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NSB335 - Integrated Nursing Practice 5 - Queensland University of Technology

Assignment Task - Online healthcare modules and simulation

You will be expected to satisfactorily complete modules to demonstrate critical thinking and decision making in diverse and complex healthcare situations across the lifespan. You will need to analyse situations in these modules and undertake a holistic understanding of these situations drawing on prior knowledge and skills. In these National Health Priorities, you will be expected to use and understand the requirements for integrated knowledge and skills, including communication, collaboration, leadership, ethical and culturally safe approaches to healthcare, and inter-professional collaboration. Once you have worked through four of the five National Health Priority Area online modules and watched the on-line simulation, you will be required to read and complete the case based scenario workbook questions.

LO 1: Knowledge and Understanding of National Health Priorities and simulation evident

LO 2: Applied critical thinking and linking core nursing concepts of National Health Priorities and simulation issues

Task:

Use the Clinical Reasoning Cycle (CRC) on the following pages to review the nursing priorities in relation to the care of Ivan.

Consider the CRC on the following pages and following your work on the modules that encompass the NHP and National Health and Quality Safety (NHQHS) Standards, you should be able to answer the workbook questions. This task will assist you to critically think about typical clinical situations that will arise when you are a Registered Nurse and you will be required to assess and make clinical decisions for your patients.

When you have done this, answer the questions at the end of this workbook and submit into Turnitin in the provided template.

Now we shall step through the CRC in relation to Ivan's' case to prepare you for the workbook assessment questions.

Consider Ivan's situation, both socially and health wise. What is your initial view of this patient and potential issues for him and his wife?
Consider Ivan's osteoarthritis and obesity and how these may be linked.

Ivan is at risk of injury - both at home and when he comes to hospital. Consider why and what can be done in these settings to prevent injury.

Question 1.  Mr Jankovic is classified as severely obese. He suffers infrequent angina that is classified as stable. Explain why Mr Jankovic is suffering angina and the link to obesity.

Question 2. Explain the difference between chronic stable angina and acute angina.

Question 3. Mr Jankovic is on medication for his stable angina. Name and discuss briefly four (4) key education points that you would outline to a patient like Mr Jankovic with chronic stable angina to assist improvement of his chronic condition and the underlying cause.

Question 4. When you watch the pre-operative videos, what communication issues do you observe? Critically analyse the situation and consider both the patient and the nurse perspective. Take one patient barrier and one nurse factor and provide a short discussion about why these occur and how they can be addressed

Question 5. a. State two reasons (2) why it is necessary for patients undergoing surgery to fast?

Question b. What are the current evidence-based recommendations for pre-operative fasting times?

Question c. What are the risks of prolonged fasting for the patient? Name two (2).

Question 6. State three (3) types of pre-operative medication which may be given to Mr Jankovic prior to his surgery while still in the ward. Provide a briefreason for the administration of that type of medication to Mr Jankovic in a surgical premedication context.

Question 7. i. When you view the video where Mr Jankovic is administered the pre-medication, what are two (2) issues you view with the first nurse's administration process?

ii Consider safety considerations for patients receiving pre-operative medication and explain briefly two (2) nursing considerations when you are caring for a patient that has received a pre-medication and is awaiting transfer to the ORS - do not include the routine checks that are performed for all medication administration.

Question 8. Mr Jankovic has chronic obstructive sleep apnoea (OSA). He uses CPAP (continuous positive airway pressure) but tells you he only uses it intermittently when his snoring annoys his wife as he finds the mask hot and uncomfortable.

i. Explain what chronic obstructive sleep apnoea is and state two (2) physical reasons that have contributed to Mr Jankovic developing this condition.

ii. Name 4 risks of untreated OSA to a patient like Mr Jankovic.

Question 9. There is extensive literature across multiple surgery types that support the use of a pre-operative surgical checklist.

i. Identify three (3) questions that could be asked of Mr Jankovic in the pre-operative checklist and explain how these questions prevent error or improve patient safety in his case.

In the National Health Standards, Standard 6: Communicating for Safety Standard, Action 6.3 states Clinicians use organisational processes from the Partnering with Consumers Standard to effectively communicate with patients, carers and families during high-risk situations to:
• Actively involve patients in their own care
• Meet the patient's information needs
• Share decision-making
ii. Explain how the use of a pre-operative safety check list for Mr. Jankovic demonstrates compliance with this Standard.

Question 10. Mr Jankovic becomes very confused and a little aggressive in the immediate post-operative period. He does not have a history of dementia or confusion. This is quite distressing for his wife, Marla. The doctor gives a diagnosis of post-operative delirium.

i. Explainpost-operative delirium?

ii. What are four (4) known contributing factors that increase the risk of developing post-operative delirium?

iii. Outline the explanation you will provide to Marla about this condition?

Question 11. Effective and accurate clinical assessment skills are imperative for the nurse working with Ivan at all times. State 1 priority nursing problem linked to the post-operative delirium in the acute post-surgical phase. Phrase your problem statements as "Problem related to cause"

Question 12. For this problem state a goal in SMART format.(no reference required for this response)

Question 13. For this problem above, state 2 nursing interventions to address these and briefly justify. These interventions can be independent or collaborative.

Question 14. Based on your stated problem, the nursing care interventions and your goals, state 2 ways you would evaluate the outcomes. Justify with links to the evidence to support your answer.

Question 15. Mr Jankovic is having difficulty voiding post-operatively. He is demanding to get out of bed post his hip replacement. He passes 120mLs into the urinal with difficulty.

i. Explain why post-operative urinary retention can occur?

ii. Ivan continues to feel uncomfortable. You do a bladder scan and Ivan has 285mLs of urine in his bladder. Explain two (2) nursing interventions you perform to help him with his discomfort and to pass urine that is not inserting a urinary catheter.

iii. Explain why a urinary catheter is not suitable at this time and what further risk it could pose to Ivan.

Question 16. It is said discharge planning should commence at admission.

i. Using contemporary evidence, outline the importance of discharge planning.

ii. What are four (4) key pieces of information that you would provide to Ivan and Marla when he is discharged on day 9 following surgery for a total hip replacement with a complication of post-operative delirium?

Attachment:- Assessment Booklet.rar