Reference no: EM132469369

You are required to complete the guided case analysis, specifically referring to your clinical practice area in either public hospitals, private hospitals or aged care. Using the guided case analysis evaluate the health care needs of the client by covering the following points:

• Clearly outline the issues and concerns that you have identified in the scenario, ensure you are holistic in your writing

• Discuss assessments and interventions appropriate for this client with rationale, ensure you stay relevant to your clinical area and are culturally safe
• Outline a plan of care by using the available data and provide a rational for each nursing action based on evidence based and best practice
• Describe how you would evaluate and monitor progress towards the expected goals and outcomes

Scenario

Within your client allocation you are looking after Mr Orkins, an 84 year old gentleman who has been admitted to your unit following a collapse at home. Mr Orkins identifies as being Aboriginal and lives in Broken Hill. Two weeks ago he came to Sydney with his wife to visit his relatives. His past medical history includes: Type 2 diabetes mellitus, hypertension and hyperlipidaemia.

Mr Orkins takes the following medications:

• Diamicron 80 milligrams twice daily
• Amlodipine 5 milligrams in the morning
• Simvastatin 20 milligram in the evening

You receive the following information during morning shift handover:

• Last night he was brought to accident and emergency department accompanied by his wife and relatives after his wife found him collapsed at their relative's place
• According to his wife he was unresponsive for a short period of time but was orientated to time, person and place afterwards.
• According to night duty staff, Mr Orkins had a reasonably good night sleep, walked twice to bathroom under supervision, bowels not open.
• His vital signs taken at 0600 hours are between the flags and no pain voiced.

After receiving handover from the night nursing staff you enter Mr Orkins' room to greet him and conduct an initial assessment. Upon entering Mr Orkins' room your findings are as follows:

• Mr Orkins looks at you blankly when you greet him and introduce yourself
• Mr Orkins is lying on the bed slightly slumped onto his right side
• When you enquire about how he was feeling, you notice that Mr Orkins makes an attempt to respond to you, however, he has slurred speech. His face is drooped towards his right side and saliva is drooling from his mouth
• You notice that there is an odour of urine present in the room.

You check Mr Orkins' vital signs which are as follows:

• BP = 150/98
• HR = 98 bpm
• RR = 24 bpm
• SpO2 = 93% on room air
• Nil pain voiced.

You also check his blood sugar level which is 10.4 mmol/mL.

You conduct a neurological assessment:

• GCS = 13/15 (E=4, V=3, M=6)
• Pupils reactive, right = size 4, left = size 2
• Strength = 3/5 for upper and lower extremities right side, and 4/5 for upper and lower extremities on the left side.

While trying to assess him he seems reluctant for you to attend to his personal hygiene, you seem to remember that from your training that sometimes people prefer nurses of the same gender for personal cares and you are a female.

Question Part 1:

Clearly outline the issues and concerns you have identified during your primary, secondary and focused assessments in relation to Mr Orkins' current status.

Question Part 2:

Explain the process for conducting primary, secondary and focused assessments in the context of this patient.

Question Part 3:

Discuss the nursing interventions appropriate for this patient based on your concerns and issues identified in Part 1, your findings and available data. In your discussion include interventions that are holistic, culturally safe and evidence based best practice. Provide relevant rationales for each of your nursing interventions and describe how you would evaluate and monitor Mr Orkins' expected outcomes.