NRS72003 Chronic Illness and Nursing Care Assignment

Juan Reyes is a 54 yr old proud Hispanic man. He has four children, Sierra, Linda, Alicia and Luis. Juan is immensely proud of all his children, and just saw his eldest two Sierra and Linda, graduate from high school, and transition to university studies. Juan is a very highly respected family solicitor who works for one of the major law firms in Brisbane, QLD. He lives with his wife and four children in Brisbane.

Juan rarely exercises and he believes that gardening is enough to maintain a healthy lifestyle. He is considered overweight. He has recently adopted a mostly healthy diet, although he does have fried food and sweets a few times a month. Juan does not smoke anymore; however, he did smoke about a pack per month from age 17-50 when he quit. He has not smoked since. Juan has a drink every night.

Juan has a family history of hypertension and heart disease from his father’s side (father had cardiovascular disease); kidney disease (sister passed away from complications related to kidney disease); dementia and Type 2 diabetes mellitus (mother). Juan’s father also had a stroke in 2010 which led to his death, and his mother died recently (2017) at an aged care facility due to complications of diabetes and dementia.

7 months ago, Juan went to his local health clinic for a regular check. Juan had noticed prior to this that his blood pressure is high and he is often feeling fatigue and dizzy.

On examination by the GP the following findings were noted:

Observations

Results

Temperature

36.9°C

Pulse

66 bpm

Blood Pressure

160/90 mmHg

Respiratory Rate

14 breaths/minute

SpO₂

98% on room air

Weight

80.5 kg

Height

168 cm (5’6” ish)

Waist Circumference

85 cm

BGL

5 mmol/L

Skin Integrity

Intact

Lipids levels:

1. Low-density lipoprotein cholesterol (LDL-C)

2. High-density lipoprotein cholesterol (HDL-C)

3. Triglyceride (TG)

4. Total Cholesterol (TC)

1. LDL-C: 3.37 mmol/L

2. HDL-C: 1.3 mmol/L

3. TG: 2.2 mmol/L

4. TC: 6.18 mmol/L

In addition to the observations above, Juan had a 12 lead ECG attended, and blood tests following the higher than expected blood pressure.

At his return visit a week later, the GP informed that he had high blood cholesterol and he is at risk of cardiovascular disease.

The doctor handed him an infographic flyer about the condition and he also provided the following medical orders:

  • Commence STATINS
  • Maintain normal blood pressure levels and lipids levels within normal range
  • Continue all other prescribed medications
  • Commence healthy eating routine
  • Low saturated fat, no added salt diet.
  • Start exercise program of moderate activity for 30-40 per day
  • Attempt to lower BMI to within healthy limits. Suggest weight loss of 12kg to achieve this.
  • All alcohol to be consumed in moderation. No more than 2 standard drinks per day, and consult an alcohol program if required
  • Rehabilitation
  • Support patient and family with adjustment to diagnosis

Juan was quite embarrassed by his diagnosis, and he didn’t tell his family members about it, nor did he engage in a cardiac rehabilitation program.

Juan’s Past Medical History

Childhood Illnesses

Chicken pox aged 7 years

Rheumatic fever aged 11 – 15 years

Immunisations

Hepatitis B (2006 for work)

Tetanus 2017

Rubella 1994

Diphtheria (all courses up to 15 years)

Poliomyelitis (all courses up to 15 years)

Measles with mumps 15 months old

Accidents and Injuries

Car accident aged 14. Broken right arm

Mycoplasma pneumonia aged 19 years (hospitalised x 4 days)

Surgical History

Pin and plate of right arm following car accident aged 14

In addition to the information above, Juan was asked by the admissions nurse about his overall health and wellbeing. The following is a listing of her perceptions of his health.

Juan’s Overall Physical and Social Health

Personal Perception of Health

Juan believes that he is maintaining a healthy lifestyle and that gardening is sufficient to help him manage his blood pressure and reduce his weight and lipid levels.

Health Maintenance

Juan looks after his garden on a daily basis and he considers it as a form of exercise and a way to improve his health

Adopted a healthier diet; however, he does have fried food and sweets a few times a month

Quit smoking aged 50 due to concerns over becoming breathless on performing activities of daily living

Does consume alcohol; one drink a day

Irregular check-ups

Social Relationships

Juan is currently married, living with his wife and four children.

Was very close to his parents, who were a strong guiding force in Juan’s life.

Mother passed away in 2017 due to complications of diabetes and dementia, aged 60. This was a very difficult time for Juan as they were very close.

Juan was also very close with his father, who died from a stroke in 2010.

Juan’s children are all academic achievers, and they are a close-knit family. The children are all assigned various household tasks to earn their allowance, and they are interested in healthy eating and physical exercise.

Stress and Coping

Juan finds his gardening to be a stress relief technique

Occasionally goes for walks with his wife and dog

Strong social network to help if needed.

Values and Beliefs

Juan describes himself as religious and often attends a religious group.

Sleep

Juan sleeps ok. Generally able to get about 7 hours.

He occasionally has bouts of insomnia in the lead up to a big case. This always resolves once the case is underway.


NRS72003 Assessment 2 Case Study

Assessment 2 – Case Study – 1500 Words

In this assessment, you are required to answer the following questions, based on the case study of Juan Reyes:

You are the Registered Nurse in the hospital that Juan is now attending. He was referred from his previous practice. Juan has finally told his family about his condition, and is here to learn more about his condition, and how to manage it.

Question 1:

What self-management strategies would you recommend to Juan that could increase his independence and well-being, when dealing with his chronic illness? How would you educate him about this in relation to his condition?

Question 2:

What role would you (the nurse) play in Juan’s care now, and into the future? (No more than 250 words).

Some things you could consider when answering these questions (remember to reference using scholarly sources):

  • What role would the nurse generally play in the treatment of a newly diagnosed patient with Cardiovascular diseases?
  • Why is it so important to empower our patients to play the lead role in their own care?
  • What is the importance of self-monitoring blood pressure, and how can this help your patient?
  • How does the education and knowledge you provide now, aid your patient into the future?

It is strongly encouraged that you make a one on one appointment with the Academic Skills, to go over your draft, well before submitting this task. This will allow you to make changes as necessary, and get advice on your draft work.

This academic activity will address the following learning outcomes:

LO2

Apply the principles of evidence-based nursing to devise strategies and interventions to promote independence, wellbeing and quality of life for individuals with chronic illness

LO3

Demonstrate integration of knowledge, safe patient management, and nursing skills relevant to chronic illness

Instructions:

  1. You are to select a minimum of 7 journal articles, systematic reviews, clinical guidelines or government policy documents, as well as any additional academic sources you can find, that address your topic. Your journals and analysis on this subject must be from an Australian perspective. You can use articles from overseas journals, so long as they have an Australian context and focus.
  2. The journals that you select for this task must be published within the last 10 years. Please only use journals published from 2010 onwards. Using articles outside of this time frame, no matter how well they address the topic area, may result in significant deduction of marks.
  3. Your overall work will be 1500 words. You are given 10% +/- for this work; however, words over this will not be marked, and may result in loss of overall marks (see rubric).
  4. You must use the structure outlined at the end of this document.
  5. This must be submitted in Word format only (doc, docx, NO PDFs)
  6. You must submit your finished document via Turnitin on the BlackBoard site. No assignments will be accepted in any other submission format (i.e. email, hardcopy, handwritten).
  7. Any assessments submitted after the due date, and without a special consideration in place, will have marks deducted as per the university assessment guidelines, found on the SCU website (-5% of the overall mark per day).

Formatting Instructions:

  1. You must have either a header or footer with your name, student number and include page numbers.
  2. You must use size 12 font throughout and you must have 1.5 or double spacing for your body.
  3. You must use double spacing for your bibliographic details as per APA 6th guidelines.
  4. You must use APA 6th referencing format. Information on this can be found on the Library Home Page.
  5. You in-text referencing is counted in your word count.
  6. If journals are deemed inappropriate, do not follow the assessment instructions, or do not meet the requirements of the assessment, you may incur significant loss of marks.
  7. You should not use headings for this assessment task.
  8. You should not use bullet points or tables/graphs for this task.

Structure:

Prior to commencing this task, you should access the various assessment writing guides from the Blackboard site, and familiarise yourself with these resources.

  1. Your case study should start with a short introduction. This section introduces your paper, to your reader (the marker), and should tell them what they will read in your paper ( 100 words).
  2. Your answers must be in paragraph format.
  3. Your body is where you make your main arguments and deliver your research findings. This is where you spend the majority of your word count. You must have in-text referencing for your case study points. Please ensure you are aware of the use of paraphrasing vs quotes for your body ( 900 words).
  4. Your bibliographic information for your essay, should follow APA 6th referencing format, and should be presented on a new page, titled reference list. References should be presented in alphabetical order.
  5. This section is not included in your word count.
  6. You should not use the first person for this assessment task.

Additional resources:

  • https://www.uts.edu.au/current-students/support/helps/self-help-resources/grammar/sentence-structures
  • Also, Griffith have English Help online resources available. These are free and open to anyone to use. Students have found them useful: https://www.griffith.edu.au/international/englishhelp/complex-structures
  • Flow of writing usually relates to logical sequencing of information and explicitly linking the relationship of paragraphs and sections to an academic argument. The University of Sheffield provides practical examples https://www.sheffield.ac.uk/ssid/301/study-skills/writing/academic-writing/paragraph-flow-connectivity

NRS72003 Assessment 4 Individual Clinical Skills

Assessment 4 – Individual Clinical Skills

Weighting: 30%

This assessment item is a clinical skill demonstration to be sat during in week 12. If a student is unsuccessful on the first attempt of this task, they may be given a second opportunity to undertake it. This will be determined on an individual student basis.

Skills Assessment

  • Students will be assessed on one clinical skill. For this task students will accept the role of the student registered nurse and will set up an IV line and administer an IV medication using a lab-based scenario
  • Students will be given 30 minutes for this task
  • All students will be notified of their result at the end of the assessment period (i.e. after all students have been assessed).
  • Students will be given 10 minutes reading time prior to the assessment. They will not be able to consult notes or textbooks during this time.
  • Students will be given a printed copy of the scenario and will be required to show their calculations. The tutor will keep this.
  • Students will then administer the drug. The tutor will ‘act’ as the second checker but will not be able to provide advice.
  • Students are strongly encouraged to form practice groups, and use the available practice labs, to ensure they are adequately prepared for this task.

Administrative details: This assessment will take place during week 12. You will need to bring your student ID card to the assessment, however you do not need to bring anything else as all paperwork (plus calculators and pens) will be provided (and retained) by the assessor.

The assessment rubric aligns with the practical checklist and clearly delineates the skills, knowledge and attributes that you need to demonstrate in order to complete the assessment successfully. Your assessment will be graded and your feedback be based on this rubric.


NRS72003 Chronic Illness Marking Criterion

Criteria

High Distinction +

High Distinction

Distinction

Credit

Pass

Fail

Critical Skills (highlighted in yellow on the performance checklist)

(60%)

All critical Skills performed safely, competently and confidently to an exceptional standard. No errors or hesitation observed.

All critical Skills performed safely, competently and confidently. No errors or hesitation observed.

All critical skills performed safely, competently and confidently. No errors; occasional hesitation observed.

All critical skills performed safely and competently. Some hesitation evident. Selfcorrected minor errors.

All critical skills performed safely and competently. Lacks confidence: hesitation evident. Selfcorrected errors.

One or more critical skills performed in error/unsafely. Lacking confidence. Deviation from safe practice observed.

Mark

60

55.5

48

42

34.5

0

Criteria

High Distinction +

High Distinction

Distinction

Credit

Pass

High Fail

Low Fail

Fail

Clinical skills (All remaining non-highlighted skills on the performance checklist)

(20%)

All clinical skills undertaken safely, competently and confidently, to an exceptional standard in an organised manner within the allocated timeframe.

All clinical skills undertaken safely, competently and confidently in an organised manner within the allocated timeframe.

Clinical skills undertaken safely, competently and confidently in an organised manner for the most part (with 1 error or omission), within the allocated timeframe.

Clinical skills undertaken safely and competently and confidently in the main with 2 errors or omissions), within the allocated timeframe. Organisation could be improved.

Some clinical skills undertaken safely and competently. 3 errors or omissions observed; exceeded allocated timeframe. Limited organisation of time and resources.

Few clinical skills undertaken safely or competently. 4 errors or omissions observed. Time limit exceeded. Poor organisation of time and resources.

Few clinical skills undertaken safely or competently. 5 or more errors or omissions observed. Time limit exceeded. Ineffective organisation of time and resources.

No clinical skills undertaken safely or competently. Time limit exceeded. Organisation of time and resources absent.

Mark

20

18.5

16

14

11.5

8

4

0

Communication

(10 %)

Exceptional communication demonstrated at all times. Engaged with patient/family/ others. Provided exceptional responsive information and advice.

Clear, respectful and effective communication demonstrated at all times. Engaged with patient/family/ others and provided excellent responsive information and advice.

Clear, respectful and effective communication demonstrated in the main. Engaged with patient/family/ others and provided thorough and responsive information and advice.

Clear, respectful and effective communication demonstrated at times.

Engaged with patient/family/ others and provided adequate information and advice.

Basic communication demonstrated during scenario. Limited engagement with patient/family/ others.

Ineffective and/or unprofessional communication undertaken during scenario. Little (and/or inappropriate) engagement with patient/family/ others observed.

Unprofessional communication undertaken during scenario. No (and/or inappropriate) engagement with patient/family/ others observed.

No communication undertaken during scenario.

Mark

10

9.25

8

7

5.75

4

2

0

Demonstrated critical thinking and clinical reasoning

(10%)

Exemplary knowledge and critical thinking demonstrated, including exceptional rationale for all aspects of medication administration. Side effects, risks and patient safety concerns addressed.

Excellent knowledge and critical thinking demonstrated, including strong rationale for all aspects of medication administration. Side effects, risks and patient safety concerns addressed.

Comprehensive knowledge and critical thinking demonstrated, including proficient rationale for most aspects of medication administration. Identified potential risks to the patient.

Proficient knowledge and critical thinking demonstrated in the main, including

adequate rationale for aspects of medication administration. Some risks and potential adverse reactions identified.

Basic knowledge and critical thinking skills demonstrated. Limited rationale for most aspects of administration of medication, with limited identification of risks and potential adverse outcomes to the patient.

Poor knowledge

and an absence

of critical thinking skills demonstrated. Poor rationale regarding collective aspects administration of medication, with inadequate identification of risks and potential adverse outcomes to the patient.

Insufficient knowledge and an absence of critical thinking skills demonstrated. Inappropriate rationale for all aspects of the administration of medication, with an absence of identification of risks and potential adverse outcomes to the patient.

No knowledge

or critical thinking skills demonstrated. No rationale for different aspects of the administration of medication. Risks and potential adverse outcomes to the patient.

Mark

10

9.25

8

7

5.75

4

2

0

TOTAL MARK