Reference no: EM132635124

NSB335 Integrated Nursing Practice - Queensland University of Technology

MRS SIMPSON CASE STUDY WORKBOOK

CASE STUDY
Caring for a patient with dementia and arthritis who is at risk of injury

Your Task:
Use the Clinical Reasoning Cycle on the following pages to review the nursing priorities in relation to the care of Ethel.

PART 1: Pre-admission Clinic and at home
Ethel presents to the pre-admission clinic with her grand-daughter to discuss her up-coming left knee arthroplasty. Please complete the following activities.

STEP 1: Watch the video
Please go to Mrs Simpson PowerPoint found on Blackboard within the Assessment Task tab.

STEP 2: Answer the questions in relation to the clinical reasoning cycle

Question 1:
What type of arthritis do you think that Ethel has? Provide a rationale for your answer linking to pathophysiology.

Question 2:
Nurses need to understand the indications for and actions of medications they administer and make clinical decisions to ensure safe medication administration.
a) Donepezil is a commonly used medication to treat mild to moderate dementia caused by Alzheimer's disease. Briefly describe the mode of action (pharmacodynamics) of Donepezil.
b) Discuss the nursing considerations for patients taking Donepezil and the education you would provide to the patient/family.
c) Name one (1) side effect of Donepeziland state how you would assess Ethel for this?
d) Ethel takes non-steroidal anti-inflammatory drugs (NSAIDs). What is the risk for her with also taking Telmisartan? What advice can you give to reduce this risk and what monitoring should occur?

Question 3:

Review knowledge on types of dementia as it is important to understand the type of dementia that Ethel has.

Ethel has been diagnosed with Alzheimer's dementia.
a) Outline briefly the basic pathophysiology of Alzheimer's' dementia.

When the family first became concerned about Mrs Simpson's cognitive status, they visited her GP. You will do a further examination of mental status. There are many cognitive tools available that you might use to assess mental status.

b) Name and justify one (1)cognitive test that would be applicable to use for Ethel.
c) Name three (3) other tests (not cognitive) a doctor might order to determine a diagnosis of Alzheimer's dementia and explain briefly why.

Question 4:
After reviewing NSQHS standard five, answer the following questions related to safety and comprehensive care

a) Ethel is at increased risk of injury while in hospital.Name three (3) reasons why.
b) Discuss two (2) interventions that you would implement to help Ethel avoid injury while she is in hospital. Justify your answer using evidence beyond the NSQHS standard.

Question 5:

Ethel is having a total knee arthroplasty. Her granddaughter asks what this means. Provide a suitable explanation for her of this surgical procedure.

PART 2: In the Ward

Ethel is day 3 post left total knee arthroplasty. Please complete the following activities.

STEP 1: Watch the video
Please go to Mrs Simpson PowerPoint found on Blackboard within the Assessment Task tab.

STEP 2: Review Further background information
Past medical history
• Diabetes Mellitus type 2 (DMT2) (diagnosed 10 years ago)
• Mild renal failure (diagnosed 2 years ago)
• Hypertension (diagnosed 15 years ago)
• Dementia (diagnosed 1 year ago)
• Arthritis (diagnosed 6 years ago)
Surgical history
• Hysterectomy
• Cholecystectomy
Medications
Ibuprofen, Donepezil (Aricept), Micardis (Telmisartan), Temazepam,Metformin
Current Assessment
Ethel is day 3 post left total knee arthroplasty. Airway and breathing are patent, mild work of breathing. Pink and warm, well perfused.
Her vital signs at 0500hrs were - BP 174/80 mmHg; HR 88 BPM; RR 18 BPM; O2 sats 98%; Temperature 37.7 degrees.
She has an IV cannula insitu with no fluids running.
Her neurovascular obs are intact. The toes on her left leg have been pink and warm with full movement and sensation. Her pedal pulses are regular, strong and equal.

Her left knee hasa waterproof dressing in place however there wasvisible purulent ooze overnight and the dressing was removed this morning in the shower. The surrounding skin was inflamed. A wound swab was taken yesterday evening and sent for culture.

She has been doing deep breathing and leg exercises. She has been resting quietly and has been pleasant and cooperative with staff this morning.
Weight: 68kg (down from 71kg one month ago)

STEP 3: Answer the questions in relation to the clinical reasoning cycle

Question 6:

Ethel has Diabetes Mellitus Type 2 (DMT2). She clearly is not overweight.
However, having DM2 poses additional risks to patients undergoing surgery. Explain two (2) of these risks and justify incorporatingpathophysiology.

Question 7:
In the video Ethel is cooperative butforgetful.
a) Name a suitable pain assessment tool you could use to assess her pain.
b) Justify your choice of this tool, considering Ethel's responses to the questions in the video.
c) Explain briefly two (2) other indicators you might observe to assess Ethel's pain level and justify why they are appropriate for Ethel.

Question 8:

Ethel has indicated that she currently has a poor appetite and has lost 3kgs in the last month.

People with Alzheimer'sdementia often suffer loss of appetite and weight loss. Explain three (3) reasons why this might be happening to Ethel.

Question 9:
Consider how Ethel's' dementia impacts the hospitalisation and nursing approach.
Discuss three (3) considerations you need when providing her care?

Question 10:
Ethel has many nursing problems. Please write three (3) clear nursing problem statements using the "problem related to cause" format based on your review of the case and your reading of supporting evidence.
(This response does not need to be referenced)

Question 11:
State a goal for each of your nursing problems in SMART format. Please provide these SMART goals in a sentence for each goal- do not provide a table. [Three (3)goals needed]
(This response does not need to be referenced)

Question 12:
State two (2) nursing interventions for each of your stated problems in question 10.

Question 13:
For each of your three (3) nursing problems in question 10, state two (2)pieces of assessment you would use to assist you to determine effectiveness and evaluate your nursing interventions.

Question 14:
Medication administration can be a specific challenge when working with people with dementia. Discuss four (4) considerations when administering medication to a person with dementia.

Question 15:
What are two (2) specific considerations for people with arthritis in regard to management and prevention of pressure injuries?

Question 16:

Review NSQHS Standards: Partnering with Consumers Standard.

After reading this Standard consider how you would partner with Ethel and her family as you deliver care.

a) Explain four (4) key actions nurses should take to ensure they meet this standard in their practice.
b) Ethel has dementia and reduced capacity for consent. How do nurses ensure that dementia patients receive safe and high-quality care through involvement in decisions and planning for future care?

*Note: Need only 2,4,5,6,14,16 Questions

Attachment:- Integrated Nursing Practice.rar