• Use the template provided • Must be saved in a word document (no PDF) • Professional 11/12 sized font with 1.5 spacing (e.g Arial or Calibri) • No contents page, introduction or conclusion...

• Use the template provided

• Must be saved in a word document (no PDF)

• Professional 11/12 sized font with 1.5 spacing (e.g Arial or Calibri)

• No contents page, introduction or conclusion required

• No acronyms, jargon or abbreviations in task 1,3 & 4.

• Task 2 Acronyms to be explained using the ‘key’ (on template) • grammatically correct sentences • Professional terminology

• No more than 10% over or under the word count (provided word counts for each task are a guide only) Presentation

• Must be APA (refer to CDU APA 7th style guide)

• Must include 10 peer reviewed journal articles – Relevant to Australian nursing practice and the scenario – Dated between 2010 and 2020 – Must be accessible by the marker

• Peer reviewed journals – no patient information leaflets (no consumer sites)

• Only 1 medical surgical textbook and 1 medications textbook

• Do not use health facility or hospital policies/procedures

• Use the right database to search for evidence based practice resources – JBI and CINAHL

Based on the case scenario and in grammatically correct sentences: Task 1: Consider the patient

• Based on the case scenario and in grammatically correct sentences: • Define the patient’s current medical condition/disease.

• Explain the pathophysiology of the disease.

• Discuss how the current presentation relates to the patients past medical history? (Approximately 500 words) Tip:

• Read through learning materials on Learn line and refer to your textbooks Task 1 – Assessment

• Task 2: Care plan

• Based solely on the handover you have received and using the template provided, complete a nursing care plan for your chosen patient. Your plan must address the physical, functional and psychosocial aspects of care.

• Three (3) nursing problems have been provided for you. For each nursing problem on your care plan you need to complete the following sections:

• What it is related to? •

• Goal of care •

• Interventions •

• Rationales for interventions •

• Evaluation

There are 4 parts to this activity.

1. Download and complete this case study: Bob's story: The beginning

2. Take a few minutes to predict, plan and prepare ....

On his day of admission, the Emergency Department has rung to advise that Bob is ready to be transferred to the ward where you are working today

(a) How would you expect him to be transferred from the Emergency Department? Walking, wheelchair, trolley or bed?

(b) What would you check, gather, have ready to admit him when he arrives?

(c) What types/groups of medications would you expect to see prescribed on his medication chart and why?

3. Now Bob has been in the ward for a few days...

Use the clinical reasoning process to identify

(a) What you know about Bob and what else you need to know

(b) What you need to do to find out this additional information

(c) To identify Bob's nursing problems

4. Develop and document a full nursing care plan for Bob.

Don't forget to provide a rationale or reason for the nursing actions or interventions you include.

Ensure you continue to address all the core concerns of nursing when completing your nursing care plan. I've attached another copy of the nursing care plan template here if you need it.

• Notes for Task 2 only •

• Dot points and single line spacing may be used in the care plan template. •

• Appropriate professional language must be used – legally recognised abbreviations may be used in this task (care plan) but a KEY with full terminology must be provided after the assignment references – key will be excluded from word count tally •

• All rationale must be appropriately referenced

• (Approximately 500 words) Task 2 – Nursing care Nursing problem: Acute Pain Related to: bacterial infection in the urinary tract and Pyelonephritis Goal of care Nursing interventions/actions Rationale Indicators your plan is working Minimise pain on movement and urination

1. Assess pain using pain score and PQRST algorithm

2. Monitor for observational pain signs facial expressions, guarding and impaired movement 3. Administer regular and break through analgesics as charted

4. Provide non pharmacological interventions – heat packs, warm shower and position

5. Discuss with medical team the use of a urinary alkalinise to reduce stinging on urination

6. Provide patient education about expected pain levels for this condition You need to find the rationales and reference them for the assignment XXX states pain has improved Pain score is low or zero XXX appears comfortable with no signs of guarding or facial grimacing XXX verbalises minimal pain on urination XXX is mobilising freely with normal gait Example care plan – Pain Discharge planning An important aspect of nursing practice is to effectively and succinctly communicate relevant information related to ongoing disease management or prevention of reinfection or deterioration on discharge. Patient education and discharge planning starts on admission and you need to provide your patient with education during your shift in preparation for discharge home.

• Explain two (2) important points/topics you will need to include in the patient’s preparation for discharge to aid healing and prevent further illness. For each education point identified provide:

• One (1) strategy to assist the patient to implement the education into their daily routine. (Approximately 500 words)

Task 3 – Patient education Choose two (2) medications that your patient has been prescribed (one (1) from their new medications list and one (1) from their usual medications list) and discuss the following:

• How does the medication work?

• Why has your patient been prescribed this medication?

• Discuss any side effects that could affect the patient. (Approximately 500 words)

Handover

You are on your second year clinical placement in the orthopaedic ward at your local hospital. Bob is one of the people you are caring for today. Bob’s Story Bob loves his motorbikes. Yesterday, Bob decided to enjoy the day with a bike ride "down the track" to Adelaide River township to do a bit of train spotting from the beer garden in the local pub. Every time he went to the bar, he’d have a look at “Charlie”, the big buffalo from the first Crocodile Dundee movie. Charlie was retired to Adelaide River after his movie career and when he died they sent him off to the taxidermist. Once he was preserved, he was given pride of place in the bar. He was a majestic animal with his horns spanning more than a metre. Bob thanked his lucky stars that he had never come across one that size when out on his bike….. Everything was going fine until he went over a crest and hit something big in the middle of the road. Bob and his bike went flying. The bike was a write off but Bob was OK, just dazed and with a large open wound on his left leg and a number of grazes and lacerations elsewhere. His leg was very painful and there was quite a bit of blood but he couldn’t work out what the white bit was sticking out of the wound though. No matter what he did, he just couldn’t get up. Some European tourists in a campervan came along not long after and did what they could to make him comfortable. They couldn’t believe that there was no mobile phone service and that one of them had to drive back to Adelaide River to get help. The local clinic ambulance and on-call nurse did what they could and then arranged for the aero medical service to collect Bob for transfer to Darwin for further treatment and care. Transfer from Emergency Department to ward The Emergency Department has rung to advise that Bob is ready to be transferred to the ward where you are working today… Take a few minutes to predict, plan and prepare…. (a) How would you expect him to be transferred from the Emergency Department? a. Walking, wheelchair, trolley or bed? (b) What would you check, gather, have ready to admit him when he arrives? (c) What types/groups of medications would you expect to see prescribed on his medication chart and why? A few days later……. Shift handover Bob was admitted 2 days ago following a motorbike accident near Adelaide River. He has multiple lacerations, grazes and a comminute, compound fracture of the tibia and fibula. It is not clear if there was any loss of consciousness at the time of the accident but his GCS has been satisfactory since admission. 2 He is booked for an open reduction and fixation of his fracture and cleaning and debridement of the larger lacerations this afternoon. He has been seen by the anaesthetist and scans and routine bloods done yesterday. He is now fasting for theatre. Vital signs are within normal limits. His left foot is slightly cyanotic, cool to touch and there is a small area of numbness on the large toe. His wounds are dressed with non-adherent dressings and he has a temporary splint on this leg. He requires regular analgesia and is on broad-spectrum antibiotics.

Before starting your care plan…. Patient safety and well-being

· What is your first priority when you first meet Bob today?

· What will you monitor closely during your shift today? Why?

· How frequently will you do Bob’s vital signs today? Why? Bob’s injuries

· What is the difference between a laceration and a graze?

· What is a comminute, compound fracture?

· What are the complications of a comminute, compound fracture? Neurovascular assessment

· What conclusions can you draw from Bob’s neurovascular observations at present? Bob’s medications

· What analgesics do you think Bob has been prescribed? Why?

· Given Bob’s injuries, what organisms would you expect the antibiotics cover? Why? Preparation for surgery

· Can you remember what is required pre and post operatively from Week 10 learning?

· If not, take a few minutes to refresh so you ensure Bob is ready to go when theatre call and all the paperwork is done. Defend or justify your care and clinical decisions

· Why does Bob need neurovascular observations at the moment?

· Will you continue to do them for the rest of your shift? Why? Now you have clarified your thoughts and checked your knowledge and understanding, it is time to start your shift. The first thing to do is to develop a care plan for Bob today. Applying the clinical reasoning cycle This activity will help you develop your understanding of Week 11 material and how understanding and skill in using the clinical reasoning cycle as part of your nursing practice. As you complete the activity, make a note of where your current level of knowledge of related A&P and professional practice requirements needs further development. In Week 11, the focus is

· The care of the person with a musculo-skeletal problem

· Developing and justifying a nursing care plan for Bob identifying o Current and potential problems, what these are related to and the evidence that indicates there is, or the potential for, a problem 3 o Goals of care for each problem o Nursing actions/interventions to achieve identified nursing goals o How you will know if Bob is responding to your care plan and interventions Focus on the situation, what you have learnt so far and the core concerns of nurses and nursing. Don't forget any OHS and workplace safety issues as well. Resist the temptation to get distracted with the specific medical treatments related to the medical diagnosis and other health problems. Begin or continue to add to a Week 11 study/revision plan to help you prepare for Assessment 2 later this semester. Take note of the questions in this activity– there could be some clues! Take the time for find one or two current journal articles to support your care plan and use Lemone, et. al. (2017) and Levett-Jones (2018) to help you develop your skills in prioritizing and defending or justifying your findings and care decisions. Once you have developed Bob’s plan, consider the following. Did you consider any of these when developing your care plan for today? Expand your thinking When you introduce yourself to Bob at the beginning of your shift, he seems happy enough but is dying for a coffee and a bacon burger. He does concede it is a bit early for a beer though! While talking to him and checking his charts and IV, you note that that his temperature early this morning was 38 degrees Celcius and his pulse was slightly elevated. During your focussed assessment of his injuries you note extensive bruising around the multiple grazes and lacerations and in other places on his body that wasn’t reported at handover. You also note similar neurovascular deficits from handover, such as poor perfusion in the left foot, and that Bob’s lips looks a bit pale. Patient safety and well-being

· In the light of Bob’s history, what do his early morning vital signs suggest to you?

· What might Bob’s pale lips indicate? Role and scope of practice

· What can you do about his elevated temperature and paleness that is in your scope of practice as a registered nurse? When reviewing Bob’s chart and progress notes, you also locate his x-rays. When you find the one of his leg, it looks like this… Source: Flickr, may be subject to copyright 4 X-rays

· Do you know what you’re looking at on an x-ray?

· Why are some areas whiter than others?

· What can you see on Bob’s x-ray? Don’t waste a lot of time here as interpreting x-rays are NOT in the role and scope of the registered nurse. While some experienced registered nurses develop some skills in reading x-rays, at this stage of your studies, they are also not a priority. Enough distractions, time to get on with core nursing care now! Over the course of morning, Bob remains stable but you are concerned about the slightly elevated vital signs. His temperature did fall slightly but when you check it just before lunch, it has gone up again. Thanks to your good work, Bob is transferred to theatre safely and with all the paperwork, charts and medical imaging with him while you are at lunch. You are expecting him to be ready to be discharged back to the ward before you go home this afternoon. Patient safety and well-being

· What are the key safety issues for Bob during, and on, his return to the ward? Post-operative management

· Can you remember the general principles from Week 10 learning?

· If not, take a few minutes to refresh so you are well prepared when you collect Bob from the PARU

· What do you need to have ready at Bob’s bed for his return? Sure enough, not long before the end of your shift, you collect Bob, settle him back to his bed and do his initial post-op observations. He is drowsy but easily roused. He wants more of that good stuff they give you up there! His vital signs and GSC are satisfactory and he is pain free at present. Both feet are cold and slightly cyanosed and Bob tells you he can’t feel a thing in either. He has intravenous fluids in progress and post-operative orders are for routine post-operative fracture care. His abrasions are covered with hydrocolloid or woven-backed adherent dressings. His fracture has been stabilised with external fixation device. What you see looks like this.. Source: Flickr, may be subject to copyright You think to yourself “Thank goodness it’s the end of my shift! I’ve never seen anything like this before and don’t know what how to care for it. I’ll have to do a bit of reading when I get home” 5 Next thing you know, the nurse for the next shift is there for a bedside handover. Apparently the Team Leader handed over your patients so you could do what you had to do for Bob and go off on time! Before going home, take a minute to check you have documented and handed over everything you need to

· What did you document in Bob’s progress notes today?

· What did you tell the nurse at the bedside handover? You go home feeling you could have done better today. There seemed to be so much to do and this was one of the first times you have had to care for some-one quite with such serious injuries on your own. You’re wondering if you’ll ever get the hang of it and admire the other RNs on the ward who never seemed to get stressed no matter what they have to deal with. At home, you do some reading… There wasn’t much in the textbooks you have, you had to searching for a couple of good journal articles. Nursing management: Care of an external fixation device

· What did you learn about care of an external fixation device?

NUR250 Nursing Care plan

Patient name:_____________________________________