NUR2206 – Integrated Nursing Practice 2 Assignment 1: Case Scenarios Value: 30% total unit mark Due: 1400 Thursday September 4th 2014 Via the online Moodle assignment Drop box and hard copy in Bld # E. Word Limit: 2000 words (+/- 200 words) Referencing: APA as per unit guide Presentation guidelines: as per unit guide Instructions: You are required to answer in written form, no dot points, with appropriate referencing to support your answers, all of the questions to each of the scenarios provided. The word limit of 2000 must be adhered to; penalties will apply to submissions outside the permitted word limit. References should be used to support your answers. References should not be older than five – eight years. Please avoid the use of public health/government websites. Please seek assistance via your unit coordinator in regards to the quality of your references to be used. A maximum of three (3) texts may be included with a maximum of five (5) academically appropriate websites. The use of appropriate and relevant journals articles is strongly encouraged. 1 Scenario One (1) Claire aged 61, has been admitted to your ward with a left (L) colles’ fracture and a fractured right tib/fib after tripping down the stairs at work. During your assessment of Claire, she states she has osteoarthritis in her hips and knees and has recently been diagnosed with osteoporosis. Your answers should relate to the above scenario and cover the following aspects a) Describe the pathophysiology of both osteoarthritis and osteoporosis b) List the modifiable and non-modifiable risk factors associated with the development of osteoporosis c) Describe the specific clinical manifestations that Claire may have experienced, directly related to a diagnosis of osteoarthritis d) Describe the specific clinical manifestations that Claire may have experienced, directly related to a diagnosis of osteoporosis (500 words approx) Claire undergoes surgery repair both fractures and returns to the ward following a GAMP to the colles’ fracture and percutaneous screws inserted into the right tib/fib fracture. You are responsible for her ongoing nursing management. e) Outline the post-operative nursing interventions specific to the care of both of Claire’s fracture repairs (200 words approx) Eight hours post-surgery Claire presses the call bell and complaints of significant pain in her hand f) Outline your immediate nursing actions including any assessments or interventions with rationales (150 words) g) What potential complication/s may arise as a result of her fracture and subsequent surgical management? ( 150 words) 2 Scenario Two (2) Justin is a 33 year old prestige car salesman and an avid golfer. He suffers from chronic back pain from an injury that he sustained in a car accident several years ago. He manages his pain with over the counter antiinflammatories and regular osteopathy and physiotherapy sessions, as well as regular low impact exercise in the form of swimming and walking. Just in recently gained a promotion at work resulting in longer working hours and increasing work related stressors and less free time. Whilst he is enjoying his new role his new lifestyle is taking some time to adjust to. Justin had previously experienced bouts of gastro oesophageal reflux which seem to be increasingly reoccurring of late. He usually manages it with over the counter antacids which seem to do the trick. He lives alone in an inner city apartment eats out on most nights both at work and on weekends and admits that he is partial to fast food. Justin identifies himself as a social drinker who no longer smokes. Justin comes home from golfing trip with mates to Singapore and Thailand finds himself experiencing significant abdominal pain and diarrhoea. He has had the pain previously but on this occasion is it quite unbearable and has also noticed some a rectal bleeding. He tells you that the diarrhoea is not something he has experienced before and that he usually suffers from constipation He is admitted to your ward with a provisional diagnosis of gastro oesophageal reflux +/-peptic ulcer disease, and the gastroenterology team has decided to undertake a gastroscopy and colonoscopy to assist with the diagnosis and investigate the rectal bleeding Your answers should relate to the above scenario and cover the following aspects a) Outline the pathophysiology of Gastro oesophageal disease and peptic ulcer disease. Describe the structural changes involved in peptic ulceration (150 words) b) Outline the specific clinical manifestations of peptic ulcer disease with rationales linking them to those experienced by Justin (150 words) c) Identify the common causative agent of peptic ulcer disease and the medication/s used to treat peptic ulcer disease (proton pump inhibitors, anti ulcer antacids) (150 words) 3 Justin is scheduled for a gastroscopy/colonscopy this afternoon. d) Outline the nursing management of patients in regards to bowel preparation/surgery (150 words) When you are about to commence the bowel preparation, you go to check on Justin as he has been in the bathroom for an extended period of time. You find him on the toilet in which he says there is a lot of blood in the toilet bowl. e) Outline your immediate nursing actions with rationales in regards to Justin (200 words) Justin soon after goes to the endoscopy suite for an urgent colonscopy/gastroscopy. His recovery is uneventful and he returns to the ward soon after the procedure. f) Outline the nursing management of Justin post his colonoscopy/gastroscopy (150 words)
