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APN108 Applying Nursing Practices (B) Assessment 1B: Case study Response Template ASSESSMENT 1B: Student Response Template Student Name Date Course HLT54115 Diploma of Nursing Subject Code and Title APN108 Apply Nursing Practice (B) Unit(s) of Competency HLTENN006 Principles of wound management HLTENN012 Implement and monitor care for a person with chronic health problems Performance criteria, Knowledge evidence and Performance assessed PC: HLTENN006: 1.1, 1.2, 1.3, 2.1, 2.2, 2.3, 2.4, 2.5, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 4.1, 4.5, 5.1, 5.2, 5.6, 5.7, 6.1, 6.2, 6.3, 6.4, 6.5, 6.7. HLTENN012: 1.1, 1.2, 1.3, 1.4, 1.5, 2.1, 2.2, 2.3, 2.4, 2.5. PE: HLTENN006: 1 HLTENN012: 1 KE: HLTENN006: 2.1, 2.4, 3, 5, 6.1, 7, 8, 9.1, 9.7, 9.8, 10.1, 10.3, 10.4, 10.8, 11.1, 11.3, 11.4, 11.5, 11.6, 11.7, 11.9, 11.10, 12.1, 12.2, 12.3, 13. HLTENN012: 1.5 a, b, c, d, e. 2.1, 2.2, 2.5, 2.7, 3.7, 4.1, 4.2, 4.6 Title of Assessment Task Case Study Type of Assessment Task Case study with short answer questions Length 10 questions with words limits of 300 – 750 per question. Submission Due by 11:55pm AEST Sunday end of Week 9 (module 5.1). Task Instructions To complete Assessment 1, Part B, you must respond to a number of questions based on the case scenario below. You are also required to complete a wound care assessment, develop a plan of care for the client and document using a clinical record on the assessment response template provided. 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, if provided. Use the correct medical terminology when assessing, reporting and recording data while 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 and the unit. 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 Mr McFarlane 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 General Practitioner (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 10⁹/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, he initially did well. However, on the seventh day after surgery, he developed pyrexia and his diabetic control deteriorated. His left foot had swollen above the bandaging. The dressing was removed and there was tissue engorgement and cellulitis surrounding the wound and 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 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 · Water low score of: 15 (High Risk) Reference: https://www.gettyimages.com.au/detail/news-photo/amputation-due-to-diabetes-news-photo/151032672?adppopup=true TASK Assessment Criteria Question 1 Discuss the physiological and biochemical process of normal wound healing. Include, in your answer, factors that impact wound healing. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 2 Discuss the nursing strategies required to minimise cross infection whilst conducting a wound assessment and implementation of a wound dressing. Discuss in your answer: a) The relevance of the client’s MRSA status, universal precautions and appropriate PPE to be considered for the client’s protection. b) Compliance with infection control practices and correct disposal of wound care products, including how hazardous waste are to be discussed. c) How Aseptic Non Touch Technique (ANTT) and Hand Hygiene practices can prevent the introduction of new bacteria to the client. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 3 Discuss how Mr McFarlane’s chronic illnesses could impact on wound healing. Include, in your answer, how the pathophysiology of Type II Diabetes, Peripheral Vascular Disease and peripheral neuropathy could delay/ hinder wound healing. Discuss the differences in pathological terms between a venous ulcer, an arterial ulcer, a diabetic ulcer and a neuropathic ulcer. (word limit 500 – 750 words) Response: TASK Assessment Criteria Question 4 Explain the differences between a simple, complex and surgical wound. In your response, consider the complications of healing with each type of wound. Discuss the reason why some wounds are left undisturbed for a longer period of time. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 5 What education should be provided to Mr McFarlane and his family in relation to his wound? Consider in your answer: a) Modes of transmission of infection b) Preventative strategies for other wounds c) Wound care post discharge including evaluation of the condition of the wound and where to seek assistance if the wound deteriorates. d) Possible psychological impacts of a chronic wound. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 6 What support networks could you suggest to assist and ease the difficulties for the client as well as family members? In your answer consider areas such as a holistic assessment and approach, and research what government health bodies are available to assist with financial assistance. Supply the Web Link for the government health bodies in your answer. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 7 Discuss appropriate pain management strategies for your client. Who, within the multidisciplinary team, could provide you with assistance with planning a pain management strategy? Include, in your discussion, appropriate pain management and time frames to be considered prior to attending to the wound assessment and dressing. Discuss the role of the pain management team and the requirement to liaise with your RN/ Team leader as outlined in the Enrolled Nurse standards for practice. (word limit 300 - 500 words) Response: TASK Assessment Criteria Question 8 Wound Management Record Discuss in the wound assessment the appearance of the wound (picture attached to case study), and the appropriate selection of the wound cleansing agent and cleaning technique; and wound products including primary and secondary dressings. Response: Think Hospital Wound Management Record WOUND MANAGEMENT RECORD Allergies: NIL URN: 00347622 NAME: George McFarlane Dressing regime: Update regime when a change in client condition occurs Wound- Location, And dimensions (width and length) Left foot diabetic ulcer and partial amputation (5 x toes) Wound bed description: % (epithelializing, Granulating, slough, necrotic, other) Surrounding skin: (healthy, dry, discoloured, macerated, cellulitis, oedema, erythema, other) Infection: (suspected, confirmed, none, swab obtained, other) Exudate amount: Nil, small, moderate, large. Exudate type: (serous, haemoserous, purulent, frank blood, other) Pain associated with wound Pre dressing scale 1 to 10: Post dressing scale 1 to 10: Frequency: When: Cleansing agent: Cleansing method. (Irrigation, N/Saline soak, ANTT swabbing, shower, debridement, keep dry, other). Primary Dressing: Secondary Dressing: Fixation: Referrals and date: (diabetic education, dietician, vascular surgeon, wound CNC, prosthetic, podiatry, plastic surgeon, OT, other) Additional instructions: Referrals and date: (diabetic education, dietician, vascular surgeon, wound CNC, prosthetic, podiatry, plastic surgeon, OT, other) Dressing Regime completed by: Date: Time: Signature, printed name, designation TASK Assessment Criteria Question 9 Nursing Care Plan Complete all areas of the Nursing Care Plan, mapping out nursing cares as appropriate for Mr McFarlane, taking in to account his current status as per the case study and the information you have discussed in your short answers. Apply appropriate nursing interventions for Mr McFarlane. Response: Think Hospital NURSING CARE PLAN