NURS13134 – Community Nursing Perspectives - Assessment 2
Due Date: Thursday, 12th of May, 2018. 11.45pm
Word Count: 2500 words +/- 10%
Assessment Two for NURS13134 – Utilising the research from your first assessment, you will be required to consider and discuss the subacute and community management of a person with a diagnosis of cystic fibrosis. In this assessment, you will be introduced to Emily at various points across her lifespan in the form of case study notes.
Segment 1 - Introducing Emily
This is Emily. She is a lively and outgoing, almost 3 year old. She is confident and talkative. Her mother, Lenka, has brought her to your clinic today. Lenka is a political asylum seeker from Slovakia and has been in Australia for 3 years. She was pregnant with Emily when she left her own country. When Lenka is asked any questions about Emily’s father, she becomes very guarded and gives very little information.
While Lenka speaks English very well, her medical history is quite sparse. She has told you that she thinks other members of her extended family might have had cystic fibrosis. When you question her further on this point, she states more than one cousin died quite young and had issues with their breathing.
Lenka states Emily had some “bowel issues” when she was born but cannot give you any further information other than Emily’s bowel motions are usually frequent, loose and very smelly. Lenka also states Emily had many tests after she was born, and then she was told Emily was diagnosed with cystic fibrosis. She has a large appetite but after weighing and measuring Emily, you note that she is on the lower end of the weight/height for age scale.
When she was about 6 months of age, she became ill and Lenka tells you she was producing lots of phlegm and was in hospital for some time.
Emily takes several medications but Lenka did not bring them with her, nor does she remember the names.
Emily has come to the clinic today for review post her last hospitalisation and for parent support and education.
Segment 2 - Adolescent Emily
Emily is 15 years old and in year 10 at high school. Emily has been diagnosed with pancreatic insufficiency but does not suffer from cystic fibrosis related diabetes mellitus. She has been hospitalised 5 times in the last 10 years for pulmonary infections. She lives with her mother, Lenka. She is a high achieving student and is motivated to study and maintain her high grades. She attends full days at school, after school music and maintains her medical regime. She has missed 6 days of school in the last year due to cystic fibrosis.
Her daily routine includes waking at 5.30am to allow time for her physical therapy and medications. After commencing with bronchodilators and a mucolytic agent, she spends at least 45 minutes in a ‘vest’. This is an electronically driven percussion device. (For further information on the vest, see the YouTube link on the Moodle site). This is usually interrupted by coughing episodes, which can be prolonged and tiring. Emily then continues with her breakfast and the multitude of medications she must take. These include prophylactic antibiotics, NSAID, anti-ulcer and antacid agents, antihistamine agent, pancreatic enzymes and vitamins. Before leaving for school, she takes another bronchodilator via nebuliser and an intranasal corticosteroid. She takes more medications with her lunch at school including an NSAID and pancreatic enzymes.
When she returns home from school, her mother performs manual physical therapy with postural drainage. This comes with the coughing episodes and can take over 45 minutes to an hour.
With her evening meal, Emily takes more medications including NSAID, antibiotics and pancreatic enzymes. She then takes another bronchodilator nebulizer and dons her vest for another 45 minutes before retiring to bed after 10.30pm.
Emily and her mother Lenka have to come to your clinic for ongoing support.
Emily states the most bothersome symptom to her is the relentless coughing and shortness of breath, especially first thing in the morning. She states she does not mind the chest physiotherapy even though it does take a significant amount of time through the day.
Emily tells you that her medical regimen is bothersome with the number of oral and inhalation medications. She states she tries to be consistent with taking her medication but sometimes ‘forgets”. Especially at school.
Emily tells you that her team have started to discuss transition to adult health care for her cystic fibrosis management. This makes Emily and Lenka quite distressed as they have had a long term and trusting relationship with their team.
Segment 3 - Adult Emily
Emily is 27 years old. She is engaged to Matt and they have been a couple since high school. They have no children, but Emily has an assistance dog in the form of Ollie, a well-trained standard poodle. Emily’s mother passed away a few years ago as a consequence of a motor vehicle accident. Emily has no other family in Australia. She has recently had to resign her position as a teacher as the demands of her health, interventions and management have become too much. Emily’s health has deteriorated to the point her health team have told her she needs to be placed on the transplant list for a lung transplant. Emily states she is unsure of how she feels about this. However…
While waiting for her new lungs, Emily’s health has deteriorated to such an extent that she is no longer fit for surgery. Emily has stated that she is tired and no longer wishes to fight. She tells you she just wants rest. After discussion with Emily and her team, it is agreed that she should be for end of life care and is transferred to the Palliative Care Team.
For this assessment, you are required to select ONE segment from Emily’s lifespan to examine. This should be clearly identified in your introduction.
Your assessment should be written in essay form, including an introduction, the body of your work and a conclusion.
Should you refer to the research items from Assessment One, these should be appropriate to the segment you have chosen. You may choose to undertake further research to provide an evidence based rationale for your responses to the segment from Emily’s lifespan you have selected.
You have a word count of 2500 words, +/- 10%.
For your chosen life stage segment, you will need to include the following:
• A discussion and rationale of self-management strategies.
• A discussion and rationale for the community and/or support services Emily may have accessed.
• Demonstration of your awareness of cultural and social issues relevant to Emily.
• A discussion and rationale for the safe use of technology to facilitate person centred nursing care. Here you might consider communication between different services or community and acute.
For your chosen life stage segment, using critical thinking skills, consider the educational/informational needs of Emily and/or her mother or partner. Also, consider management plans.
Consideration of legal and ethical issues and frameworks in relation to Emily’s care should be evident in your discussions.
Your assessment should be addressed from a Community Nursing perspective.
• Pick ONE segment from Emily’s lifespan to address.
• Write in essay style - introduction, body and conclusion.
• Word Count - 2500 words +/- 10%
• Headings are not required.
• Referencing, both in text and reference list should be in APA Style as per the APA Referencing Guide.