Assessment Type:
|
Case Study
|
Assessment Title:
|
34197/01 Chronic health conditions case study
|
Date:
|
|
Student Name:
|
|
Group No:
|
|
Student ID:
|
|
To demonstrate competence in units of competency within the HLT54115 Diploma of Nursing, a combination of assessment tasks must be completed to demonstrate an understanding of the underpinning knowledge and required skills as outlined in the National Training Package.
The following Case Study must be completed to form part of the evidence required to demonstrate the underpinning knowledge for:
u HLTENN012 Implement and Monitor care for a person with chronic health problems
|
Timeframe:
|
Week 35
|
Grading:
Each assessment task will be graded Satisfactory (S) or Not Satisfactory (NS). A Satisfactory result in each assessment task must be attained to receive a competent outcome for the unit overall.
|
Re-assessment:
Should a result of Not Satisfactory (NS) be received any re-assessment is conducted as soon as practicable after you have been provided feedback on the areas that need to be readdressed. You will be re-assessed only in the areas assessed as (NS).
After re-assessment occurs should it still be evident an overall understanding of this unit has not been demonstrated a meeting with your Principal Educator will take place to discuss options for further/varied forms of assessment or repeating of the unit of competency at a cost.
Should additional support be required it is your responsibility to request additional assistance or clarification as soon as possible after receiving initial feedback.
|
☐ “I affirm that all work submitted within is my true and original work unless otherwise credited”
|
Student signature:
|
|
Date:
|
|
|
|
|
|
|
|
|
|
Instructions
Purpose of the assessment
To demonstrate your knowledge, critical thinking and clinical reasoning of the content covered in nursing people with chronic conditions.
Task
This assessment consists of 3 scenarios with related information. To be deemed satisfactory in this assessment you are required to complete all the sections of this assessment. Once you have completed all the sections of this assessment you are required to upload your assessments into the open space platform as instructed in the module.
Read each of the detailed scenario’s pertaining to Anna, Frank and Shirley.
Answer all the related questions to each scenario satisfactorily, with the correct responses.
You must complete all the responses unassisted by the assessor or other individuals, but may refer to reference materials or resources as needed.
The question responses section is the only resource required for this written assessment to be completed. A pass mark of 85%, of the completed questions, correctly completed is required, to gain a satisfactory grade for this assessment.
Scenario 1 – Anna
Anna is a 49-year-old lady who lives with her husband and 2 sons. She is a personal care worker and works in a low care facility part time. Some of Anna’s complaints at present are that she is living with asthma and arthritis which impact on her ability to work.
Anna described to you that she had been experiencing significant joint pain, mainly in her wrists and has been diagnosed with rheumatoid arthritis.
She experiences acute, severe lumbar pain and tenderness that radiates to her right hip and lateral thigh after falling and landing on her buttocks last week. Walking and bending increases her pain, she sustained a stress fracture in her wrist 5 months ago. She has a history of osteoporosis. She has been taking corticosteroids and mineral corticoids for the past 6 years for Addison’s disease. She drinks two glasses of wine every evening and she dislikes dairy products and due to her pain issues does not part take in any physical exercise.
She is 167cm tall and weighs 52.7 kg. Diagnostic studies included:
u Bone mass /density test- showed decreased bone mineral density at the spine and hip.
u Lumbar spine X-ray reveals a slightly displaced L4 compression fracture
u Biochemistry shows: Normal Serum calcium, phosphorus and increased alkaline phosphate
1.1
Provide a summary of the pathophysiology of Rheumatoid arthritis including signs and symptoms.
1.2
Provide a brief discussion on the expected actions for each of the following medications used provide an example of a drug from each category. Include the drug classification for each.
u
NSAID’s
|
|
u
Steroids
|
|
u
Disease -modifying antirheumatic drugs (DMARD’S)
|
|
To help manage her pain, Anna has been taking Naproxen for years. She has subsequently been experiencing: tiredness, loss of appetite, headaches, itchy skin and irritability. After discussion with her GP, she was sent for a blood test. The results of one of the blood tests indicated that Anna had an eGFR (estimated Glomerular Filtration Rate) of 48, indicating stage 3, chronic kidney disease. She asks you what may have happened to her if she didn’t see her GP.
1.3 List 3 long term complications of chronic kidney disease?
1.4 To help Anna stay healthy, identify 3 main aims in managing chronic kidney disease.
1.5 Not that she is anywhere near requiring dialysis, she is however curious and asks you what dialysis is. Provide a description of 2 types of dialysis available for the treatment of CRF.
1.6 Whilst you are talking to Anna she becomes short of breath, can only speak short sentences and has an audible wheeze. Indicate your 4 immediate nursing actions you would take in this situation to provide Asthma First Aid.
1.7 List one type of inhaler medication for each category available for managing asthma? Complete the following table:
|
Action
|
Effect
|
Side effects / Special considerations
|
Reliever
|
|
|
|
Preventer
|
|
|
|
Symptom controller
|
|
|
|
Combination
|
|
|
|
1.8
List the factors that increases Anna’s risk for osteoporosis.
1.9 What are the priority teaching needs for Anna?
1.10 How might you assist Anna in increasing her intake of calcium?
1.11 Why would regular exercise be important to Anna?
1.12 Bases on the assessment data presented, what are the priority nursing care problems? Are there any multidisciplinary problems that you can identify?
1.13 In the table below complete the comparison of rheumatoid arthritis and osteo arthritis according to the listed parameters.
Parameter
|
Rheumatoid arthritis
|
Osteo arthritis
|
Age of Onset
|
|
|
Gender
|
|
|
Pain characteristics
|
|
|
Affected joints
|
|
|
Disease
|
|
|
The overall goals for a patient with Rheumatoid arthritis are:
1 Satisfactory pain management
2 Minimal loss of function of the affected joints
1.14 Explain how you would conduct a pain assessment on Anna, indicate which method you would use and record your findings correctly in her progress notes. (See the last page of this assessment for the progress notes template)
1.15 Discuss the nursing interventions and care you would undertake and implement under the following headings, for Anna’s Rheumatoid arthritis:
a. Acute intervention at flare -up
b. Ambulatory and Home care
c. Joint protection
d. Alternative therapies
e. Psychological support
Scenario 2- Frank
Frank is a 73-year-old widowed gentleman. He has a history of Parkinson’s disease, TIA’s, congestive cardiac failure, HT and unstable angina.
He has a supportive family consisting of 4 daughters and a son. They all live close by. Frank spends a lot of time at the Italian club, but deeply misses his wife who only passed away 3 years ago.
You are the visiting nurse who is doing a general review of Frank’s care needs. You notice that he has Parkinson’s Disease in the early stages. He has slight hand tremors and his gait is a little shuffle. He tells you that he is taking a medication called Sinemet to help this condition. He confides in you however, that he is not even sure what Parkinson’s Disease is, and isn’t even sure why this medication has helped.
2.1 How would you describe Parkinson’s disease to Frank? (100 words)
2.2 Based on your understanding of Parkinson’s disease, provide the following information on the drug “Sinemet” and what is its primary function?
v
Generic name
v
Trade name
v
Action
v
Contra indication
v
Side effects
2.3 List 5 nursing care considerations to support Frank in relation to his Parkinson’s Disease and provide a rational for each?
2.4 After talking to Frank for a while he tells you that he is experiencing some chest discomfort. You are aware that he suffers from unstable angina.
Describe the pathophysiology of myocardial infarction from onset of injury to the healing process.
2.5 You notice that he is becoming pale, sweaty, short of breath and clutching his chest. List the 3 most immediate nursing actions you would undertake and the rationale for each in sequence of priority (consider the domiciliary care environment).
Nursing action:
|
|
Rationale:
|
|
Nursing action:
|
|
Rationale:
|
|
Nursing action:
|
|
Rationale:
|
|
2.6 If you could administer oxygen to Frank, what mask and flow rate would you commence? Provide a rationale for your decision and indicate why oxygen would be helpful.
Frank’s chest pain has resolved, after taking his prescribed GTN and he mentions to you that this happens on and off. He tells you that every time he sees his Dr, he checks his blood pressure and does a heart trace, ‘to keep me on track’.
2.7 What is your understanding of hypertension? Provide a brief explanation outlining the pathophysiology related to hypertension.
2.8 Explain why GTN was indicated and how it helps Frank’s angina?
2.9 Identify 5 risk factors for coronary artery disease and your nursing role in the promotion of therapeutic lifestyle changes in patients at risk?
2.10 List 2 types of anti- hypertensives and include, generic name, trade name, indication, action and contraindication and side effects for each.
Generic name
|
|
Trade name
|
|
Indication
|
|
Action
|
|
Contraindication
|
|
Side effects
|
|
Generic name
|
|
Trade name
|
|
Indication
|
|
Action
|
|
Contraindication
|
|
Side effects
|
|
2.11 What do you imagine the ‘heart trace’ is that Frank’s GP is performing and what does this test indicate, explain?
2.12 Hypertension are classified as primary hypertension or Secondary hypertension, Explain your understanding of the two and list 2 causes for each. (500 words).
2.13 What is the main differences between a TIA and a CVA? List 3
2.14 Define and discuss the term “hemiparesis”?
Scenario 3 – Shirley
Shirley is a 79-year-old widowed lady with a past medical history of COPD, bronchitis and hypertension. She has also developed dermatitis of her left lower leg. With all of her coughing she is also prone to having ‘small accidents’ i.e. – passing small amounts of urine when she coughs.
She is becoming increasingly depressed and isolated, becoming too embarrassed to leave the house.
3.1 What type of incontinence do you suspect Shirley is living with?
3.2 List 5 continence management strategies that you could suggest, helping Shirley manage her incontinence? And give a rationale for each.
During the time, you are spending with Shirley, she starts coughing and becomes very short of breath. This may be secondary to her COPD.
3.3 What is COPD? Provide a brief but accurate description and include the pathophysiology associated with COPD and list 4 symptoms.
3.4 You are required to undertake a Peak flow, test for Shirley.
1. Define spirometry
2. What does a peak flow measure and what are the expected normal ranges for an adult and a child?
3.5 Which nursing interventions would you apply to assist Shirley while she is experiencing this significant episode of shortness of breath? List four and give a rationale for each.
Nursing intervention
Rationale
3.6 Shirley has had a steroid cream prescribed for a significant flair up of some dermatitis on her left lower leg. Why do you think a steroid cream has been prescribed? Describe the action and rationale.
3.7 List and describe 3 signs of depression in older people.
3.8 What are the most common organisms that cause UTi’s – List 2
3.9 Discuss the nursing strategies that you could implement to assist Shirley with her depression and isolation due to the impact of her chronic disease, include possible referrals in the community to assist her.
Progress notes Template