Student Name Student Number Unit Code/s & Name/s HLTEN512B Implement and monitor nursing care for clients with acute health problems Assessment Type ☒ Case Study ☐ Assignment ☐ Project ☐ Other (specify) Assessment Name AS2 Assessment Due Date Assessment Received Date Student Declaration: I declare that this assessment is my own work. Any ideas and comments made by other people have been acknowledged as references. I understand that if this statement is found to be false, it will be regarded as misconduct and will be subject to disciplinary action as outlined in the TAFE Queensland Student Rules. I understand that by emailing or submitting this assessment electronically, I agree to this Declaration in lieu of a written signature. Student Signature Date Assessor Feedback: ☐ Student provided with feedback Attempt 1 Satisfactory ☐ Not Satisfactory ☐ Date / / Attempt 2 Satisfactory ☐ Not Satisfactory ☐ Date / / Supplementary Assessment (Apprentices/Trainees only) Satisfactory ☐ Not Satisfactory ☐ Date / / Assessor Name Assessor Signature Note to assessor: Please record any reasonable adjustment below that has occurred during this assessment e.g. written assessment given orally. PRIVACY DISCLAIMER: TAFE Queensland is collecting your personal information for assessment purposes. The information will only be accessed by authorised employees of TAFE Queensland. Some of this information may be given to the Australian Standards Quality Authority (ASQA) or its successor and/or TAFE Queensland for audit and/or reporting purposes. Your information will not be given to any other person or agency unless you have given us written permission or we are required by law. Instructions to Student General Instructions: Size 12 font , open book Number of Attempts: You will receive two (2) attempts for this assessment. Should your 1st attempt be not satisfactory, your teacher will discuss the relevant questions with you and will arrange a 2nd attempt to be scheduled. Should your 2nd attempt not be successful, or you fail to undertake the 2nd attempt, you will be deemed “not satisfactory” for this assessment item. Only one re-assessment attempt may be granted for each assessment item. Assessment Criteria: To achieve a satisfactory result, your assessor will be looking for your ability to demonstrate the following key skills/tasks/knowledge as per the industry standard: https://training.gov.au/Training/Details/HLTEN512B Format & structure When you are answering your questions, type the answer below each question. You may choose to put the question in bold format if you wish. Please do not change the font. Referencing requirements You must use your own words to answer these questions (not a cut and paste from a textbook or website) and APA style referencing should be used, both in-text and in the form of a Reference List at the end of the paper. Please note that assessments that contain plagiarism will be allocated an unsatisfactory grade. Please refer to the student rules for more information (see link below) http://training.qld.gov.au/resources/about/pdf/tafe-qld-student-rules.pdf Submission details Once completed, you should then up load it the AS2 submission site on CONNECT, ensuring that you follow the instructions carefully (there is an instruction video on the screen). If you are experiencing difficulties uploading your paper, contact your teacher before the due date. If you are unable to submit by this date, you must ask for an extension in writing at least seven days before the due date. You can download an extension request form on CONNECT. Requests for extensions inside this seven day deadline will not be approved unless you have a medical certificate. File Name You should save this file in the following format (including the month and year your course started. This enables your teacher to download your assessments in alphabetical order: Your Surname_group_Number of assessment Example: Wilson_Apr 2015_AS1 If you are required to resubmit an assessment please name your files as follows: Your Surname_resubmit_group_number of assessment Example: Wilson_resubmit_Apr 2015_AS1 Evidence Required to be Submitted and Method of Submission Submit under corresponding assessment number on Connect Note to Student An Assessment Mapping Matrix is available from your teacher upon request. The mapping matrix shows how the knowledge and skills that you are being asked to demonstrate align to the requirements of each Unit of Competency. The Scenario: You are the admitting nurse for Mrs. Akimoto. She is 72 year old, obese patient who is admitted for repair of fractured NOF. She is booked in for an open reduction, due to go to theatre in one hour time. Mrs Akimoto has been previously diagnosed with Type 1 diabetes. Mrs Akimoto was born in Japan and lived there for over 40 years. She does not speak very much English except for a few words. She follows the Buddhist religion and cultural practices. Q1. Identify (8) eight important assessments and/or forms you should perform and/or fill out as part of the admission. (This is to exclude name, age, and address.) words Ans. The focus on the different assessments is mainly through the performance where: a. It is important to obtain the history of patient. b. The completion of the caring plan of the patient. c. The falling of the risks assessment, water flow, the pressure with the ulcer risk assessment. d. The chart of ADDS. e. The planning for the safety and the alert form. f. The completion of the physical assessment which has been set for the head to the toe approach with the inspection, percussion, auscultation and the documentation of the notes. g. The olfaction. h. The oldcart for determining a proper pain. i. The assessment of the wound. j. The assessment of the pain is important so that she is able to handle the problems that are being faced by her. With this, Mrs. Akimoto, it is important to analyse that the name, age and the addgress is important for addressing the different areas. Q2. Discuss the cultural and religious considerations that may be relevant when caring for Mrs Akimoto. Ans. The cultural factors are depending upon the patients to influence and the decision of the families set at the end of life. The consulting of the family and the friends is to care for the deceased in the culturally sensitive way. There have been religious considerations to work on the different sectors where the family also inform about the communication and documentation process. a proper caring plan is completed and then is purely available to the staff. This can help the family with the propsoectives to minimise the stress. The reglious belief is the tool for the political leaders to enable a well-defined race where there are certain loyalty and the conformance factors. Q3. In your health assessment of Mrs Akimoto, name four (4) physiological things do you need to assess for each of the following areas: 100 to 150words A. Respiration B. Pulse C. Neurological status Q4. Identify four (4) hazards/risks in the operating theatre to the patient and/or staff. 50 to 100 words Q5. What are 2 common types of skin prep use in surgery? Mrs Akimoto has an uneventful operation and recovery in PACU. She returns to your ward. Q6. List 10 observations / assessments / information you need to receive during handover from the PACU nursing staff on Mrs Akimoto’s return to the ward. (excludes Vital Obs). 100 to 150 words Post operative orders/presentation: Obs, 8/24 IVT, PCA (Morphine 1mg per ml), 4/24 BSL’s, IDC on hourly burette measures, Bellovac x 2 on free drainage, IVABs, check XR and Hb in am, Sequential Compression Device (SCD) and Charnley pillow insitu. She also has a wound site and 2 drainage site dressings, dry and intact. Q7. 150 to 200 words. A. What is the regime for general post-op vital signs? B. What are 10 observations that would be required for Mrs Akimoto’s management other than vital signs? C. Give a rationale for each of the 10 observation identified. Q8. After settling Mrs Akimoto into her room, on the second set of observations she starts complaining of severe pain at the wound site. A. Identify and give a rationale for four (4) possible effects of untreated pain on her body related to recovery. 80 to 100 words Q9. Identify four (4) non-verbal signs that Mrs Akimoto may exhibit when experiencing unrelieved pain? (25 to 50 words) Q10. With her pain unrelieved, Mrs Akimoto starts to become angry and verbally abusive. When you answer her call bell, you find she has pulled out her IDC and is trying to climb out of her bed. (75 to 100 words) A. What are three (3) actions will you take to ensure her SAFETY? Q11. In the second hour post op, you check Mrs. Akimoto’s dressing and observe the dressing has filled with bloody ooze that was not present on your last observation and has leaked out of the dressing. (100 to 150 words) A. Identify and give a rationale regarding four (4) actions you will take on discovering this bloody ooze? Q12. In the fourth hour post op, you notice that Mrs Akimoto’s respiratory rate has decreased to 8/min and her oxygen saturation has dropped to 89%. (100 to 150 words) A. Identify and give the pathophysiology behind why this complication could be the cause of this deterioration? B. Identify six (6) nursing interventions you would perform in this situation? Q13. Two days later, Mrs Akimoto complains of pain in her right chest on inspiration and shortness of breath. (150 to 200 words) A. Identify the complication that Mrs Akimoto is experience and give a rational for your answer. B. What are five (5) nursing interventions that you should perform? C. Identify four (4) preventive measures for the identified complication. Q14. After you come back from your dinner break, you enter Mrs Akimoto’s room to find her unresponsive. ( 100 to 150 words) A. As an Enrolled Nurse, what are four (4) ways you could contribute to the emergency management/resuscitation of Mrs Akimoto? B. What equipment may be brought to the bedside to assist in Mrs Akimoto’s care? C. Name the two (2) first line drugs found on the resuscitation trolley. D. Identify the actions of these 2 drugs and their route of administrations. Q15. Three days later you are assigned to care for Mrs Akimoto. You observe her wound and notice that the dressing is clean and dry although around her drain site dressing it is reddened and she states that it stings. (25 – 50 words) A. What could be the wound complication? B. What three (3) other signs and symptoms would confirm your diagnosis? Q16. (75 – 100 words) A. What four (4) changes to the presentation of the wound and patient would make you suspect an expanding infection process is occurring? B. Identify the name of a generalised infection in the blood stream and its treatment. C. What is the potential side effect of this generalised infection if left untreated? Q17. (100 – 150 Words) A. Identify four (4) concerns Mrs Akimoto may have regarding her discharge. B. Name three (3) supporting health care team members and identify how they can assist her specifically with those concerns. Please ensure all questions are answered including intext and reference list