BACHELOR OF NURSING SCIENCE
NUR 241 – Contexts of Practice: Health Alteration Case Study
SEMESTER 1, 2018
Copyright USC @2010
Course Coordinator – Dr Marc Broadbent
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NUR 241 HEALH ALTERATION – ASSESSMENT TASK 3 – CASE STUDY
This case study assignment is based on the theory and principles covered in lectures, tutorials and associated resources. It is designed to develop knowledge and problem-solving skills that apply to decision-making and safe nursing practice in complex health care settings.
Submission: Submit on or before Friday of week 11 online via safe assign by 2359.
Formatting: Format using 1.5 line spacing and font size 12.
Word Count: 2,500 words – word count includes in text references but not the reference list.
Marking Criteria: All questions must be completed according to the marking criteria in order to achieve a satisfactory grade.
References. Please use academic sources of information such as the texts used in this course and peer reviewed journal articles. Other trustworthy sites include Governmentoperated websites. Harvard reference style is required.
• There is no requirement for an introduction or conclusion.
• The case study assignment is an Individual Assessment Item.
• You may work collaboratively with others students to understand concepts in this course but your answers must be your individual research, interpretation and application of the materials.
• Answers that show evidence of deliberate copying from other student's work will be considered as collusion. Answers that show evidence of deliberate copying from authors will be considered plagiarism, investigated, and academic penalties apply. For more information see the Bb+ assessment area and course outline re: Student Academic Misconduct.
• ***Remember to save a copy of your work on an external drive or USB.
THE PATIENT WITH PNEUMONIA
Consider the patient Situation
Mr. Edward Hunter, an 89-year old widower, was admitted to your medical ward with hypoxaemia (oxygen saturations 82% in the ambulance) and a recent history of viral influenza. He has been receiving intensive home support from the ‘acute care in the home’ nursing team for over 6 months, which includes home oxygen therapy as his chronic obstructive airways disease worsens limiting his ability to care for himself at home.
Within 24 hours of admission Mr. Hunter’s condition continues to deteriorate. He is receiving 10 liters of oxygen via a Hudson mask. Severe dyspnoea renders him immobile and barely able to eat. He has little appetite and is cachexic. Overnight night he becomes quite restless, breathless, tachypnoeic and develops a productive cough. The respiratory team reviews Mr. Hunter because he was experiencing increased pleuritic pain on inspiration and was expectorating rust colored sputum. Subsequently, he was diagnosed with pneumococcal pneumonia and was prescribed cough suppressant, a sedative and antibiotics.
Consider the patient situation
Question 1. Mr. Hunter is 89 years old. What are the specific considerations a Registered Nurse should understand in relation to the clinical manifestations of pneumonia in the older person?
Collect information: pathophysiology
Question 2. Outline the pathophysiology of altered ventilation and diffusion in relation to Mr. Hunter’s pneumonia.
Yesterday evening, in handover to the night duty nurse, it was explained that Mr. Hunter was becoming confused and drowsy during the day but was easily roused and orientated once woken and maintaining oxygen saturations 92 -94%.
Mr. Hunter is clearly distressed and extremely dyspnoeic.
The consultant reviews Mr. Hunters medication and prescribes
Oxygen (high flow) to achieve oxygen saturation 92%
Benzyl penicillin 1.2g IV 6 hourly for a total of 7 days
Interpreting information can be difficult if you process it subjectively based on your own past experiences, beliefs and opinions. By critically appraising the information about the various types of pneumonia, it is possible to make a reasoned judgment about Mr. Hunter’s future management.
Question 3. What are the differences between hospital acquired pneumonia (HAP, community acquired pneumonia (CAP)and aspiration pneumonia?
Part 2. The consultant also requests that Mr. Hunter has 4 hourly observations of his vital signs and to report a heart rate above 100 and oxygen saturations below 90% and a temperature above 38.5c.
The registered nurse recognises that Mr. Hunter requires care beyond that requested by the consultant.
Question 4. Explain the nursing care required the patient with pneumonia. Provide a rationale for all elements of the care provided that reflects the particular needs of Mr.
Make reasoned judgments
Question 5. The consultant has asked to be informed if Mr. Hunters heart rate rises above 100, oxygen saturations fall below 90% and his temperature rises above 38.5c. In the context of a patient with pneumonia, explain the rational/s for monitoring the specific parameters requested by the consultant.
Part 3. The central principles of social justice are Self Determination, Equity, Access, Rights and Participation. One morning you notice that Mr Hunter agitated is more confused and agitated than normal and his oxygen mask is on the floor. He requests that his oxygen be stopped as he doesn’t like it as it is causing him discomfort. The RN recognises that he has a right to control his own treatment, however understands the impact this will have on his health.
Question 6. Explain (1) the strategies you would use to ensure Mr. Hunter understands the implications of his decisions to refuse the oxygen and (2) the actions you would take to manage the situation.
Reflection: Question 7.
What are the two most important things that you have learned from this scenario and why?
What actions will you take in your future practice because of what you have learned from this scenario?
In your reflection identify which of the NMBA Registered Nurse standards for practice relate to what you have learnt and how your practice will change.