John out of bed to take him to the shower he was fearful and when you asked him what was wrong, he had difficulty in finding the right words. He also appeared to be getting angry, agitated and aggressive. John also kept pulling at his nasogastric tube and wanted to know how long he had to have a tube to feed him and when he can start eating regular food again. The first barium swallow showed aspiration of thin liquids.
At the end of the first week in the rehabilitation unit John has a repeat barium swallow that shows he is able to swallow safely with modifications. The speech therapist orders him to perform a chin tuck and double swallow when eating. John has had his IDC removed and is present at the family conference later that day. John is encouraged by the team to set some goals but you notice that he is reluctant to get involved. Jan is taking over the discussion and asking lots of questions.
Jan is asking about having John transferred down to Coffs Harbour as one of John's daughters lives down there and she can help Jan look after John.
John asks whether he would ever be able to drive again as he likes to go camping and fishing to -get away-.
Problem 1
• Mr Smith is to administer daily medication and understand the information provision. Intervention
• Ensure the prescription with 7 days' supply is provided and sent to pharmacy in time for discharge.
• Guarantee Mr Smith and his relatives receive relevant information regarding medication. Explain in an accessible manner.
• Arrange an out patients appointment. Present written and verbal information regarding the appointment.
• Inform the GP of Mr Smith discharge.
Rationale
Mr Smith has been prescribed aspirin 75mg following an ischaemic cerebral vascular
accident (CVA). The aspirin is given prophylactically and inhibits platelet aggregation which could otherwise result in a thrombus formation British national formulary (BNF) (2009).
Eighty percent of strokes result from ischemia, caused by a thrombus blocking the cerebral circulation therefore, preventative medication such as aspirin reduces the risk of a reoccurrence Greenstein and Gould (2009a).
It is important to provide Mr Smith with written and verbal information with regard to
instruction on how and when to take his medication, along with the dosage and possible side-effects he may encounter.
Educating Mr Smith on the need for medication and possible consequence of non compliance present him with an informed choice and reduces the risk of a drug induced re-admission. Reports suggest that fifty percent of older people may not take medicines prescribed for them as they have not received valued information about the benefits and risks involved Department of health (DOH) (2001).
The NMC (2008) say's that you must share information about people's health and regime's in a way they can understand. This facilitates informed choices and compliance.
Nurses have a responsibility to continue assessment of their patient's suitability for self-administration; the NMC's standards for medicines management (2008) standard 9 require you to acknowledge changes to a patient's condition and safety with regard to self-administration.
Evaluation
Assessing Mr Smiths understanding and capability of remembering to take his medication is of great importance as if he is likely to encounter difficulty, provision for pre-dispensed medicine or help from a carer can be arranged Wade (2007). Indirect questioning will provide some indication as to how much Mr Smith understands and will not make him feel inadequate, maintaining his dignity and respect. Needs to be in place prior to discharge.
An outpatient's appointment with a neurologist will maintain consistent specialist monitoring of Mr Smith's condition even though once discharged the GP is responsible for care in the community and continued prescribing. It is therefore vital that the GP has documentation on this hospital admission and any follow up appointments to be attended. GP should receive follow-up discharge summary within 24hrs of discharge and patient to attend within one week of discharge.
Case Study - Evidence Summary
Type: Evidence Summary
Learning Objectives Assessed: 1, 2, 4, 8
Due Date: 16 Aug 19 13:00
Weight: 30%
Task Description:
This assessment item requires you to review evidence related to nursing management of a
consumer/patient with a chronic condition utilising PART ONE of case scenario provided on Blackboard,
and create an evidence summary. The evidence-based practice tutorial in Module 1 will assist you with
this assignment. Using the EBP process outlined in the module you will need to address the following
areas:
ASSESS the patient: Start with the patient — a clinical problem or question arises from the care of the
patient.
ASK the question: Construct a well built question derived from the case study
ACQUIRE the evidence: Select the appropriate resource and conduct a search
APPRAISE the evidence: Appraise that evidence for its validity (closeness to the truth) and applicability
(usefulness in clinical practice)
• Select one (1) area of nursing care outlined in the case study
• Construct a question derived from the case study (PICO or PICOT format)
• Review currently available evidence.
• Summarise your evidence findings using the JBI Evidence Summary format.
Your review of evidence summary will include a:
• Written summary of evidence which follows the JBI Evidence Summary format and includes:
• Question
• Clinical Bottom Line (maximum 500 words)
• Characteristics of evidence
• Best Practice Recommendations
• Reference List — Vancouver style referencing
It is recommended that you access and read a series of evidence summaries for the Joanna Briggs
Institute which you can access from the University of Queensland Library.
Examples of nursing care provided could include:
• Nursing assessment of a person with a chronic condition,
• Patient and family health education
• Exercise Therapy
• Self-Care Management
NURS2105 Managing Chronic Health Issues — Assessment Item 1
Case Study: JBI Evidence Summary
Weighting 30%
Due Date: Friday August 16th 2019 (Week 4), 1pm
Assignment Overview:
This assignment brings together knowledge components from your course modules and IBL tutorials including: health promotion and prevention in chronic conditions, evidence based approaches to supporting individuals with chronic health issues, exploring person-centred care and self-management.
This assessment item requires you to review evidence related to nursing management of a consumer/patient with a chronic condition utilising the case scenario provided and create an evidence summary. The evidence-based practice tutorial in Module 1 will assist you with this assignment. Using the EBP process outlined in the module you will need to address the following areas:
ASSESS the patient: Start with the patient — a clinical problem or question arises from the care of the patient.
ASK the question: Construct a well built question derived from the case study
ACQUIRE the evidence: Select the appropriate resource and conduct a search
APPRAISE the evidence: Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)
Specifically, you will:
• Select one (1) area of nursing care outlined in the case study
• Construct a question derived from the case study (PICO or PICOT format)
• Review currently available evidence.
• Summarise your evidence findings using the JBI Evidence Summary format.
Your review of evidence summary will include a:
• Written summary of evidence which follows the JBI Evidence Summary format and includes:
o Question
o Clinical Bottom Line (maximum 500 words)
o Characteristics of evidence
o Best Practice Recommendations
o Reference List — Vancouver style referencing
It is recommended that you access and read a series of evidence summaries for the Joanna Briggs Institute which you can access from the University of Queensland Library.
Examples of nursing care provided could include:
• Nursing assessment of a person with a chronic condition,
• Patient and family health education
• Exercise Therapy
• Self-Care Management
Refer to the marking criteria when writing your assignment as this will assist you in calculating the weightings for the different sections of this assignment.
Additional Information:
You may use headings to denote each section of the plan
Provide a reference list in Vancouver Style Referencing Format.
Double line-space your assignment
Use a twelve point font in Times New Roman or Arial
Submit your assignment to Turnitin as a word document only — not a PDF.
Word Limit: The word limit applies specifically to the -Clinical Bottom Line- section of the plan. This section should be a maximum of 500 words. You must meet the prescribed word limit within a range of + or — 10%. A word count that is above or below 10% will be penalised through a reduction of 10% of the total mark available for the assessment.
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NURS2105 Managing Chronic Health Issues - Assessment Item 2
Case Study: Development of a Discharge Plan
Weighting 25%
Due Date: Monday 16th September 2019 (Week 9), 1pm
Assignment Overview:
This assignment brings together knowledge components from your course modules and IBL tutorials including: health promotion and prevention in chronic conditions, evidence based approaches to supporting individuals with chronic health issues, exploring person-centred care and self-management.
This assessment requires you to develop a discharge plan for a patient based on a case study. Within your discharge plan you are required to demonstrate the application of the clinical reasoning process by Levett-Jones (2018).
Specifically, you will:
• Identify three nursing focused problems that will be addressed for this patient
• For each problem identified, outline the intervention/s you propose to put in place for the patient (may be dot points)
• Provide an evidence based rationale for initiating this intervention for this patient. (must be referenced using peer reviewed sources only)
• Discuss how you will evaluate the effectiveness of this intervention, providing a timeframe for the evaluation.
Refer to the marking criteria when writing your assignment as this will assist you in calculating the weightings for the different sections of this assignment.
Additional Information:
You may use headings to denote each section of the plan
Provide a reference list in APA 6th ed. Format. Current UQ library APA Referencing Guide available at http:// guides.library.uq.edu.au/nursing-midwifery
Double line-space your assignment
Use a twelve point font in Times New Roman or Arial
Submit your assignment to Turnitin as a word document only - not a PDF.
Word Limit: 250 words for each intervention. The word limit applies specifically to the rationale section of the plan. You must meet the prescribed word limit within a range of + or - 10./0. A word count that is above or below 10% will be penalised through a reduction of 10% of the total mark available for the assessment.
Case Study - Discharge Plan
Type: Discharge Plan
Learning Objectives Assessed: 1, 2, 4, 7, 8, 9
Due Date: 20 Sep 19 13:00
Weight: 25%
Task Description:
This assignment brings together knowledge components from your course modules and IBL tutorials
including: health promotion and prevention in chronic conditions, evidence based approaches to
supporting individuals with chronic health issues, exploring person-centred care and self-management.
This assessment requires you to develop a discharge plan for a patient based on PART TWO of the case
study found on Blackboard. Within your discharge plan you are required to demonstrate the application of
the clinical reasoning process by Levett-Jones (2018).
Specifically, you will:
• Identify three nursing focused problems that will be addressed for this patient
• For each problem identified, outline the intervention/s you propose to put in place for the patient (may be dot points)
• Provide an evidence based rationale for initiating this intervention for this patient. (must be referenced using peer reviewed sources only)
• Discuss how you will evaluate the effectiveness of this intervention, providing a timeframe for the evaluation.
Refer to the marking criteria when writing your assignment as this will assist you in calculating the
weightings for the different sections of this assignment.
Additional Information:
You may use headings to denote each section of the plan
Provide a reference list in Vancouver style referencing.
Double line-space your assignment
Use a twelve point font in Times New Roman or Arial
Submit your assignment to Turnitin as a word document only — not a PDF
Word Limit: 250 words for each intervention. The word limit applies specifically to the rationale section of
the plan. You must meet the prescribed word limit within a range of + or — 10%. A word count that is
above or below 10% will be penalised through a reduction of 10% of the total mark available for the
assessment.
Criteria & Marking:
Discharge Plan Rubric NURS2105.pdf
More Information:
Discharge plan Instructions.pdf
Submission:
All courses reouire students to submit an electronic version of their assionment via Blackboard. Please
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Part Two
John responded well to his rehabilitation regime and after 5 weeks of intensive inpatient rehabilitation. Another family conference is organised to discuss John's progress and set new goals for discharge preparation. You review his progress notes in preparation for the meeting. He is now able to ambulate with a quad cane, ankle foot orthosis, and supervision. He is continent of bowel but experiences night time bladder incontinence. It is noted that he has homonymous hemianopia but is adapting to this slowly. His aphasia has improved though some nurses have noted that John continues to have the occasional emotional outbursts and having difficulty controlling this. He has a total of five medications to manage at home and has to check his own BP weekly. His swallowing has improved, but he must still perform a modified swallow with thickened fluids.
During the family conference John and Jan were given the opportunity to discuss their concerns about discharge. Given the improvements that John has made, Jan seems more confident in her ability to care for him at home alone. However she would like to continue her part-time job and is concerned about leaving John alone for extended periods of time as he still can't manage the stairs independently. John is optimistic about his future and would like to achieve his independence again. He is worried about the risk of another stroke and wants to know how to prevent this from happening again.
Armed with this information you set about creating a discharge plan in consultation with John, Jan and the multidisciplinary team.