Word Length: 2000 words
Notes: Written assessment - Situational Case Study
This assessment relates to:
Learning Outcomes 1. 2. 4. 5
(Option 1)
Case Study
Clare Giardini is a 70-year old women, who frequently presents to both her local General practitioner and also the local emergency department. In the last three months she has presented to the local hospital with shortness of breath six times. On occasion she misses her local GP appointments and runs out of her medications whilst waiting for her pension.

Social History
She lives happily on her own and has two adult children who live several hours away. Clare’s husband passed away over five years ago from complication of his diabetes and cardiac disease and she cared for him during his last few years Clare lives in town in government housing and she enjoys knitting and playing with her pet cats. Clare grew up in her local town and has never left in her 70-years she has many friends that she meets at the local club for lunch twice a week.

Medical History
Clare has a history of osteoarthritis, non-insulin dependent diabetes and hypertension. A recent echocardiogram showed systolic dysfunction and a poor left ventricular ejection fraction, and she is noted to have chronic controlled atrial fibrillation.

Medications
• Metformin
• Paracetamol
• Diclofenac
• Quinapril
• Furosemide

Objective data
• Temperature 36.8
• Radial pulse 121 beats per minute and irregular
• BP 92/60 mmHg
• Cardiac system S1 and S2, present, no murmurs
• Respirations: 32 breaths per minute and shallow
• Lung sounds: crackles in both bases
• BGL: 8 mmol/L
• HbA1C: 75mmol/mol

Subjective data
• Pain is 4/10
• Fatigue
• Orthopnea
• Nocturia up to six times per night

You can choose option 1 or option 2 to write this assignment.
Task: Provide a Clinical Handover (option 1)
You are the registered nurse working in the medical ward and are preparing Claire for discharge from the hospital. From the information you have read above regarding Clare Giardini, consider the following questions below in providing a clinical handover to Claire’s chronic care nurse manager working in primary health care. Provide the relevant references to support your clinical handover
• Identify the relevant data that you would monitor immediately from the case study above and what further nursing assessments would you perform?
• Review the medication list and identify any medications that may be contraindicated?
• What further test/s and medications would you anticipate the Medical Officer will order?
• Review her medical diagnoses, which is diagnosis if any explains her clinical presentation and recent visit to the local hospital?
• What social factors are contributing to her increased exacerbation of her chronic condition/s?
• When planning Clare’s discharge from hospital what further education would you provide for her ongoing care at home?
• Two days after Clare’s discharge you make home visit what are the priority nursing assessments and interventions required?

(Option 2)
Clare Giardini is a 70-year old women, who frequently presents to both her local General practitioner and also the local emergency department. In the last three months she has presented to the local hospital with shortness of breath six times. On occasion she misses her local GP appointments and runs out of her medications whilst waiting for her pension.

Social History
She lives happily on her own and has two adult children who live several hours away. Clare’s husband passed away over five years ago from complication of his diabetes and cardiac disease and she cared for him during his last few years Clare lives in town in government housing and she enjoys knitting and playing with her pet cats. Clare grew up in her local town and has never left in her 70-years she has many friends that she meets at the local club for lunch twice a week.

Medical History
Clare has a history of osteoarthritis, non-insulin dependent diabetes and hypertension. A recent echocardiogram showed systolic dysfunction and a poor left ventricular ejection fraction, and she is noted to have chronic controlled atrial fibrillation.

Medications
• Metformin
• Paracetamol
• Diclofenac
• Quinapril
• Furosemide
Objective data
• Temperature 36.8
• Radial pulse 91 beats per minute and irregular
• BP 112/65 mmHg
• Cardiac system S1 and S2, present, no murmurs
• Respiration rate: 22 breaths per minute and shallow, SpO2 94%
• Lung sounds: crackles in both bases
• BGL: 8 mmol/L
• HbA1C: 75mmol/mol

Subjective data
• Pain is 2/10
• Fatigue
• Orthopnea
• Nocturia up to six times per night

Task: (option 2)
You are the registered nurse working in the medical ward and are preparing Clare for discharge from the hospital into the care of a chronic care nurse manager working in primary health care. Discuss the following to demonstrate your understanding of Clare’s ongoing care.
- Identify all data that is relevant to complete a comprehensive nursing assessment for Clare’s chronic condition/s and priorities her current care needs specific to her presentation as part of the nursing assessment.
- Identify all contributing factors for Clare’s chronic conditions and current health exacerbation.
- Identify all nursing assessments, interventions and strategies for Clare to effectively manage her chronic condition using a self-management approach.
- Discuss the literature on the nurse’s role in chronic disease self-management.
- Discuss primary & secondary health promotion & education strategies appropriate to Clare.