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Assessment one: Complex health issues Stroke case study Leng
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Assessment one: Complex health issues Stroke case study Length:1500word limit +/-10%, 10 of APA 7th referencing style. This assessment item has 3 parts: Students will review the specific case scenario materials provided for this assignment. Using this information students will identify and prioritise the patient’s complex health issues. The student will provide rationales for their prioritisation decisions which will be supported by current literature and related nursing and healthcare standards and health department policies. 1. Identify a total of three patient health issues from the Stroke case scenarios that nurses can address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health issues. (Please see sample of patient health issues related to the stroke case: Ineffective airway clearance, Risk of aspiration, Impaired physical mobility, Impaired oxygenation, Fluid imbalance and Impaired self-care management.). 2. Rank the three-patient health issues that were selected in part 1 in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current literature. 3. Outline the nurse’s role in addressing the top three priority patient health issues in relation to patient assessment, coordination of care and delivery of care. Relate the discussion to nursing and healthcare standards and health department policies. ., RN Standards for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards etc. Students need to demonstrate their ability to identify and prioritise patient health issues that nurses can address within their scope of practice and rationalise the order of priority. This will enable students to articulate decisions they will need to make in clinical practice. In addition, students will be able to demonstrate their ability to write clearly and succinctly to reflect their understanding. Referencing: American Psychological Association (APA) 7th referencing style for in text referencing and production of a reference list. Accurate referencing using is expected –poor referencing will result in loss of marks. Marks may be deducted if the assessment is not within the word limit. Rubric Criteria Rating well developed Identification of health issues Identification of the patient health issues from the case scenario that nurses will address within their scope of practice (5marks) •Total of 3 patient health issues are identified. •The 3 patient health issues are described comprehensively Prioritisation of health issues and rationale Rank the 3 health issues in order of priority and provide a rationale supported with literature (18 Marks) •Comprehensive, persuasive and logical rationale for order of prioritisation. •High quality and current evidence used to comprehensively support the ranking of priority. Nurse’s Role The role of the nurse is outlined in relation to assessment, coordination of care and delivery of care. Discussion is related to nursing and healthcare standards and health department policies (12marks) •Detailed outline of the broad role of the nurse. •Discussion related to comprehensive range of nursing and healthcare standards and health department policies. Referencing Evidence of in-text referencing and reference list provided APA referencing style (5Marks) •At least ten different references are utilised. •An accurate reference list is provided, no errors. Frequently asked questions Assessment item 1–Complex health issues case study STRUCTURE What format should the assignment be presented in? Use paragraphs and clear introductory sentences in your assignment. You are not required to include a formal introduction or conclusion. You need to present referenced responses in full sentences and paragraphs (No dot points). The assignment is asking you to respond to 3parts. You will need to make it clear to the marker which case scenario (cardiac scenario or palliative care scenario orstroke scenario) you have chosen to base your assignment on. Headings can be used in the assignment, for example: Part one Part two Part three How many health issues should I identify in part 1? You will need to identify 3patient health issues in order to respond adequately to part 1 of the assignment. CONTENT What case scenarios can I choose from? Choose ONE of the case scenarios (cardiac scenario or palliative care scenario or stroke scenario) State the case scenario that you have chosen at the beginning of your written assignment. The case scenarios are available on Assessment information above What are the standards and health policies referring to in part 3? As RN’s we practice in accordance with the RN Standards for Practice and Code of conduct and adhere to NSW health policy, A-G Algorithm, National Safety and Quality Health Service (NSQHS) standards as we deliver patient care. What types of references can I use in my assignment? The following is a list of examples: •Textbooks •Journal articles •RN Standards for Practice •NSW health policy •Government policy •Australian resuscitation council •NSW detect program •A-G algorithm •Between the flags frameworks •National Safety and Quality Health Service (NSQHS)standards•Reputable or government websites REFERENCES How many references do I need to include? One reference per 100-150 words is acceptable. The word limit for this assignment is 1500 words. Can I use textbooks as a reference? Yes, you can use textbooks to reference information you use in this assignment along with journal articles and reputable or government websites. Assessment Stroke case study Stroke case scenario Patient name: Robyn Stewart Handover report to the Stroke Unit Date of handover report: 24thSeptember2021at hours MRN:875 344 DOB: Weight: 82kg Height: 170cm BMI: (overweight) Introduction Robyn Stewart is a 65year old female brought in by ambulance to the Emergency department this morning following a collapse at home. Patient observed by husband to be slurring her words. Patient was unable to lift teacup to her lips with her righthand during breakfast at 07. then fell off her chair to the righthand side. The patient husband has accompanied her to the hospital. Situation On examination in the Emergency department upon , Robyn presented with right sided facial droop, dysarthria, incomprehensible sounds, and right sided limb weakness. ECG: Sinus Rhythm. CT Brain angiography confirmed a Left middle cerebral artery (MCA) occlusion and no haemorrhage. Medical diagnosis confirmed as a Left MCA territory acute ischaemic stroke. The patient received intravenous thrombolytic therapy Alteplase (tPA) three hours from symptom onset at hours. Robyn was not a candidate for digital subtraction angiography and did not require Thrombectomy or stenting. Background Robyn has a medical history of Hyperlipidaemia, Hypertension and Type II Diabetes Mellitus (Diet controlled). Robyn lives with her husband and has two daughters with families of their own. Both daughters reside in the same local district as Robyn. Assessment Observations taken on arrival to the Emergency department: BP: 184/93mmHg HR: 98beats per minute SpO2: 94% R/A RR: 20breaths per minute Temp: (oral) Glasgow Coma Scale (GCS): 12/15 (Eye=4, Verbal = 2, Motor = 6) Cranial nerves: VII, XI and XII affected, others intact Limb strength: 5 in left arm and leg, 0 in right arm and leg CT Brain: Nil bleed Peripheral oedema BGL: Recommendations Admission to Stroke Unit Falls risk assessment Keep patient NBM, for swallow assessment with speech pathology Cardiac monitoring Monitor Neuro obs 4/24 Monitor Vital signs 4/24 Monitor GCS (any decline in more than 2 points GCS, please notify medical officer) Formal Bloods including Full Blood Count, Urea, Electrolytes, Creatinine (UEC’s) Anticoagulation with Warfarin (target INR 2 –3) Useful References Recommended texts LeMone, P., Bauldoff, G., Gubrud-Howe, P., Carno, M., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., Berry, K., Carville, K., Hales, M., Knox, N. & Stanley, D. (2019). LeMone and Burke’sMedical-Surgical Nursing Critical Thinking for Person-Centred Care. (4th edn). Pearson, Sydney Australia. Berman, A., Synder, S., Levett-Jones, T., Burton, T. & Harvey, N. (2017). Skills in clinical nursing. (1st edn). Pearson, Melbourne. Levett-Jones, T. (2018). Clinical Reasoning Learning to think like a nurse. (2nd edn). Pearson, Melbourne. Levett-Jones, T. (2020). Critical conversations for patient safety. (2nd edn). Pearson, Melbourne. Tizani, A. (2013). Harvard’s nursing guide to drugs. (9th edn). Elsevier, Sydney References Alinier, G. (2003) Nursing students’ and lecturers’ perspectives of objective structured clinical examination incorporating simulation. Nurse Education Today, 23, pp. 419–26. Austin Health (2020). Advance Care Planning Australia. Retrieved from Australian Institute of Health and Welfare (2021). Chronic disease. Retrieved from Australian Institute of Health and Welfare (2019). Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. 22. Canberra: AIHW. Australian Commission on Safety and Quality in Healthcare (ACSQHC) (2017). National Safety and Quality Health Service Standards 2nd edn, ACSQHC, Sydney. Australian Government. (2019). National Palliative Care Strategy 2018. Reterieved from Australian Health Ministers’ Advisory Council. (2017). National Strategic Framework for Chronic Conditions. Australian Government. Canberra. Retrieved from Australian Institute of Health and Welfare. (2008). Report Nursing and midwifery labour force 2005, National health labour force series no. 39, Cat. No. HWL 40, AIHW, Canberra. Australian Institute of Health and Welfare (2009). Nursing and midwifery labour force 2007. National health labour force series no. 43. Cat. no. HWL 44. Canberra: AIHW. Australian Institute of Health and Welfare (AIHW) (2017). The burden of chronic respiratory conditions in Australia: a detailed analysis of the Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 14. BOD 15. Canberra: AIHW. Brighton, ., Bristowe, K. (2016). Communication in palliative care: talking about the end of life, before the end of life. Postgraduate Medical Journal 92:466-470. Retrieved from Brownie, S., Scott, R., & Rossiter, R. (2016). Therapeutic communication and relationships in chronic and complex care. Nursing Standard, 31(6), 54–63. Retrieved from Conway, J. (2007). The changing skill mix and scope of practice of health care workers in New South Wales: Implications of education and training reforms for registered nurse practice, performance and education. Contemporary Nurse. 26, pp. 221-224. Garling, P. (2008). Final report of the Special Commission of Inquiry into Acute Care Services in New South Wales Public Hospitals, NSW Government, Sydney. Health Workforce Australia. (2014). Developing Aboriginal and Tores Strait Islander cultural capabilities in health graduates: A review of the literature. Retrieved from Hourihan, F., Bishop, G., Hillman, K. M., Daffurn, K., & Lee, L. (1995). The medical emergency team: A new strategy to identify and intervene in high-risk patients. Clinical Intensive Care. 6, pp. 269 – 272. NSW Health. (2019). Integrated care for patients with chronic conditions. Retrieved from Nursing and Midwifery Board of Australia (2016). Registered nurses standards for practice, Melbourne, Victoria. Nursing and Midwifery Board of Australia (2018). Code of conduct for nurses, Melbourne, Victoria 1. Australian Commission on Safety and Quality in Health Care (ACSQHC) 2018, Falls resulting in fracture or intracranial injury, viewed 27 September 2020, < 2. Australian Institute of Health and Welfare 2013, Stroke and its management in Australia: an update, viewed 27 September 2020, < 3. Bradley, E. G. 2015, ‘Nursing management: Hypertension’, adapted by D. Brown, in D. Brown & H. Edwards (eds), Lewis’s medical-surgical nursing: assessment and management of clinical problems, 4th edn, Elsevier Australia, Chatswood, NSW, pp. 716-736. 4. Clinical Excellence Commission 2012, Falls prevention- in hospital, viewed 27 September 2020, . 5. Clinical Excellence Commission 2014, NSW Health Standard Observation Charts, viewed 27 September 2020, . 6. Cox, B. 2008, ‘The principles of neurological assessment’, Practice Nurse, vol. 36, no. 7, pp. 45-50, available on UTS Online. 7. Dwyer, T. & Friel, D. 2018, ‘Circulation’, in A. Berman, B. Kozier & G. Erb (eds), Kozier and Erb's fundamentals of nursing: concepts, process and practice, vol. 3, 4th edn, Pearson Australia, Melbourne, VIC, pp. 1467-1490. 8. Goyal, A., Cusick, A. & Bansal, P. 2020, Peripheral Edema, StatPearls Publishing, viewed 27 September 2020, < 9. Gromova, D. O. & Zakharov, V. V. 2016, ‘Dysphagia after stroke’, Directory of open access journals, vol. 7, no. 4, pp. 50-56. 10. Harvey, N. 2017, ‘Neurological nursing skills’, in A. Berman, S. Snyder, T. Levett-Jones, P. Burton & N. Harvey (eds), Skills in Clinical Nursing, Pearson Australia, Melbourne, VIC, pp. 621-650. 11. Harvey, N. 2017, ‘Safe patient moving’, in A. Berman, S. Snyder, T. Levett-Jones, P. Burton & N. Harvey (eds), Skills in Clinical Nursing, Pearson Australia, Melbourne, VIC, pp. 41-94. 12. Namasivayam, A. & Steele, C. 2015, ‘Malnutrition and Dysphagia in Long-Term Care: A Systematic Review’, Journal of Nutrition in Gerontology and Geriatrics, vol. 34, no. 1, pp. 1–21. 13. Nazarko, L. 2017, ‘Stroke and dysphagia: fluids, diet and medication’, Nursing And Residential Care, vol. 19, no. 1, pp. 12–14. 14. Persson, C., Kjellberg, S., Lernfelt, B., Westerlind, E., Cruce, M. & Hansson, P. 2018, ‘Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT)’, Clinical Rehabilitation, vol. 32, no. 3, pp. 398–409. 15. Rothwell, P. 2015, ‘Blood pressure in acute stroke: which questions remain?’, The Lancet (British Edition), vol. 385, no. 9968, pp. 582–585. 16. Stroke foundation 2012, Swallowing problems after stroke, viewed 27 September 2020, < available on UTS Online. 17. Zomorodi, M. 2015, ‘Nursing management: The patient with stroke’, adapted by E. M. O’Brien & J. Barr, in D. Brown & H. Edwards (eds), Lewis���s medical-surgical nursing: assessment and management of clinical problems, 4th edn, Elsevier Australia, Chatswood, NSW, pp. 716-736.
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