Medical History • Mr Smith has a past history of a primary Ca lung with liver and bone metastases. • He also has a past history of COPD as he was a heavy smoker ( > 20 cigs a day for 45 years). Physical Assessment on admission • Mr Smith has dyspnoea, ascites, pruritus and bone pain (moderate to severe at times). • He is very thin as he has been anorexic for several weeks. According to a neighbour, he lived on beer and baked beans with an occasional meal at the club when he could be taken there by a friend. • His skin is stretched over his distended abdomen and bony prominences. • He is not able to walk unaided further than from the bed to the bedside chair. • He requires oxygen at all times.

Social History • Mr Smith lives alone in a unit with 23 stairs. He is unable to care for himself and refuses any home help. • According to his daughter who was contacted by the Social Worker, Mr Smith has a past history of domestic violence and abuse towards his former wife and children. His son and daughter are finding it hard to visit him even at this end stage of his life and have stated that they are not willing to care for him at home. • Mr Smith identifies himself as an indigenous Australian (a person of Aboriginal or Torres Strait Islander descent). He was born in Arnhem Land but moved firstly to a rural township in the Northern Territory before settling in his current home in a metropolitan city at age 65 to be nearer to his estranged children.

SCIENTIFIC RATIONALE: (#NOTE REFERENCES) A pressure ulcer is an injury to the skin as a result of constant pressure due to impaired mobility. The pressure result in reduced blood flow and eventually causes cell death, skin breakdown, and the development of an open wound. Pressure ulcers can occur in persons who are wheelchair-bound or bed-bound, sometimes even after a short time (2 to 6 hours).(Brown & Edwards, 2012, p. 239) Malnutrition can cause increased infection, electrolyte imbalances, altered skin integrity, anaemia, weakness, and fatigue (Furman, 2006). Poor dentition can cause difficulty with chewing food and swallowing, leading to a decrease in nutrient intake.( Maher et al, 2010, p.42 )

Intervention and Scientific Rationale Pt will be turned every two hours as evidence by nursing documentation Conduct a full skin inspection twice daily paying close attention to the skin directly over bony prominences Regularly check for moist areas -determine the cause of moisture and aim to reduce the amount on the skin Pt’s wounds will be changed daily per wound care orders and proper hand hygiene will be performed before and after dressing changes. Administer medications for stomatitis as ordered Soft diet 2 – 4 hrly mouth care

Evaluation By the end of day 7 there is reduced redness over the sacral area No new skin breakdown is recorded No other areas of pain or discomfort are reported. Other pressure points remain intact. Pt’s wounds will be kept clean and free from any further infection. Adequate oral intake as tolerated

Assessment Nursing Problem Goals/Expected Pt Outcomes Subjective data: Decreased mobility (bed bound) Decreased oral intake Objective data: Wt loss 5kg in past week Small pressure ulcer (0.2 x 0.1cm) on his sacrum. Inadequate nutritional intake Oral mucosal stomatitis Impaired Skin Integrity related to malnutrition and pressure ulcers as evidence by disruption of epidermal tissues. Within 2 weeks No itching or skin dryness Good skin hygiene Clean intact skin Pressure relief by position changes and special mattress.

Provides a clear layout of the assessment in essay format with a plain font (e.g. Arial, Times New Roman), size 12 font • Plagiarism/Academic Misconduct You must use your own words to answer these questions (not a cut and paste from a textbook or website) and APA style referencing should be used, both in-text and in the form of a Reference List at the end of the paper. Please note that assessments that contain plagiarism will be allocated an unsatisfactory grade. Please refer to the student rules for more information.

Did the student meet the following criteria: Note: Ensure that the marking criteria aligns with the Elements and Performance Criteria identified for this assessment in the Unit Assessment Plan FM-342 Please add rows as required Formulates a nursing care plan based on the nursing process Completes an accurate assessment of the patient based on information provided in the case study scenario Identifies client problems based on assessment data provided in the case study scenario Outlines appropriate nursing interventions to address identified patient problems based on information provided in the case study scenario and supports these planned interventions with referenced scientific rationales. Provides evaluation criteria to determine if goals / outcomes have been met.