APH102 Assessing physical health status
Assessment 2 Response Template
ASSESSMENT 2 - Response Template
Student Name
Date
Course
HLT54115 Diploma of Nursing
Subject Code and Title
APH102 Assessing physical health status
Unit(s) of Competency
HLTAAP002 Confirm physical health
HLTENN003 Perform clinical assessment and contribute to planning nursing care
Performance criteria, Knowledge evidence and Performance assessed
PC:
HLTAAP002 = 1.1, 1.2, 1.3, 1.4, 2.1, 2.2, 2.3, 3.1, 3.2, 3.3, 3.4
HLTENN003 = 1.2, 1.3, 1.6, 1.7, 1.8, 1.9, 2.1, 2.2, 2.3, 2.4, 3.1, 3.2, 3.3, 4.1, 4.2, 4.3, 4.4
PE:
HLTAAP002 = 1
HLTENN003= 1, 2, 4
KE:
HLTAAP002 = 1, 2b, 4a, 4b, 5, 7a, 7b, 7c, 7d, 7e, 7f, 7g, 8, 9, 10, 11a, 11
HLTENN003 = 1, 2a, 2b, 2c, 2d, 3, 4, 5, 6, 7, 8, 9, 11, 12a, 12b, 12c, 12d, 12e, 12f, 12g, 12h, 12i, 12j, 12k, 12l, 13, 14, 15, 16, 17, 18, 19, 20
Title of Assessment Task
Assessment 2: Case Study
Type of Assessment Task
Short Response
Length
As indicated in each question
Submission
Due by the end of Module 5.2 (Week 10)
For this assessment, you must read two case studies provided and answer the questions below each one. When responding to the questions, please pay attention to the entire question being asked, as well as the prescribed word count. Co
ect medical terminology must be used when answering all questions.
Scenario 1 Mrs Yu Yan McFarlane (questions 1-7 refer to this scenario)
I: Mrs Yu Yan McFarlane is a 38-year old female.
S: She had an abdominal hysterectomy bilateral salpingo-oophorctomy (removal of fallopian tubes and ovaries) two (2) days ago.
B: Yu Yan lives with her 70-year-old mother Fei Hong, her husband George and their three-year-old twins, and Yu Yan’s 17-year-old son Jason from a previous relationship.
A: Yu Yan is on four (4) hourly observations. The most recent recorded observations were:
· Temperature 36.5 °C
· Respirations 22
· HR 110
· BP 135/80mmHg
· SpO2 98% on room ai
· 7/10 abdominal pain
Yu Yan has received opioid analgesia for two (2) days and has reported that she has not opened her bowels.
She shared in confidence that she was concerned about becoming menopausal. Her mother experienced a lot of emotional distress when she went through menopause, and her body changed as well. Yu Yan suffers from anxiety and has poor self-image. She already finds it difficult to adjust to her body, and now that she is no longer fertile she is becoming quite anxious about what might happen to her when menopause begins.
Yu Yan feels emba
assed when undressing in front of nursing staff. She admits to having difficulty identifying with her own sexuality as a result of the changes she is going through and has said it is causing issues with her husband.
Yu Yan is sceptical of the support she might be able to receive from you regarding the changes of her body as she does not feel that a healthcare team can do anything to stop them, and she feels quite pessimistic about any interventions.
R: Yu Yan requires assistance to perform ADLs (Activities of Daily Living) due to her pain and has expressed emba
assment at being assisted in the shower.
Question 1
Based on the information provided to you in the case study, use the template below to develop an appropriate care plan for Yu Yan. You are required to:
· Specify four (4) nursing diagnoses or risk factors associated with the client’s health variations
· Record at least two (2) nursing interventions that could be applied for each diagnosis
· Clarify how your planned interventions reflect the client’s interests and physical, emotional and psychosocial needs
· Note at least one (1) expected outcomes that you would hope for as a result of each intervention (consider SMART goals when discussing outcomes)
Nursing diagnosis
Planning - (Nursing intervention)
Link to personal needs
Expected Outcome
Question 2
Yu Yan has confided that she is having trouble adjusting to her body image now that she is no longer fertile. For this question, review the stages of adulthood and;
a) Specify what developmental stage of adulthood Yu Yan is going through after her surgery, and list two (2) physiological/psychological changes people may go through at that stage.
) List two (2) other stages of adulthood and for each, specify two (2) psychosocial or physiological changes that might be experienced by people going through the stage listed.
Reference required
Response:
Question 3
Yu Yan has expressed emba
assment at needing assistance with her ADL’s (Activities of Daily Living) due to her poor self-image. This implies that she may need support both emotionally and physically.
1. Outline the seven (7) areas of wellness and explain your understanding of each one
1. Explain which areas of wellness Yu Yan is having difficulty with given her cu
ent anxieties (there is more than one area)
1. Provide two (2) nursing interventions you could provide to assist Yu Yan with her feelings of emba
assment
1. Provide one (1) community support agency that may be able to assist you to facilitate a wellness approach to care
Reference/s required
Response:
Question 4
Yu Yan’s situation is common amongst many women her age. Additionally, it may also be influenced by how she has grown and developed, and what her genes are.
· Specify four (4) stages of human growth and development
· In XXXXXXXXXXwords, explain how genetics and environment may impact a person’s own development
Reference required
Response:
Question 5
As soon as clients present to and are admitted into a healthcare facility, the healthcare team starts planning discharge requirements. List six (6) possible requirements Yu Yan may need to be a
anged/discussed before she is discharged, and explain why they are needed. Use 10 words for each.
Response:
Question 6
Yu Yan has 3-year-old twins at home whose developmental needs differ from hers greatly. It is important that you understand these needs when considering the type of care that Yu Yan could be provided after discharge as her wellbeing will affect theirs. Describe the developmental stages of childhood by addressing each point below:
a) Complete the table by listing the physical growth, psychosocial, cognitive and motor development needs of infants, toddlers and pre-school and school aged children
) Explain in 20 words, the role of play in a child’s development
c) Explain in 20 words, the impact that hospitalisation of a child can have on the child and family
References required.
Response a):
Physical growth
Psychosocial development
Cognitive development
Motor development
Infant (0 – 12 months)
Toddle
Pre-school
School aged
Response b):
Response c):
Question 7
Yu Yan also has a 17-year-old son, Jason. His stage of development is different from both hers and the twins. In 30 words, describe the developmental stages of adolescence and list four (4) common health issues or psychological concerns that adolescents face.
References required.
Response:
Scenario 2: Mrs Fei Hong (Questions 8-13 refer to this scenario)
On Sunday at 1000hrs, you are assigned to admit a new client to your ward.
Fei Hong is a 70-year-old female who was admitted to your ward this morning following a fall at home. On admission, her daughter Yu Yan is in attendance. Fei Hong has sustained significant
uising and swelling to her right hip and shoulder with a large skin tear to her right forearm. She did not sustain any fractures. She is admitted for pain relief, dressings to her forearm and a physiotherapy review.
On assessment of Fei Hong, you note that she has bony prominences on her hips and pelvis, and is at risk of developing pressure areas.
Yu Yan has requested an interview with the doctor to determine if her mother needs any extra care at home, as Fei Hong is beginning to show signs of dementia according to her daughter. Fei Hong generally eats a small, but nutritious diet at home that includes all food groups, and is predominantly Asian cuisine.
Fei Hong has reported no urinary issues and takes Metamucil daily to prevent chronic constipation. She can shower and dress independently but requires supervision and prompting at times due to early signs of dementia. She had been mobilising independently prior to this fall.
She will need to be assessed by a physiotherapist for a walking aid. Medically, Fei Hong has some hearing and sight impairment, and wears glasses and bilateral hearing aids, but is on no regular medications.
Socially, she lives with her daughter Yu Yan, son-in-law George and their children – three-year old twins – and Yu Yan’s 17-year-old son Jason from a previous relationship.
Yu Yan cares for her mother and her three (3) children and has no community support for her mother. Fei Hong has no other extended family as she immigrated to Australia 16 years ago to help her daughter raise her son. She speaks little English and is Buddhist. She states that her strong faith and her daughter help her cope with her ageing process.
Fei Hong’s observations on admission are:
· Temp 36.1
· BP 105/68
· Respirations 18
· HR 64
· Height: 156cm
· Weight: 46kg.
· BMI of 19
Question 8
Based on the information provided to you in the scenario, use the template below to document an ISBAR handover for Fei Hong. Use appropriate medical terminology and ensure the documentation meets legal requirements.
I
S
B
A
R
Question 9
Another nurse has drafted a plan of care for Fei Hong. Respond to the questions below based on your scope of practice as an enrolled nurse. Use 20 words for each to explain:
a) How you would confirm that this plan reflects the needs of Fei Hong and her family
) If the care plan seems to conflict with the client’s needs and requirements, who you would speak with and how you would justify your assumption
c) If Fei Hong’s situation deteriorated after admission, who you would communicate this to, and when and how that should be done
Nursing diagnosis
Planning (Nursing intervention)
Expected Outcome
· Pain to hip and shoulder due to
uising and swelling following fall
· Monitor pain levels with regular pain assessments, may need to use A
ey pain scale due to limited English.
· Minimise pain by administering regular analgesia as prescribed.
· Apply ice pack