Assignment Task
Topic: Nursing care of a patient with a medical condition
Learning objectives
Are developing the ability to locate, interpret, integrate, synthesize and apply nursing knowledge from NUR251 to a relevant nursing practice scenario in medical surgical settings
Are developing appropriate critical thinking, clinical reasoning and sound clinical decision-making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings
Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings
Are able to explain and justify or defend their nursing care decisions
Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context
Are progressing towards the level of professional written communication required for nursing practice in Australia
Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy.
Background:
Mary lives alone, in an assisted living facility. She is independent with her cares, she has a walking frame but she refuses to use it, she needs assistance with cleaning and laundry. She lives in a single storey home with her cat Gerald who keeps her company. She has been widowed for the last 10yrs and has a supportive son who lives locally, and he helps where possible. He is married with 2 teenage children. Mary sees her grandchildren every weekend.
She has an extensive past medical history including:
T2DM (on insulin), HTN, Hyperlipidaemia, chronic kidney disease stage 3 (Baseline eGFR 40 ml/min/1.73m2). She has been admitted previously due to syncopal episodes.
No known drug allergies (NKDA).
She is obese (BMI 35) she drinks 2-3 glasses of sherry each night.
Assessment:
Airway: Own, patent
Breathing: RR 23, O2 Sats 93% on RA.
Circulation: HR 68bpm, BP 165/85 mmHg.
Disability: GCS 14/15, she is drowsy and ‘I’m so tired, I can’t keep my eyes open, where’s Gerald?’.
Exposure: Temp 36.2 oC, BGL 3.5mmol/L
Mary looks unwell. She is restless and confused. Her urine is dark in colour and has an offensive smell. She has passed approximately 30ml of urine in 6 hours. She had 2 x IVC’s inserted to both ACF’s and is not tolerating any food due to nausea. She last attempted to open her bowels this morning and says ‘It was too painful’.
Recommendations/Read back:
Medical orders
Routine ward assessments and observations
Strict fluid monitoring
Administer Intravenous fluids as prescribed
MSU for MC & S
Diabetic diet and fluids as tolerated
TED stockings and DVT prophylaxis
IV Fluid orders
Intravenous compound sodium lactate (CSL) 500mls over 2 hours followed by:
Intravenous sodium chloride 1000mls/8 hourly.
Medication orders
Furosemide 20mg BD (IV)
Ramipril 10mg OD (PO)
Insulin Glargine 30 Units OD (s/c)
Nursing orders
Devise a plan of care for your patient
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