NUR250 Medical Surgical Nursing 1

Subject Code :
NUR250
Country :
AU
University :
Charles Darwin University

Topic:

Nursing care of a patient with a medical condition

Purpose

Developing the ability to locate, interpret, integrate, synthesize and apply nursing knowledge to a relevant nursing practice scenario in medical surgical settings.

Assessment 1: Case scenario one

Identify:	Mr Peter Jones, HRN: 123456, DOB: 26/03/1958
Situation:	Peter is a 61 year old Indigenous man from a remote community.
	He has been admitted to the CDU medical ward with chest pain. He
	has a 6/24 history of central crushing chest pain. His ECG shows
	that he has suffered from and inferior NSTEACS (NSTEMI).
Background:	Peter lives in a single story home with his wife, 4 children and 2
	grandchildren. He is independent with his cares.
	He has an extensive past medical history including:
	T2DM, smoker (10 per day), HTN, hyperlipidaemia, rheumatic
	heart disease and mitral valve regurgitation.
	No known declared allergies (NKDA).
Assessment:	Airway: Own, patent
	Breathing: RR 22, Sats 94% on RA.
	Circulation: HR 96 bpm, BP 160/95 mmHg.
	Disability: GCS 15/15, 4/10 central chest pain, feels tired and a bit
	worried.
	Exposure: Temp 37.0 oC
Recommendations/Read	Medical orders
back:	•	Repeat ECG

	•	Pain management
	• TED stockings and DVT prophylaxis
	Medication orders
	New medications:
	• GTN sublingual spray 400mcg PRN
	• Oral paracetamol 1g QID
	•	Aspirin 300mg STAT
	•	Clopidogrel 300mg STAT
	Usual medications:
	• Metformin XR 1gm BD
	•	Ramipril 10mg OD
	•	Simvastatin 20mg OD

Assessment 1: Case scenario two

Identify:	Mrs Rose Wilson, HRN: 123678, DOB: 19/02/1962
Situation:	Rose is a 57 year old Caucasian lady from Darwin. She has been
	admitted to the CDU medical ward with exacerbation of COPD. She
	has a 2/7 history of dyspnoea, productive cough and a fever.
Background:	Rose lives in a two story home with her husband. She is
	independent with her cares.
	She has a past medical history of:
	T2DM, smoker (20 per day), HTN, hyperlipidaemia and obesity.
	No known declared allergies (NKDA).
	She is obese (BMI 30) and drinks 1 bottle of wine every night.
Assessment:	Airway: Own, patent
	Breathing: RR 26, Sats 89% on RA.
	Circulation: HR 89 bpm, BP 160/95 mmHg.
	Disability: GCS 15/15, 2/10 sharp chest pain on inspiration
	Exposure: Temp 38.6 oC
Recommendations/Read	Medical orders
back:	• Chest X-ray ordered

	• Administer medications as charted
	•	Pain management
	• TED stockings and DVT prophylaxis
	Medication orders
	New medications:
	• Oral paracetamol 1g QID
	•	Ceftriaxone 1g BD
	•	Amoxycillin 1g TDS
	Usual medications:
	• Metformin XR 1gm BD
	•	Simvastatin 20mg OD
	• Salbutamol MDI 100 mcg PRN
	• Seretide MDI; 1 puff BD

Assessment 1 Tasks:

Choose from one of the patients handed over to you. Using the template provided in the Assessment 1 folder and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following tasks.

Task 1: Consider the patient

Based on the case scenario and in grammatically correct sentences:

Define the patient’s condition.

Discuss the pathophysiology of the disease.

How does the condition link with the patient’s past medical history?

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 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

Task 3: Patient education: 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 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 strategy to assist the patient to implement the education into their daily routine.

Task 4: Medication

Choose two medications that your patient has been prescribed (one (1) from their new medications list and one (1) from their old medications list) and discuss the following:

How does the medication work?
Why has your patient been prescribed this medication?
Are there any red flags/drug interactions that could affect the patient?
Use the clinical guidelines provided to support your claim.