A Student Name: Student ID: Group: Date: Assessment Coding Assessment for this unit of competency is based on competency based grading. All assessment tasks, except Practical Observations and Clinical Placements are weighted and graded. Overall final grades applied to this unit of competency are: Competency Not Achieved (CNA) 0-49% Competency achieved – graded (CAG) 50-59% Competent with Credit (CC) 60-69% Competent with Distinction (CDI) 70-79% Competent with High Distinction (CHD) 80-100% Re-assessment Any re-assessment is conducted as soon as practicable after you have been informed of the requirement to be re-assessed and have been given the opportunity to be re-trained and assimilate the training. You are re-assessed only in the areas your assessor deems that you have not met the required standard. It is at the assessor/s discretion to re-assess the entire assessment should it be demonstrated an overall understanding of this unit has not been achieved. Reasonable Adjustment for this unit College Based Workplace Based Assistance of a learning support teacher for LLN issues Choose an item. Choose an item. Modifications to physical environment, e.g. wheelchair access Choose an item. Choose an item. Changes to course design, e.g. instead of written assessment task – change to verbal questioning & assessor to write the answers Choose an item. Choose an item. Changes in lecture schedules and arrangements, e.g. relocating classes to an accessible venue Choose an item. Choose an item. I acknowledge the assessment process has been explained and agree to undertake assessment. I am aware of Careers Australia's appeals process, should the need arise. I also understand that I must be assessed as 'satisfactory' in all parts of the assessment to gain a competent result for this unit of competency. I declare that the work contained in this assessment is my own, except where acknowledgement of sources is made. I understand that a person found responsible for academic misconduct will be subject to disciplinary action (refer to student handbook). Student Signature: Date: Assessor use only Assessor Comment/Feedback: Assessor Name: ____________________ Assessor Signature: ________________ Date: _________________ Result: _________% Resubmission: YES / NO Due Date: ________________ Office use only: Results entered by: Date: Skills Centre: Assessment: Practical - Case Study – submit via Blackboard Weight: 50% Pass Grade: Candidate must obtain 50% (CC) or greater to pass this assessment Student Instruction: 1. There are four (4) case studies to be completed. • Case studies 1 and 2 have 2 (two) parts. • Students are required to read each case study carefully then answer ALL of the questions. • Each question has been apportioned marks (shown beside each question). • The total marks for each case study are calculated and shown in the table below. 2. All of the assessment is to be completed on this word document, saved and submitted via the online portal within the unit on blackboard. Case Study Allocated MARK Case study 1 /15 Case study 2 /17 Case study 3 /13 Case study 4 /5 TOTAL /50 Textbooks: • Brown & Edwards, 2012, Lewis's Medical-surgery nursing, assessment and management of clinical problems, 3rd edn, Mosby Elsevier, Sydney. • Waugh & Grant, 2010 Ross and Wilson Anatomy and Physiology in Health and Illness, 11th edn, Elsevier, Australia.   Case study 1 (Part 1) (Total 15 marks) Case study 1 – Tom Tom is a 48 year old male, presenting with substernal crushing chest pain. He has swelling to his feet and ankles, and shortness of breath on exertion. 1. It is likely that Tom's symptoms are being caused by problems with which body system? (1 mark) 2. Explain the likely pathophysiology of Tom's chest pain and the swelling to his feet and ankles. (2 marks) 3. In planning services for Tom you note that organizational requirements state that any client admitted with chest pain requires the following procedures: • Electrocardiogram (ECG) • Chest x-ray • Blood screening for cardiac enzyme biomarkers (a) Explain the purpose of one (1) of the above tests. (1 mark) (b) Tom's ECG shows ST segment depression. Would you consider this to be normal or abnormal? Justify your answer. (1 mark) 4. Identify two (2) health professionals and the services they would provide for this clients condition. (4 marks) Case study 1 (Part 2) Case study 1 – Tom (continued) As part of Tom's health assessment, you discover that he smokes 40 cigarettes/day. 5. (a) Explain the implications of smoking in a client with coronary artery disease. (2 marks) It is extremely important to Tom's health outcomes that he cease cigarette smoking. (b) Complete the Action Plan for Tom using the activity of Nicotine Patches. (Remembering dating and time frames to reflect currency of documentation). Use the template for Question 5 b), as provided. (2 marks) Three (3) days following the commencement of the Action Plan, Tom states that the Nicotine Patches are stopping his cravings. However, he shows you the areas where the patches have been placed and his skin is very red and itchy indicating a severe skin reaction to the patches. (c) Document Tom's reaction to the Nicotine Patches and change the action plan using different activities to assist Tom with his objective to stop smoking. Use the template for Question 5 c), as provided. (2 marks) QUESTION 5b) Template: Action Plan commenced 02.04.2015 Objective (What do you hope to achieve?) Activities (What activities could help in achieving the objective) Anticipated outcomes (What is the expected outcome of the activities?) Timeline (What is the expected timeline?) Resources (What resource(s) will you need to achieve your objective?) WHS (What workplace health and safety (WHS) are required?) Nicotine replacement patches 1 month QUESTION 5 c) Template: Action Plan review date: 20.04.2015 Objective (What do you hope to achieve?) Activities (What activities could help in achieving the objective) Anticipated outcomes (What is the expected outcome of the activities?) Timeline (What is the expected timeline?) Resources (What resource(s) will you need to achieve your objective?) WHS (What workplace health and safety (WHS) are required?) Case study 2 (Part 1) (Total 17 marks) Case study 2 – Mary Mary is a 56 year old woman who has recently been diagnosed with type 2 diabetes. She is morbidly obese and has a body mass index (BMI) of 35. She is visiting a community health clinic for assessment and education for her newly diagnosed condition. 1. (a) Explain six (6) potential health issues Mary faces as a result of her obesity. (3 marks) (b) In planning services for your client, you follow organizational requirements and obtain a urine test from Mary. You note that Mary's urinalysis shows that there is a moderate amount of protein present. Is this finding normal or abnormal? Justify your answer. (1 mark) 2. Name two (2) external and (2) internal factors that could be affecting Mary's health status. (2marks) 3. What type of health education should nurses give this client to assist her with controlling her condition? (2 marks) 4. In your planning of services for Mary you identify that she needs to see a Dietician. What is the most likely impact of this intervention for Mary? (2 marks)   Case study 2 (Part 2) 5. Identify the body systems that are affected by Mary's Type 2 diabetes. (2 marks) Cardiovascular system Nervous system Integumentary system Endocrine system Sensory system Urinary system Body System Structure and function Consists of heart and blood vessels. Heart pumping action ensure constant circulation of the blood. Blood vessels through which the blood flows. The system is dividing into pulmonary and systemic systems. The main excretory system and consists of the following structures: • 2 kidneys, which secrete urine • 2 ureters, which convey the urine from the kidneys to the bladder • The bladder where urine collects and is temporarily stored • The urethra through which the urine is discharged from the urinary bladder to the exterior. Plays a vital part in maintaining homeostasis of water and electrolyte concentrations within the body. Produces urine that contains metabolic waste products, including the nitrogenous compounds urea and uric acid, excess ions and some drugs. Detects and responds to changes inside and outside the body. Response to changes in the internal environment regulates essential involuntary functions, such as respiration and blood pressure. Response to changes in the external environment maintains posture and other voluntary activities. Together with the endocrine system, this system controls many vital aspects of body function and maintains homeostasis. Therefore it is important to study and understand the structure and organisation of different aspects of the nervous system. Completely covers the body and is continuous with the membranes lining the body orifices. Protects the underlying structures from injury and from invasion by microbes contains sensory (somatic) nerve endings of pain, temperature and touch is involved in the regulation of body temperature. Consists of glands widely separated from each other not physically connected, endocrine glands are groups of secretory cells surrounded by extensive networks of capillaries that facilitate diffusion of hormones directly into the blood stream. Hearing, sight, smell and taste all have specialised sensory receptors outside the brain. These are found in the ears, eyes, nose and mouth. In the brain the incoming nerve impulses undergo complex processes of integration and coordination that result in perception of sensory information and a variety of responses inside and outside the body. 6. Complete the table below with the health impact that diabetes can have on the body systems provided. (2 marks) Sensory systems, the eye Cardiovascular system Nervous system Cardio vascular system – Hypertension Urinary system Body System Potential effects of Diabetes Prolonged raised blood glucose can lead to atherosclerosis – hardening and narrowing of the arteries, and if affects the coronary arteries, it can cause coronary heart disease leading to heart attacks and angina Diabetes, obesity and a sedentary lifestyle are all risk factors contributing towards development of hypertension. Untreated hypertension can lead to heart failure, stroke and kidney damage. Atherosclerosis in the brain can cause an ischaemic stroke. High blood glucose damages small and large blood vessels throughout the body. In the kidneys the damage is referred to as diabetic nephropathy (Waugh and Grant, 2010, p 345). Glomeruli are progressively damaged allowing protein into the urine. Atheroma of renal arteries can lead to renal ischaemia, hypertension and eventually chronic renal failure. Microvascular complications of diabetes can impair eyesight or cause vision loss. 7. Fill in the blanks regarding the impacts of health services in relation to the health issues experienced by Mary, refer to the example provided as your guide. (3 marks) Health Issue Health Service Impact of service on clients condition Example: Peripheral neuropathy Podiatrist Minimise risk of potential ulcers/sores developing and becoming infected (Peripheral neuropathy causes decreased sensation to feet) Dietician Treat underlying depression/eating disorders General practitioner Manage blood glucose monitoring, and overall health and well-being of a client with a chronic condition Diabetic retinopathy Endocrinologist Monitors diabetes and insulin/medication regime and specialised treatments Case study 3 (Total 13 marks) Case study 3 – William William, a 24 year old male presents at the emergency department following a motor vehicle accident (MVA). He had an elevated blood alcohol reading and appears to be intoxicated. The client suffered a blow to the forehead in the accident. He is reported to have lost consciousness at the scene. On admission he is incoherent and aggressive. 1. What internal factors are likely to be affecting the client's physical condition? (2 marks) 2. What external factors have contributed to this client's condition? (2 marks) 3. If the client's level of consciousness declines 6 hours after admission, what may be their diagnosis? When responding, consider the onset, peak and duration of alcohol in the system and factor in your knowledge of brain injuries. (6 marks) 4. What specific diagnostic tests would be required for this client? (1 mark) 5. Name two (2) specific health care professionals who would be involved in the care of a client with an acute head injury, in the hospital setting (2 marks) Case study 4 (Total 5 marks) Case study 4 – Palliative Client A 79 year old Buddhist woman has been admitted for palliative care in a respite facility. She has requested that no opiates be given to her as she wishes to die without pharmacological intervention. The organisational policy on palliative care reflects following the patient's wishes. 1. Referring to the organisational policies and procedures, and the Enrolled Nurse standards for practice, explain the ethical issues that would need to be considered when caring for this client. (1 mark) 2. This client appears to be in increasing pain, and the Enrolled Nurses caring for her understand the importance of her request to have a medication free death, yet they are upset by her discomfort. Following organisational policies and procedures, what are the responsibilities of an Enrolled Nurse in this situation, and who could they seek advice from? (3 marks) 3. What non pharmacological treatment could be provided as pain relief? (1 mark) END OF CASE STUDIES