Posted: June 14th, 2023

NURS90155: Nursing of Acute Health Conditions

NURS90155: Nursing of Acute Health Conditions – End of Semester 1 Take Home Examination 2023: Exam 1
Due Date: Monday 8th May 2023, 1000 hours
Weight: 20%
Word Count: 2000 words
Submission: Online via Canvas, through the link in this subject.
Assessment Outline: This take-home exam consists of one case study, containing questions that you are
required to answer.
Introductions and conclusions are NOT required; go directly into answering each question.
Take-home exam must be typed using double spacing and size 12 font and text left justified.
The take-home exam must be presented in accordance with the American Psychological Association (7th ed APA) style.
All pages must be numbered consecutively from the title page.
The title page should include the Department, University, Course name, Student number, Subject name, and Subject code.
Insert your student number and subject code as a footer.
You do not have to present your work in paragraph form (except where directed to do so). Dot points and/or tabled format can be used where you are specifically directed to do so.
Provide citations in your responses wherever you have used ideas or information from other sources (texts, journal articles, websites). Reference your work carefully and include a reference List at the end. https://library.unimelb.edu.au/recite/apa
Penalties: You may lose up to five (5)% of the total marks for non-compliance with referencing requirements, including in-text citations and Reference List.
You may lose up to five (5) % of the total marks allocated to the assessment component for errors or inaccuracy in spelling/grammar and sentence construction.
Word Limit and penalties: Any piece of work which is over or is under the stipulated word limit by more than 10% will result in the deduction of five (5)% of the total marks allocated for the assessment for each 10% over the word limit. The maximum penalty that a student can receive is 50% of the mark for that piece of work.
Failure to submit an assignment by the required deadline will result in a penalty of the deduction of 10% of the total marks allocated to the assessment component for each day that the assignment is late.
Assessments submitted later than 5 working days after the due date will not be marked and will receive no marks.
The Board of Examiners may offer supplementary assessment to a student in special circumstances.
Students should refer to the assignment submission and return guidelines under the ‘Policies, forms and resources’ link for further information. www.nursing.unimelb.edu.au
I
Keith Griffiths| D.O.B. 12/09/1948| Male (he/him) |NKA| Full Resuscitation
S
Keith was admitted to the hospital yesterday after visiting his general practitioner (GP) 2 days ago with increasing shortness of breath, reduced appetite and feeling hot. His GP diagnosed him with community acquired pneumonia and commenced him on oral antibiotics, but in the 2 days since, Keith has continued to deteriorate.
O
Observations at 0530 hrs
Alert & Orientated; Temp 38.4 OC, HR 104 irregular, RR 24; BP 120/60 Sp02 91% on Room Air; BGL 10.6 mmol/L
Keith had an IVC inserted into his L) hand (22g) yesterday, which is clean and patent with no signs of infection
B
Worked as a carpenter/builder before retiring at 60 years after being diagnosed with asbestosis and moving to Melbourne to live with his daughter and her family. His daughter reports that he sleeps poorly, has few social contacts in Melbourne, and rarely leaves the house.
Smoker since aged 17 years. 30 cigarettes per day recently reducing to 5 per day.
Phx: Diagnosed with asbestosis and emphysema at 58-yrs old, Coronary Artery Bypass Grafts x2 at 55 yrs Hypertension; Type 2 Diabetes; asbestosis, emphysema, coronary artery disease
Current Medications: Aspirin; perindopril; metoprolol; atorvastatin; metformin; amoxicillin
A
Admitted to Medical unit
Investigations: ECG – 12 Lead; Bloods: FBC; U&E’s; Blood cultures; Chest X-Ray; Urinalysis Sputum specimen
Fluid Balance Chart (FBC)
R Current nursing problems:
Risk of Delirium
Altered breathing pattern Risk of infection
Question 1
Excluding the three problems identified in the handover, identify one (1) actual and one (1) potential problem. For each problem, provide a rationale using data from the case study and relevant literature or practice guidelines.
(3 marks)
Question 2
For each of the three problems identified in the handover:
i. Identify one independent nursing intervention and one collaborative intervention
ii. For each intervention, provide a rationale using relevant literature or practice guidelines
iii. For each, write a SMART goal and describe how you would evaluate the outcomes Present your responses in tables as shown below:
Problem 1: Risk of Delirium
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
Problem 2: Altered breathing pattern
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
Problem 3: Risk of infection
Nursing intervention: Rationale(s):
Collaborative Intervention: Rationale(s):
SMART goal:
(8 marks)
Question 3
It is now 0800 and Keith is due to be administered the following medications:
• Metoprolol 25 mg
• Metformin 750 mg
• Amoxicillin 1 gram
For each medication:
i. explain why Keith requires the medication, with reference to his medical diagnoses and assessment data ii. describe the assessment(s) you would undertake prior to administering the medication (excluding checking the patients’ name, number, and date of birth against the prescription)
(3 marks)
Question 4
Keith’s medical team decides to commence him on a short-acting beta agonist (salbutamol) and long-acting betaagonist/inhaled corticosteroid (salmeterol/fluticasone), both via metered dose inhaler (MDI).
Describe two (2) important points about taking these medications via MDI that you will need to provide Keith with education about prior to discharge. Support your response with relevant literature or practice guidelines.
(2 marks)
Question 5 (400 words)
One of the aims of the Comprehensive Care Standard is to “…ensure that risks of harm for patients during health care are prevented and managed” (p 44, ACSQHC, 2021), including actions for preventing harm related to delirium.
In a short essay response, discuss why screening for delirium and implementing preventative care is important for preventing harm associated with healthcare. Support your response with reference to the standards, other relevant literature, and the case study,
Present your ideas in your own words, in paragraph form with linked sentences to establish the flow of. There should be no single sentence paragraphs. Use double spacing between paragraphs. Reference your work carefully and include a Reference List at the end. https://library.unimelb.edu.au/recite/apa
Reference
Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Health Service Standards. 2nd ed. – version 2. Sydney: ACSQHC
Rubric (Question 5)
Criterion 2 marks 1 mark 0 mark
Applies standards, relevant literature and policy to Keith’s case in discussion of importance of delirium screening and prevention.
Supports responses with appropriate references
Presentation (spelling, language, grammar, referencing)
(4 marks)
END OF EXAM

_____________________________________________
Question 1

Actual problem: Hypoxemia
Rationale: Keith’s oxygen saturation (SpO2) is 91% on room air, which is below the normal range. This indicates a problem with the exchange of oxygen and carbon dioxide in his lungs, which may result in tissue hypoxia and organ dysfunction (Farrell & Dempsey, 2021).

Potential problem: Impaired gas exchange
Rationale: Keith’s respiratory rate (RR) is elevated, indicating that he is working harder to breathe. In addition, his chest x-ray and sputum specimen are being investigated, which may suggest an underlying respiratory infection, further affecting his oxygenation (Farrell & Dempsey, 2021).

Reference:
Farrell, M., & Dempsey, J. (2021). Smeltzer & Bare’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins.

Question 2

Problem 1: Risk of Delirium

Nursing intervention Rationale(s)
Administer medication for pain and discomfort as ordered Unmanaged pain and discomfort can lead to confusion and agitation, which can increase the risk of delirium. Administering medication for pain can help alleviate these symptoms and prevent delirium (Farrell & Dempsey, 2021).
Collaborate with the healthcare team to implement a delirium prevention protocol A delirium prevention protocol includes strategies to optimize the patient’s environment, minimize the use of restraints, promote sleep, and encourage family involvement in the patient’s care, which can reduce the risk of delirium (Inouye et al., 2014).
SMART goal: Keith will maintain an alert and oriented mental status throughout his hospital stay as evidenced by a score of 0-1 on the Confusion Assessment Method (CAM) tool.

Problem 2: Altered breathing pattern

Nursing intervention Rationale(s)
Assist Keith to assume a position of comfort and optimize oxygen delivery A comfortable position, such as elevating the head of the bed, can help reduce the work of breathing and improve oxygenation. Supplemental oxygen may be required to maintain adequate oxygen saturation levels (Farrell & Dempsey, 2021).
Collaborate with the healthcare team to implement a plan of care for Keith’s respiratory management Collaborating with the healthcare team can help ensure that Keith receives appropriate respiratory therapies, such as nebulized bronchodilators, chest physiotherapy, or non-invasive ventilation, to improve his respiratory function (McEvoy et al., 2015).
SMART goal: Keith will maintain an oxygen saturation level of at least 94% on room air within 24 hours of admission, as evidenced by pulse oximetry readings.

Problem 3: Risk of infection

Nursing intervention Rationale(s)
Perform hand hygiene and ensure appropriate infection prevention and control measures are in place Hand hygiene is the most effective way to prevent the spread of infection. Ensuring appropriate infection prevention and control measures, such as isolation precautions, can help prevent the transmission of infectious agents to other patients and healthcare workers (Centers for Disease Control and Prevention, 2019).
Collaborate with the healthcare team to implement an appropriate antibiotic therapy Collaborating with the healthcare team to implement an appropriate antibiotic therapy can help treat the underlying infection and prevent its progression (Farrell & Dempsey, 2021).
SMART goal: Keith’s temperature will remain within the normal range and his white blood cell count will decrease to within the normal range within