Posted: May 3rd, 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

One actual problem for Keith is acute respiratory failure, indicated by his shortness of breath and low oxygen saturation (SpO2) levels. One potential problem is the development of sepsis due to community-acquired pneumonia, as indicated by his high temperature, increased heart rate, and high white blood cell count. According to the Surviving Sepsis Campaign guidelines (2021), early recognition and treatment of sepsis is crucial to improve patient outcomes.

Rationale for acute respiratory failure:

Keith’s shortness of breath and low SpO2 levels indicate an inability to maintain adequate oxygenation, which can lead to respiratory failure if left untreated (Sole, Klein, & Moseley, 2021).
Keith’s history of asbestosis and emphysema also puts him at risk of developing acute respiratory failure (Stefanutti, 2019).
Rationale for potential sepsis:

Keith’s high temperature, increased heart rate, and high white blood cell count indicate a systemic inflammatory response, which can progress to sepsis (Singer et al., 2016).
Community-acquired pneumonia is a common cause of sepsis, and prompt treatment with antibiotics and supportive care is essential to improve outcomes (Rhodes et al., 2017).
(3 marks)

Question 2

Problem 1: Risk of Delirium

Nursing intervention: Implement regular reorientation techniques
Rationale: Delirium is a common complication in hospitalized patients, especially in the elderly, and reorientation techniques, such as providing a familiar environment, can help reduce confusion and promote cognitive function (Inouye et al., 2014).
Collaborative Intervention: Consult with a geriatrician or psychiatrist
Rationale: Delirium can have multiple causes, including medication side effects, infections, and metabolic disturbances, and a specialist consultation can help identify and treat underlying causes (Inouye et al., 2014).

SMART goal: Keith will remain oriented to person, place, and time throughout the hospitalization by the end of the admission, as evidenced by a score of 10/10 on the Confusion Assessment Method (CAM) (Inouye et al., 2014).

Problem 2: Altered breathing pattern

Nursing intervention: Administer supplemental oxygen
Rationale: Adequate oxygenation is essential for tissue perfusion and can help prevent respiratory failure in patients with pneumonia (Sole et al., 2021).
Collaborative Intervention: Consult with a respiratory therapist
Rationale: A respiratory therapist can assist with the management of Keith’s altered breathing pattern, including monitoring and adjusting oxygen therapy as needed (Sole et al., 2021).

SMART goal: Keith will maintain an SpO2 level of 92% or above while on room air by the end of the second hospital day, as evidenced by a stable respiratory rate and absence of dyspnea (Sole et al., 2021).

Problem 3: Risk of infection

Nursing intervention: Implement strict infection control measures, including hand hygiene and isolation precautions
Rationale: Pneumonia is a contagious infection that can spread easily in the hospital setting, and strict infection control measures are essential to prevent transmission (CDC, 2021).
Collaborative Intervention: Initiate appropriate antibiotic therapy
Rationale: Prompt administration of appropriate antibiotics is essential to treat bacterial pneumonia and prevent the development of sepsis (Rhodes et al., 2017).

SMART goal: Keith’s temperature will remain within normal limits, and his white blood cell count will decrease to within normal limits by the end of the third hospital day, as evidenced by laboratory results (Rhodes et al., 2017).

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