What you need to do:
Read through Case study 2 (Molly) at the end of this document. Based upon the information from case study 2, discuss your initial assessment for Molly.
Your written response should:
I. Discuss how you would gather new/further information about Molly’s condition.
II. Identify Molly’s immediate (next few hours) and short-term (next few days) problems.
III. III. Identify how clinical reasoning has been applied (what stages of the clinical reasoning cycle have you engaged in? And, what *types of reasoning have you used?)
* Types of reasoning refers to the theoretical content from first 3 weeks of the unit
Tips:
Use the 2nd, 3rd and 4th stages of the Clinical Reasoning Cycle
Use appropriate medical terminology
Aim to avoid repeating lines of information already provided in the case study (refer to pertinent facts concisely)
A Ru
ic is also provided in the Assessment Tasks and Submission tab on your Black Board site, to help you identify what is expected
Suggested Structure (you can use subheadings for each section)
Paragraph 1:
Methods of gathering further information > XXXXXXXXXXwords
•Questions you would ask? •Any physical assessments?
•Any RN diagnostic tests (BGL, urinalysis?)
•Okay to include other diagnostic test however keep in mind these may require a medical officer order (e.g. xray, pathology tests)
•Explain rationale and support with references
Paragraph 2:
Molly’s immediate and short-term problems > XXXXXXXXXXwords
•Immediate problems are happening now or next hour or so
•Short term problems are next few hours to next day
•Potential problems can be included •Holistic RN perspective –avoid focusing on medical diagnoses
•Support with scholarly references
Paragraph 3:
How clinical reasoning has been applied > XXXXXXXXXXwords
•How have you applied the Clinical Reasoning Cycle (Levett-Jones, 2013 or 2018)
•What type(s) of reasoning have you used? Inductive, deductive, na
ative or collaborative? (explain and support with references) Format & Submission Details:
In-text references included in word count
Use Font size 12, minimal 1.5 spacing Use APA 7 th edition referencing and aim for scholarly sources no more than 10 years old
Molly (81 year old, weight 85kg)
Background
Molly, aged 81, lives alone since her husband died four years ago. Prior to this, Molly and her husband (Frank) were “Grey Nomads” touring across Australia to visit their kids. Molly’s interests now include learning to use her new iPad (she is fond of Facebook and has discovered internet banking), attending local bingo, baking cakes for fund raisers and tending to her small garden. She has recently joined the local choir and a friend drives her to/from practice as she does not have a driver’s licence.
Two days ago, Molly was admitted to hospital following a fall in which she fractured her left neck of femur (#NOF). Molly fell at home in her backyard and was found by her neighbour four hours later who heard her cries for help. Molly’s only daughter lives 170km away and has been concerned about her mother’s memory and general health for the past 18 months and wants her to move into a nea
y aged-care facility. Molly has a history of osteoarthritis and associated hip and wrist pain for which she takes Osteo-eze and ibuprofen. Molly was recently diagnosed with cataracts and was awaiting surgery. She
oke her glasses during her fall and the ambulance officer packed an old pair of glasses that belonged to her husband.
Context
Molly was admitted to the orthopaedic ward following an open-reduction and internal fixation (ORIF) for her #NOF. Molly is now day 2 post-operative and you are allocated to care for Molly on the morning shift.
Clinical handover (from the night duty RN)
“Molly appeared to sleep intermittently and was stable until this morning. At 0600 hours Molly needed to use her bowels and mobilised to the bathroom on her forearm support frame with assistance. We opted to shower her whilst up but she became short-of-
eath and somewhat confused and mildly agitated. She appeared tachypneoic though less so once resting on a chair. Her oxygen saturations ranged from 90%-94% on a Hudson mask though she kept moving her hand and removing her mask so I don’t know how reliable these readings were. We returned Molly to bed as she was attempting to get out of the chair without her frame. She remained a bit tachycardic around 109 and hypertensive but not so much once resting. She complained of some chest pain but provided a vague description.” “We did an ECG which showed sinus tachycardia with no ST changes. Molly was encouraged to use her Fentanyl PCA more and she has since settled down somewhat though she seems to be quite confused. Molly has been asking “will dinner be served soon?” Her vital signs have settled somewhat but it might be worth requesting a clinical review as her heart rate is still elevated and her oxygen saturations remain borderline around 92-94% on 8L of oxygen. Although she was tired first up, she agreed to a shower and has opened her bowels. Her wound looks good, there’s minimal drain loss and she’s afe
ile. Although she’s not trying to climb out of bed yet, Im wo
ied this may occur ans she may need a special.”