NURS2101 Assessment Essay

NURS2101 Assessment Essay

NURS2101
Assessment 4: 24-hour Open Book Assessment
10am June 11th to 10am June 12th, 2020
INSTRUCTIONS
1. This assessment consists of four (4) scenarios, each with five questions.
2. There are six (6) pages
3. Total number of questions is twenty (20). Marks available for each question are provided.
4. The total marks for this assessment are 50. NURS2101 Assessment Essay

5. Please save the document to your computer and then type your answers directly under each question using the heading ANSWER.
6. The word limits for questions are the maximum words required.
7. Dot points can be used
8. Please provide in-text referencing for any source material used to answer the questions. In-text referencing is not included in the word limits.
9. Every answer must have an intext reference to gain maximum marks
10. Provide a Reference List of all source material at the end of the document, using APA referencing style.
11. Upload your completed document to Turnitin portal in Blackboard NURS2101 Assessments Assessment 4 – 11th June by 10am Friday 12th June
12. Assessments submitted after the due date and time must be submitted into the Late Submissions portal and will have a 10% per day deduction of available marks.

Scenario 1 (Total 15 marks)

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You are a new graduate registered nurse working in a small local hospital emergency department.
Mr Gary MacDonald is a 52- year-old businessman. McDonald has a very stressful position, and as a coping mechanism he drinks quite heavily. Mr McDonald has been feeling increasingly unwell lately but has been too busy to go to the doctor for a check-up. His abdominal girth has increased, his ankles are a bit swollen and he gets short of breath on exertion.
Mr McDonald was attending a business meeting when he began to vomit quite a lot of bright red blood. NURS2101 Assessment Essay
On arrival at the Emergency Department of the local hospital he has a vomit bag with about 350 mL of bright red blood. He is pale and complaining of feeling dizzy and appears confused as to what is happening to him and where he is. His immediate vital signs are:
Blood pressure 80/50mmHg, Pulse 130bpm, Respiratory rate 28, Oxygen saturation 91% on room air, Temperature 36.1 Celsius, Glasgow Coma Score (GCS) 13.
Question 1: Maximum word limit 100 words. (2 mark) (Reference not required for this question)
Based on your A-G assessment identify two (2) areas that are your highest priorities and express then as Nursing Diagnoses with “Related to” and “Evidenced by” statements.
Question 2: Maximum word limit 150 words. (4 marks)
The doctor makes an initial medical diagnosis of bleeding oesophageal varices due to alcoholic cirrhosis. Explain the pathophysiology that caused his bleeding oesophageal varices.
Question 3: Maximum word limit 200 words. (4 marks)
Based on Mr McDonald’s current condition, and NSW Health SAGO chart and DETECT policy requirements, outline four immediate nursing actions and their rationales within your scope of practice (as RN new graduate).
Question 4: Maximum word limit 150 words. (3 marks)
Briefly discuss the current best medical practice recommendations for the treatment of bleeding oesophageal varices including likely intravenous fluids, medications, and procedures.
Question 5: Maximum word limit 150 words. (2 marks)
Following treatment, Mr McDonald’s bleeding varices settled, and he was discharged home on the following medications: Lactulose orally 20 mL BD, Spironolactone 50mg mane. Explain the reason for each of these in relation to his underlying disease process. NURS2101 Assessment Essay

Scenario 2 (Total 11 marks)
You are a new graduate registered nurse working in the paediatric ward of your local hospital.
Sam Nicolaides is a nine-year-old boy who until recently has been in good health. Sam lives with his mother and father and two siblings. Following a respiratory virus a few weeks ago he has been slow to recover, lacking in his usual energy. He has been hungry and thirsty all the time, and has recently begun wetting the bed, which he has not done for many years.
Sam presented to the Accident and Emergency department two day ago with nausea, abdominal pain and feeling generally unwell. His observations taken on admission were:
Blood pressure 80/50mmHG, pulse 140, respiratory rate 28 deep and sighing with an unusual sweet smell to the breath, oxygen saturation 100%, temperature 37.2 degrees Celsius. Urinalysis SG1025, pH 5, sugar++++ ketones+++ no other abnormalities. BGL 28mmol/L.
A medical diagnosis of Diabetes type 1 with keto-acidosis was made.
Question 6. Maximum word limit 120 words (approximately 30 words per section) (2 marks)
Briefly explain the pathophysiology causing the following symptoms Sam was experiencing on admission: NURS2101 Assessment Essay
a) Glycosuria
b) Thirst
c) Ketonuria
d) Kussmaul breathing
Question 7. Maximum word limit 50 words. (2 marks)
List four (4) ongoing nursing assessments, other than vital signs, that will be required to monitor Sam’s fluid status and ensure safe fluid replacement therapy over the next 48 hours.
Question 8. Maximum word limit 150 words. (3 marks)
Explain the concept of family centred care and why this is important to the physical and psychological care for Sam.
Question 9. Maximum word limit 150. (2 marks)
For the ongoing management of type 1 diabetes, current best practice recommends an intensive insulin therapy regime called multiple dose insulin (MDI) or basal/bolus regime. Explain:
a) What this insulin regime involves and
b) Discuss why this is considered best practice management for type 1 diabetes.
Question 10. Maximum word limit 150 words (2 marks)
Explain what the HbA1c test is and why it is important in the management of patients with diabetes.
Scenario 3 (Total 11 marks)
You are a Practice Nurse in a small rural medical centre.
Mr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.
Mr Murray presents to his local medical centre saying he was not feeling well. Mr Murray’s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered. NURS2101 Assessment Essay
• His blood pressure is 167/95mmHg, pulse 92bpm, respiration rate 24.
• Blood biochemistry reveals: Sodium 132 mmol/L, Chloride 92 mmol/L, Potassium 5.7 mmol/L
• Bicarbonate 20 mmol/L, Urea 27.6 mmol/L, Creatinine 428 umol/L, Hb 82g/L, eGFR 20
• HbA1c 8.6%
Question 11. Maximum word limit 20 words. (1 mark)
You are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.
Question 12. Maximum word limit 20 words. (1 mark)
List the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.
Question 13. Maximum word limit 10 words. (1 mark)
Based on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?
Question 14. Maximum word limit 300 words. (5 Marks)
Mr Murray’s doctor prescribes the following dietary modifications and additional medications.
• Sodium bicarbonate tablet 500mg tds
• Calcium carbonate tablets 600mg tds
• Erythropoietin injection 40,000 units SC weekly
• 1500 mL fluid restriction
• Low potassium and 70-gram protein diet
As the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.
Question 15. Maximum word limit 150 words. (3 marks)
The doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go. NURS2101 Assessment Essay
a) What cultural concerns may be raised for Mr Murray by this possibility?
b) Briefly describe strategies that could be implemented to help maintain Mr Murray’s autonomy.
c) Briefly describe strategies that could be implemented to help maintain Mr Murray’s cultural safety.
Scenario 4 (Total 13 marks)
A new graduate nurse is working in a surgical ward of the local hospital. She has been allocated to care for Mrs Beverly Smith, a 70-year-old woman admitted for a hemicolectomy for stage 2 bowel cancer. Mrs Smith has a history of hypertension and stage 2 Chronic Kidney Disease (CKD). Mrs Smith had her surgery yesterday and is reported to have been stable overnight. She has a midline incision closed with staples, one Belovac of with minimal haemo-serous drainage, IV 4% Dextrose in 1/5 Normal Saline running at 85mL/hr and a PCA of Morphine sulphate 100mg in 100mL Normal Saline set to deliver 1mg with each press. She has an indwelling urinary catheter draining an average of 60mL/hr.
When the nurse assesses Mrs Smith at the beginning of the shift, she appears distressed and complains of pain rated 7 out of 10 in her abdominal area. Her observations are blood pressure 140/85 mmHg, pulse 90 bpm, respiratory rate 12, oxygen saturation 92% and temperature 36.2 degree Celsius. She is unwilling to sit up in bed and has difficulty taking a deep breath.
The nurse explains to Mrs Smith the importance of pressing the PCA button regularly. She then checks her medication chart for any orders for “breakthrough” medication. Mrs Smith has an order for oxycodone (Endone) 10mg oral PRN, so the RN asks the endorsed EN to accompany her to the locked medication cupboard, check out the dose of Endone, and administer it to Mrs Smith, checking all the “5 rights” of medication administration. NURS2101 Assessment Essay
The RN continues to give care to her other patients. When she returns to the room, she notes that Mrs Smith is sleeping peacefully. Because she had a poor night, she decides not to wake her for observations and charts “sleeping” on her PCA chart. The nurse then goes to morning tea.
When she returns from morning tea, she notes that Mrs Smith is slumped down in the bed and looks very pale. She does a set of observations and notes the following:
Patient is semi-conscious, rousing to voice, unable to give a pain score, PCA history delivered dose 15 times in the last 2 hours, blood pressure 90/60mmHg, pulse 70 bpm, respiratory rate 4 breaths per minute and shallow, oxygen saturation 84%.
Question 16. Maximum word limit 50 words. (1 mark) (Reference not required for this question)
Express the immediate priority patient problem indicated by this situation as a Nursing Diagnosis with a ‘Related to’ and ‘Evidenced by’ statement.
Question 17. Maximum word limit 200 words. (4 marks)
List four immediate priority nursing actions that are required in this situation to address the identified problem and a rationale for each.
Questions 18. Maximum word limit 200 words. (3 marks)
Discuss what you believe were the main patient factors and nursing or system errors, that led to this occurrence.
Question 19. Maximum word limit 150 words. (2 marks)
Following treatment by the medical and nursing team, Mrs Smith is significantly improved by the time her daughter visits later.
Describe the actions required following this incident as part of NSW Health and hospital policy to address issues of patient safety and standards of care. NURS2101 Assessment Essay
Question 20. Maximum word limit 200 words. (3 marks)
What are the legal requirements for a Tort of negligence? Do you believe that the new graduate RN was negligent in this situation? Justify your answer.
END OF ASSESSMENT

The introduction forms the most important section of NURS2101 Assessment qualitative report. This is because you would highlight the topic that you have chosen for the report here. Whichever disease or problem that you aim to solve through the report must be discussed in this section. Then, suggest some reasons as to why you feel that the topic is important for a nurse. Next, in just 100 words end the introductory paragraph by highlighting the keywords or the database that you have used to find about this problem.

2. Discussion
The discussion would be the lengthiest portion of your report wherein you must include the aims of your research, how you will design the research, who all will be participating in this process, how you will collect and analyse data, the main findings, ethical considerations as well as the limitations of your study. You may also make use of CASP questions. NURS2101 Assessment Essay

3. Reflection and Recommendations
The next section of your report must include your reflection on what all you have learnt while dealing with the patient and his/her family. Then, you must suggest some of your own recommendations which you would be using in the future.

4. Reference list
I feel that a reference list is the most important section in a NURS2101 Assessment 2 report which most of the students forget. This is because this section gives credit to all the three research papers and other sources of information that you have used in your report. Also, remember that this section is not included in the word count.

So, these are the sections which are compulsory to include in this report. However, this is just a brief of a complex assessment in nursing. For further guidance on how to write a NURS2101 Assessment 2 report, you can send in all your queries to us and we would solve them in a jiffy. NURS2101 Assessment Essay

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Emotional support of caring guardian or parent is vital inclusion for treating a hospitalized child. It allows a child to heal fast and acquire needed motivation to fight against the disease. The caring aid of parent creates a positive environment for children in responding nursing goals and objectives set out to recover the condition of a child.

However, stress and emotional burnout are major resultant factor for parents with hospitalized child. It creates a sense of deprivation among parent while facilitating the medical growth of a child admitted in hospital. One of the major elements that cannot be ruled out is that parents expect instant improvement of their wards admitted under medical care. They seek higher priority from nurses to treat their children and help in recovery of child. NURS2101 Assessment Essay

It can be considered natural response for parent to get hyper and experience emotional trauma due to hospitalization of their children. Recurrent experiences of ill health of child in medical centre lead parents to distress and unfulfilled expectation from nurses (Wiener et al. 2016). On the contrary, contemporary technological ways provide distress care to parent and allow them to recover from psychological trauma. It has been a repetitive incidence for parents to get stressed out and scoop to negative feeling due to the suffering of their children. The prevalence rate of parents getting higher anxiety and emotional wreckage due to hospitalization of child cannot be ruled out as it affects their mindset. NURS2101 Assessment Essay

Modern ways of handling the needs and demands of parent with hospitalized child are met through family centred care (Yager et al. 2017). The consistent care and decision making process of a child’s medical growth is being consulted with parent to make sure necessary reduction in anxiety and stress can be achieved. It cannot be ignored that most of the parent experiences symptoms of post traumatic stress regarding their ward’s health. The PTS feeling of parents are mostly generated due to uncertainty, loss and concern for their child (Stremler et al. 2017). NURS2101 Assessment Essay

This report has evaluated the understanding of parent’s inner experience and feeling with hospitalized child which is important for a nurse for providing effective care. A comprehensive study on parent experience with child in hospital can help a nurse to prioritize those activities that can provide immediate relief to parent which can be used to heal a child. It is the most significant aspect in determining the present condition and helps in maintaining effective care of a child.

b) Briefly outline the search strategy used including key search words and data bases.

Answer: Search Strategy: In order to find relevant journal articles and key information on parent experience with child in hospital certain keywords such as experience in hospitalization of child, impact of hospitalization on parent and stress experience from hospitalized child are being followed. It has been effective in acquiring 3 relevant journals from Journal of Paediatric Nursing, Hospital paediatrics and Journal of Paediatric nursing are gathered to state the impact of hospitalized child on their parents. Updated version of online browsers has been utilized to find relevant information.

Question 2: Briefly describe and appraise each study. Include in your discussion the research aims, design, participants, data collection method, data analysis, main findings, ethical considerations and study limitations. NURS2101 Assessment Essay

Answer: Literature review: Weiss, M. E., Sawin, K. J., Gralton, K., Johnson, N., Klingbeil, C., Lerret, S., … & Schiffman, R. (2017). Discharge teaching, readiness for discharge, and post-discharge outcomes in parents of hospitalized children. Journal of pediatric nursing, 34, 58-64.

Research aim: The aim of this research was to acquire an understanding of parental experience with nursing practice and post discharge of hospitalized child

Research design: It has conducted a pilot study samples that have agreed to provide their clinical details during caring practice on their children. The research has been progressed with correlation design as it helped researchers to find a relevant correlation between coping difficulty of parents and child hospitalization. Lewis (2015) has stated that correlation design helps in identifying the common link between two variables of research study. NURS2101 Assessment Essay

Participants: The research has acquired relevant data from a sample of 194 parents of two medical units

Data collection method: The research has acquired data through qualitative approach by sampling out relevant information from acquired data

Data analysis: The study has followed secondary analysis for making a critical viewpoint on parental exposure to discharge of their wards

Main finding: The primary findings of this research indicated that a guardian or parent goes through intense coping difficulty during the transition period of a child from being sick to getting discharge certificate. Most of the parents seek discharge approval of their child to get momentary relief from stressful situation. However, the coping difficulty of parent gets minimal in post discharge of their wards and lowers the impact of hospitalized child on parents. It cannot be denied that most parents seek quality care services and proper discharge of their children. The family or parents with history of chronic illness shows less coping difficulty in comparison to parents with non-chronic illness. NURS2101 Assessment Essay

Ethical consideration: It has followed the code of conducts that restrict a researcher to manipulate data and present it for personal use.

Study limitation: The research has not produced coherent evidence of experiences of intervention parents and control groups. It is also limited in finding discharge experience rather than clinical experience of parents.

Jones, J., Nowacki, A. S., Greene, A., Traul, C., & Goldfarb, J. (2017). Investigating parent needs, participation, and psychological distress in the children’s hospital. Hospital pediatrics, 7(7), 385-394.

Research aim: The primary purpose of this research is to garner the experience of parents that are participated in care practices of hospital and their needs fulfilment.

Research design: This research study has followed correlation design to garner the link between parent’s participation in care and positive outcome of hospitalized child

Participants: In order to conduct survey, 186 parents are being considered as sample population within which only 166 responded to questionnaire surveys. NURS2101 Assessment Essay

Data collection method: The data has been collected through Primary quantitative means through close ended questionnaire surveys. The participants were questioned in English and liker scale has been utilized by the researcher.

Data analysis: It has conducted a linear regression analysis of the information that has been collected from quantitative data. As per the opinion of Abdulkadiroglu et al. (2017), regression analysis acts as a statistical aspect of data that helps in connecting two or more available variables.

Main finding: The assessment of parent survey with regression analysis determined that fulfilment of parent’s needs and demands resulted in less psychological distress. It has also been pointed out that higher psychological distress and negative expectation on child hospitalization result in increased amount of care demands from parents. Narrating the expectation on child recovery process assist parents to make disregard stress and participate in care of their wards NURS2101 Assessment Essay

Ethical consideration: The study has followed the ethical practices of hospital paediatrics to acquire data from parents that have authentically participated in hospitalized care of their child. It allowed the research to provide data without any manipulation and result in higher relevancy of parents needs from hospitals.

Study limitation: This research has not provided enough evidence on coping strategies implied by parents to handle their mental condition with admitted children. It has only included English speaking participants which did not allow it to explore parents with other cultures.

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Rankin, D., Harden, J., Waugh, N., Noyes, K., Barnard, K. D., & Lawton, J. (2016). Parents’ information and support needs when their child is diagnosed with type 1 diabetes: a qualitative study. Health Expectations, 19(3), 580-591. Retrieved on 29 April 2019.

Research aim: The aim of the study is to find the relevant experience and need of parent that has to seek hospitalized care for children with type 1 diabetes. NURS2101 Assessment Essay

Research design: The research has followed inductive approach and also carried out the study with descriptive design. It has been highlighted by Abdulkadiroglu et al. (2017) that descriptive design helps in describing logically the events that leads to particular findings.

Participants: The samples space for this research was limited to 54 parents of diabetic children.

Data collection method: The research has followed qualitative method to acquire data from semi structured interviews. This particular approach helped in discussing the situation rather than closing in on particular response.

Data analysis: Thematic analysis has been conducted on acquired information. As per the opinion of Lewis (2015) thematic analysis results in logical understanding of collected information as it examine each answer with individual themes and conducts individual analysis of axial codes. NURS2101 Assessment Essay

Main finding: Parents required reassurance from medical unit before their children got diagnosed with type 1 diabetes. It seemed that most of the parents are fell victim to psychological distress due to complex information on the management of diabetes. The parents of hospitalized child needed emotional and psychological support from experienced medical professionals to support their child during recovery in home and hospitalized care. On the contrary, nervousness and fearful nature of some parents did not let them to acquire empathetic support from nurses and also suffered from less peer support.

Ethical consideration: The research has followed ethical consideration of research committee of nursing practices and presented an authentic data without any unnecessary manipulation.

Study limitation: The research is limited as it had presented information from parents that have experienced hospitalization of child with type 1 diabetes of 11 years in previous records. It did not cover contemporary experience and practices of medical professional.

Question 3: Identify key common findings in the studies, or significant variations. NURS2101 Assessment Essay

Answer: Key findings: Parental enquiries regarding their ward’s health is a relevant approach for acquiring the present condition of child health. It has been highlighted by Weiss et al. (2017) that majority of parents experiences coping difficulty during the recovery period of children. The statement of author does not only points out the effectiveness of psychological support for parents but also brings out the primary issue of discontentment in hospitalized condition of child. NURS2101 Assessment Essay

On the contrary, Rankin et al. (2016) have stated that a parent gets confused due to complex set of information about management of hospitalized child. It does not only lower the confidence of parents in revival of their children but also does not allow them to help in the recovery process of hospitalized child. The major similarities between the two author’s findings are that a professional guidance is required to manage intellectual and psychological support of parents. This could help in bridging the gap between responsible care and elimination of parental concern with post diagnosis condition. NURS2101 Assessment Essay

However, Jones et al. (2017) has stressed that high caring demand are subjected to parents with low confidence and negative feeling. Their fear of slow recovery of child makes them demand more attention for their wards irrespective of critical nature of patient. It can be point out that there is a similarity with other journal articles regarding the satisfaction criteria of parents. In order to meet the necessary fulfilment and reduction in parental distress, more clinical assistance is required. The contrary viewpoint is that parents with negative expectation of their child tends to require more support whereas some parents wants to include themselves in decision making process by becoming an active participant of child recovery process. There is an impending amount of distress among parent that does not allow them to make positive environment for children. NURS2101 Assessment Essay

Question 4: Reflect on what you have learned about the experience of the patient and/or family and discuss how you will apply this in your future nursing practice.

Answer: Reflection and application: The comparing and contrasting of relevant journals and articles allowed me to acquire in depth understanding of parental needs and their concern with ailing child in hospitalized condition. It is required by parents to get complete access to their ward’s present medical condition for sufficing the need of acquiring positive feeling toward recovery process (Levett-Jones, 2014). I have noticed that all three journals pointed out the distressing condition of parents and emotional effect of child hospitalization. NURS2101 Assessment Essay

There is a need to provide effective psychological care for parents with hospitalized child because in my perception it could help in reducing PTSD and mental concern of either parent. The most prominent aspect that I learned from above sections is that there is a high expectation among parents regarding nursing care practices towards a sick child and also seeks participation in care. I also got to know about family centred care which has been adopted as the advanced care practices that occurs under the observational eye of parents/family. NURS2101 Assessment Essay

Application: I can utilize the above acquired information on parental experience for setting up a support group for psychological comfort. This could not only allow me to have proper understanding of parent mental condition but also initiate recovery steps to prevent traumatic experiences. In my future practice as a nurse, post diagnosis report would be important as it might help in briefing parents about the management of disease in home care and the relevancy of their participation in recovery process. It cannot be denied that parents with positive expectation require less attention from nurses. So, my prime focus will be toward parents with negative expectation because active support of parents results in quick recovery of a child health. NURS2101 Assessment Essay