Nursing Bioscience for Chronic Conditions
Assessment 2 Guidelines
Critical Review Individual Assessment (Total Value 30%)
Due Date for Submission Thur 22 Oct 2020 by 2359 hours
Case Scenario
Georgina Farrell is a 75-year-old female who lives in a moderate to high care aged care facility with her husband Mario. Both Georgina and Mario have recently commenced residing at the facility. Registered Nurses (RN’s) provide leadership in the delivery of nursing care in the facility. The RN coordinates, delegates, and supervises the care provided by enrolled nurses (ENs) and unlicensed support workers. The support workers (Carers) in the facility provide the majority of general care for the residents and have TAFE qualifications Certificate IV in Ageing Support.
Georgina recently has developed signs and symptoms (clinical manifestations) of lower respiratory tract infection including a productive cough, an audible wheeze, and dyspnoea on exertion. The RN approaches the visiting Nurse Practitioner (NP) and describes the patients’ clinical manifestations. The NP performs an assessment on Georgina.
Her vital signs are:
• Temperature 38.8 degrees Celsius
• Blood Pressure 148/90
• Pulse 108/min
• Respiration 28/min
• Oxygen saturation 92-93% on room air.
Georgina presents with fever, malaise, rhinorrhea, and ‘aching joints’. The patient presents with mild to moderate dyspnoea on exertion, orthopnoea, coughing on exertion and spontaneously, coughing up thick whitish sputum, air entry on lung auscultation is equal on both sides with bilateral wheeze and coarse crackles in both lung bases.
Past medical and surgical history includes: Chronic bronchitis, chronic obstructive pulmonary disease (COPD) stage 3, osteoarthritis, mild hypertension, childhood illness included appendectomy, fractured left clavicle, fractured right wrist, and the repair of a right inguinal hernia in middle age.
Weight: 85kg
Height: 173cm
Allergies: Nuts
Smoking History: Had smoked 20 cigarettes per day for 50 years and gave up five years ago. Her husband stated that Georgina has not had her influenza vaccination for this year and hope she does not have ‘the flu’.
Medications include:
• Salmeterol 50 micrograms inhaler BD
• Ventolin 200 mcg inhaler prn
• Glucosamine sulphate 1 daily
The Nurse Practitioner asks the facility RN, is the patient prescribed any other medications? The NP orders Ventolin inhaler stat and paracetamol 1G oral stat. The NP asks the staff if Georgina is on a COPD action plan? Also, what is the patients average range for peak expiratory flow? The NP discusses the patients condition with the patient, husband and facility RN. It is recommended to transfer Georgina to a hospital for medical care to stabilize her respiratory status. An ambulance is called and the ambulance officers assess Georgina. She is prescribed and commenced on oxygen via nasal prongs at 2 litres per minute. Georgina is transported via ambulance to Fiona Stanley Hospital Emergency Department (ED).
Background Information
The residential aged care Nursing home facility organizational trainer resigned 6 months ago. An existing organization staff member took on the acting trainer role on top of their existing designated role. As a result, the usual training timetable for education about patient care is less frequent. Some of the Support Workers (Carers) in the residential care section of the facility commenced employment 5 months ago. The RN on shift commenced employment 4 months ago.
Assessment 2 Task
For this task, you must write a critical review based on the case study above. Your review should include the following components:
1. Overview of the main Nursing Home patient management errors and problems in the case report.
2. Conduct a literature review of chronic bronchitis and chronic obstructive pulmonary disease (COPD), including the aetiology, pathophysiology, clinical manifestations (sign and symptoms), assessment, and evidence-based therapeutic management of COPD including clinical practice standards.
3. Describe the clinical abnormalities presented in the case study.
4. Explain why the nursing home management issues contributed to the patient clinical deterioration and the acute exacerbation of COPD.
5. Recommend evidence-based practice standards for the nursing home aged care facility. The recommendations outline change management guidelines for the facility.
Additional Information:
• The word limit is 1800 (+/- 10%). Any words over the word limit will not be marked.
• Use the APA 7th Edition referencing style http://libguides.library.curtin.edu.au/c.php?g=202308&p=1332729
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