Reference no: EM133175287

HLTENN012 Implement and monitor care for a person with chronic health problems

Task Instructions

To complete Assessment 1, Part A, you must respond to the questions in both Section 1 and Section 2. These questions must be answered in full. When responding to the questions, please pay attention to the entire question being asked, as well as the prescribed word count. Use the correct medical terminology when answering all questions. Your answers should be reflective, analytical and based on critical assessments and the Enrolled nurse standards for practice and Codes of Ethics for Nursing.

You will be assessed on the responses to the questions and will be deemed as either satisfactory or not satisfactory. All of the responses must be marked as satisfactory in order to pass the assessment. If your assessment is not deemed satisfactory, you will be re-assessed as per the THINK Education Assessment Policy for Vocational Education and Training (VET), before being awarded a Non-Satisfactory mark for the assessment.

Case Scenario:

Mr George McFarlane is a 53-year-old Caucasian Male, admitted to hospital after seeing his General Practitioner (GP) for an infected left (L) toe, caused by a blister/ lesion, possibly from ill-fitting shoes. When he realised there was a lesion present, he initially did not consider it serious and did not seek medical treatment straight away. After a week, the smell disturbed him, and he sought advice from his GP who prescribed oral antibiotics and stressed the importance of cleansing and changing the dressing on his wound regularly. Due to Mr McFarlane's job which required being on the road for long hours at a time, these regular dressing changes did not occur.

Subsequently, due to irregular dressing changes, Mr McFarlane's Methicillin-resistant Staphylococcus aureus (MRSA) positive status and Type II diabetes, the lesion failed to heal and became larger and deeper. Mr McFarlane returned to his GP five (5) weeks later. The GP immediately referred him to a specialist wound clinic. Investigations included a full blood count (FBC). The white blood cell (WBC) count was 17x 10?/L, predominantly neutrophils. The erythrocyte sedimentation rate (ESR) was 75mm/hr. An x-ray showed changes consistent with osteomyelitis.

Mr George McFarlane was admitted to hospital for surgical debridement of his wound. A large amount of tissue was excised from his left foot, which resulted in amputation of all 5 toes. The wound was packed and placed on a suction wound dressing (negative-pressure wound therapy), to minimise the exudate at the wound surface and promote healing by granulation. Post-operatively, initially he did well. However, on the seventh day after surgery, he became febrile and his diabetic control deteriorated. His left foot had swollen above the bandaging. The dressing was removed, there was tissue engorgement and cellulitis surrounding the wound as well as evidence of necrosis (as shown in the photograph below).

Mr McFarlane has a Past Medical History (PMHx):
• Type ll Diabetes needing close management
• Osteoarthritis in L) Knee
• Peripheral vascular Disease (PVD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Methicillin-resistant Staphylococcus Aureus (MRSA) positive
• peripheral neuropathy

Social History (SHx):
• Second marriage
• Occupation- Long Haul truck driver
• ETOH (Alcohol) usage on a regular basis
• Smoker, averages 15/20 cigarettes per day
• Often consumes take away/ fast food diet as he is away from home regularly

Mr McFarlane's current assessment consists of the following:
• BP 135/85
• RR 18
• SpO2 92% Room Air (RA)
• HR 89
• Temp 38.2oC
• BGL 13.8mmol
• U/A (Glucose ++, ketones+, protein +, SG 1010, PH 5)
• Pain score 7 at rest
• GCS 15
• Waterlow score of: 15 (High Risk)

Section 1
This section relates to Mr. McFarlane's case study

Question 1:
Discuss the pathophysiology each of Mr McFarlane's chronic illnesses-Type 2 Diabetes Mellitus, Osteoarthritis, Peripheral vascular Disease, Chronic Obstructive Pulmonary disease and peripheral neuropathy.
What are the signs and symptoms of each condition?
How does each of these conditions impact his body systems and affect his quality of life and independence
References required
(word limit 300-500 words)

Question 2:
Outline the possible social, emotional, physical, psychological and financial implications of a chronic illness on a client's lifestyle. How might this also impact on their family and loved ones?
References required
(word limit 200 - 400 words)

Question 3:
Outline five (5) rehabilitation strategies (in addition to the ones listed below), techniques and/ or equipment that can be used to assist and provide a greater level of independence to Mr.
McFarlane. Briefly discuss how each of these would be of benefit to the client and their family and assist with their care. Consider both community and hospital-based services.

Discuss what members of the multi-disciplinary team could be involved in Mr. McFarlane's care.
Please also briefly outline the use of the following additional rehabilitation techniques (50 words
maximum per technique)

a) Hydrotherapy
b) Pilates
c) Art therapy
d) Prosthetics

Question 4:
Discuss what further education and preventative strategies would be required to reduce the risk of this scenario re-occurring to Mr McFarlane.

References required
(word limit 200-400 words)
Question 5:
Mr McFarlane has a past medical history of
• Type ll Diabetes
• Osteoarthritis in L) Knee
• Peripheral Vascular Disease (PVD)
• Chronic Obstructive Airway Disease (COAD) also known as Chronic Obstructive Pulmonary Disease (COPD)
• peripheral neuropathy

Using the template, students are to plan the care with and for Mr McFarlane, within their EN scope of practice.

Section 2.
Question 6:
Describe the World Health Organisation's (WHO) focus on chronic illness, and provide a description of one of the following Chronic disease models/ programs

References required
(Word limit 200 words)

• The Chronic Care Model
• The Flinders Model (program)
• The Stanford Model
• The National chronic disease strategy
• The Chronic Care for Aboriginal people model of care

Question 7

A. Identify the 10 National priorities for chronic disease in Australia.
B. Provide a diagram for the continuum of chronic disease and briefly explain the model.

References required

Question 8.
For the chronic disease or chronic health condition listed below, state three (3) clinical
manifestations for each (Signs and symptoms)
References Required
(100 words for each)
• Chronic asthma
• Chronic pain including back pain
• Chronic renal failure
• Congestive heart failure
• Eczema
• Incontinence
• Neurological injury
• Long- term unconsciousness
• Parkinson's disease
• Rheumatoid arthritis
• Stroke
• Systemic lupus erythematosus

Question 9:
Regarding palliative care, what would be the nurse's goal to manage chronic disease within the palliative care environment?

References required (word limit 150 words)

Question 10:
Discuss three (3) sites within the human body for common cancer development for individuals from Australians.

References Required

Question 11:
Discuss the purpose of a tracheostomy and why a person may have one.

Define both permanent and temporary tracheostomy procedures and explain why each one may be required.

References required
(word limit 100-200 words)