Marking Criteria measured: (1800 words excluding intext reference)No Introduction or Conclusion is required as this is not an essay.Utilisation of appropriate assessment frameworks to identify the pathophysiology of the condition in the case study.Application of evidence to explain the actions the registered nurse / registered midwife take to implement and evaluate two (2) interventions to care for the patient in the case study.Critical appraisal of evidence supporting nursing / midwifery practice applicable to the patient in the case study.Application of the ICN or ICM codes of ethics to the actions of the registered nurse / registered midwife in patient discharge.Encouragement of access to, and participation in healthcare using the Social Justice Framework to underpin the actions of the registered nurse / registered midwife in patient discharge.Academic writing evidences academic integrity in the application of the APA7 referencing style.
Task goal:The goal of this case study is for you to identify the role of the registered nurse / registered midwife in evidence-based assessment and care of individuals experiencing health alterations when access to healthcare is suboptimal or compromised. You also articulate the role of the nurse in encouraging access to, and participation in healthcare.Task description-Present a response to a clinical scenario demonstrating appropriate assessment, management and discharge of an individual experiencing health alterations.
What You need to do:In this task you will conduct a case study. Please follow the steps below:Step 1: Secondary assessment of the patientDetail the secondary assessment and investigations appropriate for this patient (400 words).Step 2: Explain the pathophysiology of the health alterationExplain the pathophysiology that explains the patient assessment findings and underpins the interventions (300 words).Step 3. Implementation and evaluationSelect, justify and describe two (2) essential interventions and describe the nursing / midwifery actions required to implement and evaluate it (800 words).Step 4. Plan the patient dischargeSelect and describe nursing / midwifery actions to prepare the patient for discharge utilising the social justice framework to address the social determinants of health (SDH) that impede the access to, and participation in healthcare (300 words).Additional notesSelect interventions that corrects the pathophysiological change within the patient. Patient monitoring actions (completing vital signs and fluid balance charts) is considered as assessment or evaluation, it is not an intervention.Case.Situation IdentificationMrs Sadie Mangle, 82 year old, retiree
Mrs Mangle found in collapsed in the front yard by neighbours Scott & Charlene at 8:30am. She had weakness in the right arm and leg, facial droop and was “talking nonsense”. The patient is admitted to the Medical Ward with an ischaemic CVA.Background Allergies: penicillinMedication: Metformin, actrapid, atorvastatin, ACE inhibitors Past illnesses: T2DM, hypercholesterolaemia, hypertension Last meal: Dinner the previous night.Events leading up to presentation: recent episodes of abnormal sensation that resolved within the hour.Assessment RR: 22SpO2: 95% RA (room air)HR: 95, strong pulseBP: 200/110T: 35GCS: 14 (confused to time, place, person)BGL: 10 mmol/LCap. Refill Time: 2 seconds, flushed faceCT: ischaemic strokeOther informationWhen Mrs Mangle was found she was in her pyjamas without her dressing gown. This is unusual as normally she is up and dressed, walking with Alby at 6am. Alby was inside the house calling out to Sadie. It is suspected that Mrs Mangle collapsed during the night while letting her dog, Bouncer, go to the toilet.Mrs Mangle is now bed bound due to weakness in the right side (failed on bed mobility test). Mrs Mangle is unable to change positions in bed. The physiotherapy review is pending.Mrs Mangle requires a modified diet due to delayed swallow (assessed by a speech pathologist this morning). The patient is exhibiting “word salad” where the patient is selecting incorrect words.The patient has not been incontinent, but has a pad in place for now. Mrs Mangle has a normal western diet low in fibre, high in fats and carbohydrates, moderate alcohol intake, but she does not smoke. Normally she sleeps little and is usually independent with ADLs. Mrs Mangle and her husband Alby chief recreation is walking and gossiping with neighbours.Mr Mangle lost his license for medical reasons (partial blindness), they both live on the pension and have minimal savings. They own their own home, this is a high set building with 12 steps to the front door. You have been told that Mike, from next door is dropping in to keep an eye on Alby every day. Mrs Mangle seems frustrated in her attempts to communicate, she is often found crying.
RecommendationsComplete a secondary assessment of the patient including investigations and link the findings to the pathophysiology.Select, justify and describe two (2) interventions and describe the nursing actions required to implement and evaluate them.Select and describe nursing actions to prepare the patient for discharge utilising the social justice framework to address the social determinants of health (SDH) that impede the access to, and participation in healthcare.
Notes from tutor:Secondary assessment 400 WORDS (REFERNCE JUST TECHNICAL WORDS)Patho OF STROKE AND THOMBOSIS STROKE 300 WORDS LINK WITH INTERVENTION SELECTED. ONE PARA FOR GENERAL PATHO AND THEN TALK ABOUT ISSUES THAT WILL RELATE UR INTERVETION CHOSEN. -REEFRENCE -300Intervention -REFERNCE -800Discharge planningStrokeCns – GCS 14,temp, E m VCwms colour, warmth,movement,sensation- LIMB SPECIACLLY LOWER confusion,speech
CVSECG DONE NORMAL RATE?CAP REFILL, BP, PULSE
RCSPINSPECT, PALPATE, PERCUSSION, AUSCULTATION, O2 SATS,RR
ABDOINSPECT, AUSCULTAION-- NORMAL BOWEL SOUNDS, PALPATION/PERCUSION
RENALU/T, INCONTIENET PAD ONE, DONOT KNOW URINE OUTPUT
MUSCULOSKETEL, SKIN – WATER LOW SCORE
SOCIAL( LIFESTYLE, PSYCHOSOCIAL, PATTERNS OF HEALTH CARE) – FAMILY AND HOUSING
DYSPHAGIA- CANT SALLOWINVESTIGATIONCT SCAN/MRI WHENEVR FITS ( HOW MUCH BRIAN LOOK BAD OR DAMAGE)CHEST XRAYBLOOD TEST- COAGULATION PROFILE (HOW HER CLOT LOOKS LIKE), FULL BLOOD COUNT, UREA AND ELECTROLYTESCONFUSION WORDS- DISPHASIA
CNSInspection - what is seen? Pupil response to light, muscular weakness, altertness, repetetive questioningPalpation - what is felt? strength & coordination, temperatureInvestigations - CT head?
RespiratoryIPPA
CVSInspection - what is seen? facial colouring? lower leg discolouration, alopeciaPalpation - what is felt? Pulse, capillary refill, peripheral oedemaAuscultation - What is heard? heart soundsInvestigations - blood tests?
GITInspection - what is seen? bruising, scaring, swallow intact, blood at the rectum, faecal incontinence, number on the bristol stool chartAuscultation - what is heard? bowel sounds present or absentPalpation - what is felt? Soft? Tender? Rebound tendernessInvestigations - BGL? AXR? USS?
RenalInspection - what is seenPalpation - distended bladder? swollen kidneys?Investigation - UA? MCS?
Musculoskeletal systemInspection - What is seen? Active ROM? Joint enlargement & deformityPalpation - What is felt? Passive ROM? Increased tone? Decreased tone?
Integumentary systemInspection - what is seen? pressure injuries, bruising, scarring, cuts, abrasions, rashesPalpation - what is felt? tissue integrity of skin, dehydration,
Lifestyle, socio-economic and patterns of healthcare useIs the home environment safe for the patient?If the patient goes home after the acute medical issues are managed, will they be safe?
So , your words are limited. Focus on the systems that have abnormal findings. The systems that are not impacted may only require 1 sentance to evidence the lack of abnormal findings.
USE 2 INTERVENTION FROM MENTION BELOW for which you find most of evidence and referencing (ALONG WITH NURSING ACTION)HYPERTENSION- 400 words EACHNURTITION- ( NURSING ACTION)- DIETATION, SUITABLE FOOD. FOOD ALLERGIES, POSTION SIT UP WHILE FEEDING AFTER COM[LETING HALF HOUR TO ONE HOUR , REACESS WITH FLUID CHART.
PAC- PRESSURE AREA CARE- REPOSITIONING, AIR MATRESS, LIMBS NOT RESTING ON EACH OTHER PUT PILLOW, WARM, COMFORTABLE.ADLS- ACTIVITY OF DALIY LIVING- TAKING CHAI RTO SHOWER, ENSURE SAFE OUT OF BED ON CHAIRCOMMUICATION- CALM APPRAOCH,DVT PERVENTION- TED STCOKING, PASSIVE EXCERISE,ELIMINATION- TOILET EVERY 2 HOURS, CHANGE PADS AND CLEAN AREA.
EVALUTAION YOUR INTERVENTIONBP WHILE LYING AND WHILE SITTING TO SEE DIFFERENT.
NOTE- ON AUSCULATTION AIR ENTRY EQUAL BOTH LUNGSEQUAL RISE AND FALL OF THE CHEAT ON INSPECTION.EXCEPT MOVEMEMENT EVRTHING WILL BE NORMAL.
DISCHARGE PLANNING 300 WORDSREHABHOME MODIFICATIONWHERE PATIENT GOING TO GO HOME, NURSING HOME OR REHAB
ETHICS ARE CONSENT OF PATIENT AND FAMILY, COMMUNICATING WITH PATIENT, SUPPORTING PATIENT PUT WHILE DISCHARGE PLANING.SOCIAL JUSTICE FRAMEWORK PATICIPATE IN THEIR CARE. AND HEALTH IN DICHARGE
JUST ACCESS NOT PROVIDE RATIONALE. LESSDescribe nursing actions to improve the person's access to health care or participation in healthcare.These actions could address lifestyle factors, psychosocial issues or patterns of healthcare use.Frame these nursing actions in at least one (1) of the elements of social justice framework.Identify elements of nursing codes and standards that also support these actions.Allow 300 words for this section