NRSG378 Principles of Nursing Task
Word Count : 2000
Weight : 50%
Purpose : This assessment enables students to apply knowledge from unit learnings to an issue requiring extended clinical reasoning. The assessment will engage students with the application of theory to practice and is designed to facilitate an understanding of the impact of illness on the patient. It is also intended to give students the opportunity to demonstrate the ability to use a clinical reasoning framework to plan the care of an acutely unwell patient.
NRSG378 Principles of Nursing Task
LEO Resource : A national pre-recorded video will be uploaded onto LEO in week seven (7), which will provide students with an overview of the assessment as well as resources and advice on how to approach the task. Students are encouraged to post questions on the discussion forum on LEO and to check for answers there as a first point of query.
LOs Assessed : LO1, LO2, LO3, LO4
NRSG378 Principles of Nursing Task
Task
Students will assess, prioritise and plan the care of the case study patient using a clinical reasoning framework.
Sections you need to respond to include:
- Disease pathophysiology and patient assessment (500 words):
- Provide an initial impression of the patient and identify relevant and significant features from the patient presentation;
- Discuss in detail, the pathophysiology of the disease and how Kate’s presenting signs and symptoms reflect the underlying pathophysiology;
- Identify further elements of a comprehensive nursing assessment (this can be presented as a list)
2. Identify nursing and patient issues (500 words):
- Identify and prioritise 3 nursing issues you must address for Kate and justify why they are priorities and support your discussion with evidence and data from the case study. These can be actual or at-risk issues.
- Discuss the potential impact of this admission on Kate’s 2 most important activities of living (can be biological, psychosocial, spiritual or cultural factors)
3. Discuss the pharmacological management (400 words):
- Identify and discuss two (2) common classes of drugs used for Kate, including the drug mechanism of action, indication and nursing considerations. This does not mean specific drugs but rather the class that these drugs belong to.
4. Nursing interventions (600 words):
- Identify, rationalise and explain, in order of priority, the nursing care strategies you should use within the first 24 hours post-surgery for Kate.
NRSG378 Principles of Nursing Task
Case Study
Kate Sansbury is a 22-year-old female who presented to the emergency department (ED) with abdominal pain, nausea and vomiting, and general malaise. She stated that the pain appeared 3 days ago but was dull and localised to the right lower quadrant only, and resolved when she applied a heat pack and took some paracetamol. She assumed the pain was due to her upcoming period.
Last night at 3am she woke when the abdominal pain became sharp and was so “intolerable” she vomited. She has since had 2 further vomits, and states she feels ongoing nausea. She has not been able to eat or drink her usual amounts for the past day. She states she has only voided once yesterday and it was “very dark yellow” in colour.
On assessment:
- Kate appears pale, cool and clammy. Her lips appear dry
- She is lying in a semi-Fowler’s position and has her hands across her stomach (guarding). Kate appears reluctant to move
- Her abdomen is distended and tender, and there are minimal abdominal sounds on auscultation
- On abdominal palpation, she states the pain is 8/10 on the right lower quadrant, but the pain also occurs across her abdomen, and it is becoming worse
NRSG378 Principles of Nursing Task
Health assessment findings and laboratory results at presentation:
- HR 118 bpm, regular pulse
- BP 90/60 mmHg
- RR 24 bpm, mild WOB
- Temp 39.2C
- SpO2 97% on RA
- Alert and orientated to time, place, and person. GCS 15
- CRT 2 seconds
- Last bowel motion – yesterday but patient states she feels “constipated”
- Weight – 62kg
| Result | Normal Values | |
| Haemoglobin (Hb) | 145 g/L | 150-160 g/L (females) |
| WBC | 15 x 109/L | 4-11 x 109/L |
| Sodium | 132 mmol/L | 135 to 145 mmol/L |
| Potassium | 3.5 mmol/L | 3.5 to 5.2 mmol/L |
| Lactate | 2.0 mmol/L | <1.0 mmol/L |
| C-reactive protein (CRP) | 150 mg/L | <5 mg/L |
| Human chorionic gonadotropin (hCG) | < 5 IU/L | Not pregnant < 5 IU/L |
| Blood cultures | Pending | Negative |
NRSG378 Principles of Nursing Task
Patient history:
Kate currently lives with two friends in a share house in an inner-city suburb in Melbourne. She works part-time as a retail worker in a bookshop, and studies veterinary nursing at TAFE full-time. She states that she is due to commence placement soon for her studies, and is “worried I won’t be able to attend and fail”.
She consumes a healthy diet, and only eats takeout once every few weeks. Kate exercises 4 days a week, for approximately 1 hour each time and considers herself “fit and healthy”. She does not smoke and has 2 standard alcohol drinks every Saturday when she goes out with her friends. She also smokes marijuana recreationally when she becomes “stressed out”.
Family history:
- Parents live in Darwin and are both well with no medical concerns
- Kate visits them once a year during Christmas
Medical history: - Depression
- Asthma
Medications: - Sertraline 50mg daily
- Salbutamol 4-6 puffs via pMDI PRN
Following the review of her laboratory tests and assessment results, Kate has been diagnosed with ?perforated appendix leading to secondary peritonitis
NRSG378 Principles of Nursing Task
Management
- Administer IV bolus NaCl 0.9% 500ml over less than 15 minutes
- Commence IV NaCl 0.9% at 70ml/hr
- Administer IV ceftriaxone 1g BD
- Administer IV morphine 2mg PRN
- Administer IV ondansetron 4mg PRN
- 1/24 vital obs and pain assessment
- Repeat UEC 2 hours post IVF commencement
- SFBC
- NBM
- Pre-op preparation for an emergency appendectomy and peritoneal cleanout
You are the registered nurse looking after Kate, and you are required to plan her care guided by a clinical reasoning framework and the provided case study information.
FORMATTING
File format
The information will be presented as a question-and-answer format. There is no need to include an introduction or conclusion.
Do not include the question in your assessment, just label it as 1), 2), etc.
Each answer has a word limit; answers beyond this limit will not be considered in your mark.
The assessment will be submitted as a Microsoft Word document file via Turnitin. Please do not submit pdf files.
NRSG378 Principles of Nursing Task
REFRENCING
Referencing Style : APA 7th edition
Minimum References : A minimum of 15 high quality resources are to be used. All arguments must be supported using a variety of high-quality primary evidence. Avoid using any one source repetitively.
Age of References : Published in the last 5 years unless using seminal text.
NRSG378 Principles of Nursing Task