Promoting the 6 C’s of Nursing in Patient Assessment

 Part A: Article Summary

You are required to access the article detailed from the HCBN6104 Moodle site and summarise in 1,000 words or less. This information pulls together some of your learning from previous semesters and introduces some of the learning for this semester. 

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Part A:  Article Summary 

Read the following article available on Moodle and summarise. Your summary must be written in an appropriate academic format with attention to structure, grammar, paragraphs and a logical flow ensuring you cover the main points of the article.  Bullet points or numbering is not acceptable. (1,000 word limit) 

Clarke, C. (2014). Promoting the 6 C’s of Nursing in Patient Assessment, 28(44), 52-59

Part B: Workbook

Respiratory – Week 1

You are allocated the following patient at the commencement of your eight hour shift and given the following information during handover.Marty Price, a 24 year old man, has been admitted with a provisional diagnosis of tuberculosis. He has recently returned from spending the last three months travelling through Asia on a surfing holiday. He has a four week history of coughing, breathlessness, nocturnal sweating, weight loss and malaise. On admission he looked unwell and was febrile with a RR of 24. A chest x-ray showed a shadow on his right upper lobe.  He is in a negative air pressure isolation room for airborne infection isolation; is awaiting blood culture results and needs a sputum spec.Using your course text, the articles available on Moodle and any other relevant and appropriate resources you wish, ensuring these are correctly referenced, answer the following:

  • **Provide an overview of the aetiology and pathophysiology of Tuberculosis (TB) in relation to Marty. (Suggest 300-400words.) Watch theTB videos on Heath Navigator (Moodle) to help with your answer.

 

 

  • Describe the infection control precautions that must be taken when a patient is considered to be at risk of having or is diagnosed withTuberculosis.Your answer must include personal protection of healthcare workers as well as environmental controls
  • Describe the sputum and blood tests which are ordered to diagnose TB.

MrTahu Wiremu, a 62 year old man, is also on the ward. He is a retired car painter and ex- smoker.  He was admitted to the ward four days ago with an exacerbation of his COPD – his fifth admission in the last 18 months. Tahu has responded well to treatment and his discharge is planned for 11:00 a.m. today, after a spirometry test at 9:00 a.m. 

  • How is spirometry different to Peak Expiratory Flow (PEF)measurements?
 

 

 

 

 

 

  • **Provide an overview of the aetiology and pathophysiology of COPD. (Suggest 300-400 words.)

 

 

 

 

 

 

 

 

  • Wiremu is prescribed inhalers. Review the use of an inhaler with a spacer device. Briefly outline relevant information for a patient education session (include – how, why, benefits, and care of thespacer).
 

 

 

 

 

 

  • **Mr. Wiremu identifies as Maori. How will you ensure Tikanga is observed during hisstay?
 

 

 

 

 

 

 

  • **Mr. Wiremu’s daughter expresses concern that she will develop COPD as she has a history of asthma. Outline the aetiology and pathophysiology of asthma and analyse whether it is likely she will develop COPD. (Suggest 300-400words.)
 

 

 

 

 

  • Apply the Rapid Assessment framework and outline the priority nursing assessments that would be relevant if a patient were to experience an asthma attack, and identify the expected findings.
 

 

 

 

 

  • What would the red flags be if someone was experiencing an asthmaattack?

 

 

 

 

 

 

 

  • What nursing interventions must be implemented in this potentially life-threateningsituation?

 

 

 

 

 

 

 

 

  • Briefly review strategies for controlling breathlessness, managing ADLs, coughing techniques, positioning and other information you consider would be helpful for Mr Wiremu prior to his discharge.

 

 

 

 

 

 

 

 

 

 

Part B: Workbook

Cardiac – Week 2

Student Name:

N.B. question may be answered with bullet points etc unless marked with ** in which case answers must be written in correct academic writing, including references.

You are allocated the following patients at the commencement of your eight hour shift and given the following information during handover.

Mr George Jackson, a 65 year old man, was admitted yesterday afternoon with chest pain. He was watching sport on TV when the pain started and felt that the pain was radiating down his left arm and up into his neck.  He required O2, GTN and morphine to get on top of the pain.

George has a history of CAD and hypertension. His usual medications are aspirin 100 mg daily, metoprolol 95 mg daily and GTN spray as required.

Using your course text, the articles available on Moodle and any other relevant and appropriate resources you wish, ensuring these are referenced correctly, answer the following:

  • As part of his admission screening, George will have cardiac enzyme analysis including troponin. In addition he will have a lipid profile completed. Explain what each of these medical diagnostic tests can tell us about the underlying pathophysiology?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • George’s ECG shows a NSTEMI. What is the rationale for doing a 12 lead ECG? What is the difference between NSTEMI and STEMI? Explain the underlying pathophysiology ofeach.

 

 

 

 

 

 

 

 

 

 

 

  • **Modifiable risk factors for Coronary Artery Disease (CAD) include hypercholesterolaemia, cigarette smoking and hypertension.Discuss how each of these factors contribute to the development of CAD? (Discussion must include the underlying pathophysiologicalprocesses.)
 

 

 

 

 

 

 

 

 

 

 

  • What is the difference between a cardiac arrest and a Myocardial Infarction (MI).

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Explain what is meant by normal sinus rhythm with reference to cardiacconduction.

 

 

 

 

 

 

 

 

 

 

 

 

  • Explain the difference between the treatment options of PCI and thrombolysis for George while inhospital.

 

 

 

 

 

 

 

 

 

 

 

 

 

  • George rings the bell and tells you he is experiencing an episode of chest pain. You have already completed a Rapid Assessment using the ABCDE framework. Outline nursing interventions, with rationale, it would be appropriate to implement/or anticipate implementing in thissituation.

 

 

 

 

 

 

 

 

 

 

 

 

Mrs Smith, a 64 year old female, has just been admitted with an exacerbation of her heart failure. She has a history of MI, CAD and a left total hip joint replacement (THJR). She has become increasingly breathless over the last week and has gained 3 kg. Mrs. Smith has pitting oedema at her ankles and some sacral oedema. She has a cough, nocturia and orthopnoea.

  • **Explain the difference between right sided and left sided heart failure. What are the associated signs and symptoms which may be expected with both of these? (Suggest 200- 300 words.)

 

 

 

 

 

 

 

 

 

 

 

 

  • The medical staff order blood tests which include B Natriuretic Peptides (BNP). Explain the significance of these tests in heart failure.
 

 

 

 

 

 

 

 

 

 

 

  • Smith is sent for an Echocardiogram (ECHO). Explain the rationale for this test and how it is utilised to confirm a diagnosis of heartfailure.

 

 

 

 

 

 

 

 

 

 

  • **Mrs. Smith’s management includes administration of prescribed furosemide, metoprolol and cilazapril. Describe the class and mechanism of action of each of these drugs. How will you assess their effectiveness? (Suggest 200-300words.)

 

 

 

 

 

 

 

 

 

 

 

 

  • Outline other nursing interventions, with rationale, that it would be appropriate to anticipate implementing for Mrs. Smith in thissituation.

 

 

 

 

 

 

 

 

 

 

 

 

 

Part B: Workbook

Neurology – Week 4

Student Name:

N.B. question may be answered with bullet points etc unless marked with ** in which case answers must be written in correct academic writing, including references.

You may view all the information/resources on moodle e.g. online/hardcopy textbooks, links to HealthNavigator and others  under ‘Independent learning’ Altered Neurological Health Resources to assist with answering the following questions.

You are allocated the following patient at the commencement of your eight hour shift and given the following information during handover:

 

 

Mrs Wilhelmina Jacobs, a 72 year old female, was brought in with lowered Level of Consciousness (LOC). Her husband states she is having difficulty speaking, seems confused and was unable to stand up. She has been diagnosed with a right Cerebrovascular Accident (CVA), has a history of hypertension and is an ex-smoker.

 

Using your course text, the articles available on Moodle and any other relevant and appropriate resources you wish, ensuring these are referenced correctly, answer the following:

 

  • Apply the Rapid Assessment framework in this situation. Identify the assessments you would carry out using this framework and describe some of the findings you mayexpect.

 

 

 

 

 

 

 

 

 

  • Briefly describe the aetiology of CVA related to Mrs.Jacobs.

 

 

 

 

 

 

 

 

 

  • Describe the pathophysiology of thrombotic and embolicCVA.

 

 

 

 

 

 

 

 

 

  • Describe any other assessments you would expect to be carried out prior to her transfer to a rehabilitation unit and provide the rationale forthese.

 

 

 

 

 

 

 

 

During your shift, Mrs Parsons, a 79 year old woman, has fallen whilst getting out of bed. Another patient in the same room has rung the bell and you are the first person to respond. She is on the floor when you enter the room and has an obvious laceration to her scalp which is bleeding. She is conscious and appears to be in pain.

  • Outline your initial actions and nursing assessments on entering theroom.

 

 

 

 

 

 

 

 

 

  • Outline other information necessary to gain a comprehensive assessment of thissituation.

 

 

 

 

 

 

 

 

 

  • Identify the nursing interventions that will be implemented during yourshift.

 

 

 

 

 

 

 

 

 

  • **You are concerned Mrs Parsons has suffered a traumatic brain injury (TBI). What are the red flags that would alert you to a deterioration in her condition? Link these to the underlying pathophysiology. (Suggest 200-300words.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • **Using your course text briefly discuss the goals of rehabilitation. What are these and who does it involve? (Suggest 100-200words.)

 

 

 

 

 

 

 

 

 

 

Utilising your course text, the resources available on Moodle and any other appropriate or relevant resources you wish, complete information related to Spinal Cord Injury. Information can be written in any format you choose but information must be clearly referenced to the source.

 

  • Spinal cordinjury:
    • Using the ASIA scale, identify how spinal injuries areclassified.

 

 

 

 

 

 

 

 

 

  • Identify and explain signs of Autonomic Dysreflexia (AD), who is at risk of this and essential assessments andinterventions.

 

 

 

 

 

 

 

 

 

  • Identify and explain signs of spinalshock.

 

 

 

 

 

 

 

 

  • Provide a brief overview of eachof the following conditions. Discussion should include a brief outline of the pathophysiology along with common clinical manifestations.

 

  • Meningitis

 

 

 

 

 

 

 

 

 

 

 

  • Epilepsy

 

 

 

 

 

 

 

 

 

 

 

 

  • Parkinson’s Disease

 

 

 

 

 

 

 

 

 

  • MultipleSclerosis

 

 

 

 

 

 

 

 

 

  • Alzheimer’sdisease

 

 

 

 

 

 

 

 

 

  • Lewy Body Dementia

 

 

 

 

 

 

 

Part B: Workbook

Surgical – Week 6

Student Name:

N.B. question may be answered with bullet points etc unless marked with ** in which case answers must be written in correct academic writing, including references.

 

You are allocated the following patient at the commencement of your eight hour shift and given the following information during handover:

 

Mrs Elaine George, a 55 year old female, has returned to the ward from PACU following a left hemicolectomy as a result of Irritable Bowel Syndrome (IBS). She has a morphine Patient Controlled Analgesia (PCA) pump for pain relief that she has been independently using.

 

On re-assessment, two hours after her return to ward, you find she is very drowsy and falls asleepduringconversation.Hersedationscoreis2,respiratoryrate9,SpO298%on2litresO2 via nasalcannula.

 

Using your course text, the articles available on Moodle and any other relevant and appropriate resources you wish, ensuring these are referenced correctly, answer the following:

 

  • Briefly discuss the difference between IBS, Ulcerative Colitis (UC), Crohn’s disease and diverticulitis.

 

 

 

 

 

 

 

 

 

B             **Mrs George is at risk of a number of post-op complications including those listed below. Provide a definition of these complications and include the signs and symptoms and underlying pathophysiology.  (Suggest 100-200 wordseach.)

 

  • Respiratory depression (opiate-induced respiratorydepression)

 

 

 

 

 

 

 

 

 

  • Deep Vein Thrombosis(DVT)

 

 

 

 

 

 

 

 

  • Pulmonary Embolism(PE)

 

 

 

 

 

 

 

 

  • ParalyticIleus

 

 

 

 

 

 

 

 

 

  • Identify the nurse’s assessments and interventions involved in preventing aDVT.

 

 

 

 

 

 

 

 

 

 

Bruce Jones, aged 54, has returned to the ward following a left below knee amputation (BKA). He has a 10 year history of Type II diabetes.  He is no longer NBM.

 

  • **You take his blood sugar and it reads 2.2 mmol/L. What is the likely reason forthis?

 

 

 

 

 

 

 

 

 

  • Explain what nursing actions would be taken andwhy?

 

 

 

 

 

 

 

 

 

  • **Explain the pathophysiology of how diabetes affects wound healing. (Suggest 100-200 words.)

 

 

 

 

 

 

 

 

 

 

John Smith, 22 year old male, with an open fracture of his right tibia and fibula has arrived on the ward. He has saline gauze and a Plaster of Paris (POP) back slab insitu on his right lower leg and is awaiting operating theatre (OT).  You receive the following additional information:

O/E: pale, clammy and diaphoretic, HR 112, RR 18, SpO2 97% on O2 2L via NP, BP 98/40,

T 36.2. A&O x 3, IV NS 1L over 6 hrs, morphine 10 mg last given at 1300 hrs – pain currently 5/10. Left N/V assessment: foot cool to touch, cap refill 3 secs, sensation to sole of foot and full movement.

 

 

  • Identify the key components of neurovascular assessment and what each specific assessment is monitoringfor.

 

 

 

 

 

 

 

 

 

  • Identify the potential neurovascular red flags that would alert you to a deterioration in John’s condition and identify what complications may bedeveloping.

 

 

 

 

 

 

 

 

 

  • You are preparing John for OT later in the shift. Review the pre-op checklist and discuss five of the pre-op nursing assessments/interventions and explain why they areimportant.

 

 

 

 

 

 

 

 

 

 

 

HCBN6104 Marking Schedule – Part A: Article Summary

 

Excellent 16-20 Marks allocated for:

·         Main points comprehensivelycovered

·         Understanding clearlydemonstrated

·         Excellent academic language andparaphrasing

·         Well written sentences and paragraphs, grammar and spellingcorrect

Good 13-15 ·         Most key pointscovered

·         Understandingdemonstrated

·         Appropriate academic language andparaphrasing

·         Most sentences and paragraphs well written with minimal grammatical and spellingerrors

Satisfactory 10-12 ·         Adequate key pointscovered

·         Limited understandingdemonstrated

·         Evidence of beginning academic writing andparaphrasing

·         Sentences and paragraphs need review with several grammatical and spellingerrors

D

 

Resit

 

< 10

 

or Fail

·         Insufficient key pointsidentified

·         Insufficient understandingdemonstrated

·         Insufficient evidence of academic writing and/or limited paraphrasingdemonstrated

·         Fundamental errors in sentences, grammar and spelling that interfere withmeaning

 

A 5% penalty will be taken off the total mark for assignments submitted 10% above the stated word limit.

 

Comments:                                                                                                                                                                  

 

 

 

Mark:                    

Marker:                                                                     

Date:                                        

 

 

 

Part A:

Part B: Part C:

                                 

                                 

                                 

OverallMark/Grade:                   

 

HCBN6104 Marking Schedule – Part B: Workbook

 

Mark Worksheet Pathophysiology, Aetiology and Diagnostic Tests

(15)

Nursing Assessments and clinical manifestations

(10)

Nursing management (10) Structure, Links to knowledge and Presentation

(5)

 

Excellent 32-40

·            Key pathophysiologyclearly described

·            Aetiologycomprehensively explored

·            Comprehensive discussionof diagnostictests

·            Clear demonstration ofexpected knowledge

·            Relevant key priority assessments clearlydiscussed

·            Comprehensive identificationof typical presentingconcerns

·            Clear demonstrationof expectedknowledge

·            Comprehensive discussion of specificnursing interventions

·            Clear rationale provided fornursing interventions

·            Clear demonstration of expectedknowledge

·            Demonstrates safe and appropriatenursing care

·            Excellent academic languageand paraphrasing

·            Well written sentences and paragraphs, grammar and spelling correct.

·            Full Adherence to APA (6thed.).

 

Good 26-31

·            Most keypathophysiology described

·            Aetiologyexplored

·            Diagnostic testsdiscussed

·            Some knowledge demonstratedat expectedlevel

·            Most relevant keypriority assessmentsdiscussed

·            Most typicalpresenting concernsidentified

·            Some knowledgedemonstrated at expectedlevel

·            Discussion of appropriate nursinginterventions

·            Rationale provided for nursinginterventions

·            Some knowledge demonstrated atexpected level

·            Demonstrates safe and appropriatenursing care

·            Appropriate academiclanguage andparaphrasing

·            Most sentences andparagraphs well written with minimal grammatical and spellingerrors

·            APA (6thed.). mostly adheredto

 

Satisfactory 20-25

·            Basic pathophysiologydescribed

·            Some aetiology identifiedbut limiteddiscussion

·            Limited discussion ofdiagnostic tests

·            Limited demonstration ofexpected knowledge

·            Some key priorityassessment discussed

·            Some presentingconcerns identified

·            Limited demonstrationof expectedknowledge

·            Limited discussion of nursinginterventions

·            Weak rationale provided fornursing interventions

·            Limited demonstration of expectedknowledge

·            Demonstrates safe and appropriatenursing care

·            Evidence of beginningacademic writing andparaphrasing

·            Sentences and paragraphs need review with severalgrammatical and spellingerrors

·            APA (6thed.). needsattention

D

 

Resit

 

< 20

 

or fail

·            Insufficient evidence of pathophysiologyidentified

·            Insufficient aetiologydiscussed

·            Minimal discussion ofdiagnostic tests

·            Insufficient demonstrationof expected level ofknowledge

·            Insufficient or irrelevant key nursing assessmentsdiscussed

·            Limited or inaccuratepresenting concernsidentified

·            Insufficient demonstrationof expected level ofknowledge

·            Insufficient discussion of nursinginterventions or inappropriate selection of nursing interventions

·            Omits or provides incorrect rationalefor nursinginterventions

·            Insufficient demonstration of expected levelof knowledge

·            Does not demonstrate safe andappropriate nursingcare

·            Little evidence of academic language and limitedparaphrasing

·            Fundamental errors insentences, grammar and spelling that interfere withmeaning.

·            APA (6thed.). incomplete or insufficient

Comments:                                                                                                                                                                  

 

 

 

Mark:                    

Marker:                                                                     

Date:                                        

 

HCBN6104 Marking Schedule – Part C: Handover Scenario Exercise

 

 

Mark

Nursing Assessments and Clinical Manifestations

(25)

Nursing Management, Structure, Links to Knowledge and Presentation

(15)

 

Excellent 32-40

·       Comprehensive application of Rapid Assessmentframework.

·       Comprehensive identification of typical presentingconcerns.

·       Comprehensive identification of other nursingassessments.

·       Identification of all actual/potential redflags.

·       Clear demonstration of expectedknowledge.

·       Comprehensive discussion of specific nursinginterventions.

·       Clear rationale provided for nursinginterventions.

·       Nursing interventions comprehensively reflect assessmentsdiscussed.

·       Clear demonstration of expectedknowledge.

·       Demonstrates safe and appropriate nursingcare.

·       Excellent use of terminology and professionallanguage.

·       Well written sentences and paragraphs, grammar and spellingcorrect.

·       Clear, concise accuratedocumentation.

 

Good 26-31

·       Most areas of Rapid Assessment frameworkapplied.

·       Most typical presenting concernsidentified.

·       Most other nursing assessmentsidentified.

·       Most actual/potential red flagsidentified.

·       Some knowledge demonstrated at expectedlevel.

·       Discussion of appropriate nursinginterventions.

·       Rationale provided for nursinginterventions.

·       Nursing interventions mostly reflect assessmentsdiscussed.

·       Some knowledge demonstrated at expectedlevel.

·       Demonstrates safe and appropriate nursingcare.

·       Appropriate use of terminology and professionallanguage.

·       Most sentences and paragraphs well written with minimal grammatical and spellingerrors.

·       Mostly clear, concise and accuratedocumentation.

 

Satisfactory 20-25

·       Some areas of Rapid Assessment frameworkdiscussed.

·       Some presenting concernsidentified.

·       Some other nursing assessmentsidentified.

·       Some actual/potential red flagsidentified.

·       Limited demonstration of expectedknowledge.

·       Limited discussion of nursinginterventions.

·       Weak rationale provided for nursinginterventions.

·       Nursing interventions do not always reflect assessmentsdiscussed.

·       Limited demonstration of expectedknowledge.

·       Demonstrates safe and appropriate nursingcare.

·       Terminology and language use needs review in someplaces.

·       Sentences and paragraphs need review with several grammatical and spellingerrors.

·       Documentation could be more concise andaccurate.

D

 

Resit

 

< 20

 

or fail

·       Insufficient or irrelevant discussion of RapidAssessment framework.

·       Limited or inaccurate present concernsidentified.

·       Insufficient other nursing assessmentsidentified.

·       Inadequate identification of actual/potential redflags.

·       Insufficient demonstration of expectedknowledge.

·       Insufficientdiscussionofnursinginterventionsorinappropriateselectionofnursinginterventions.

·       Omits or provides incorrect rationale for nursinginterventions.

·       Selection of nursing interventions demonstrates limited reflection ofassessments.

·       Insufficient demonstration of expectedknowledge.

·       Does not demonstrate safe and appropriate nursingcare.

·       Poorexpressionofprofessionalterminologyandlanguageorillegible/incomprehensible.

·       Fundamental errors in sentences, grammar and spelling that interfere withmeaning.

·       Documentation inaccurate orinappropriate.

Comments:                                                                                                                                                                    

 

 

Mark:                         Marker: Date:      

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