This assessment requires students to make an oral presentation which demonstrates knowledge of and ability to apply the Clinical Reasoning Cycle (CRC) to plan nursing care of the older adult (based on a provided case study). The plan of care will be documented on a powerpoint presentation and you will explain the plan of care in your 5-minute video presentation. Due date: Wednesday 9th October 2019 by 1159 Weighting: 20% Length and/or format: 5 minute presentation; maximum of 6 powerpoint slides (5 for content and 1 for the reference list) How to submit: You are required to submit your oral presentation recording (which includes your PowerPoint slides) into the Assessment 2 dropbox located on NRSG266 LEO campus tiles. Note you do not have to submit the powerpoint slides as a separate file. Return of assignment: Feedback and grades for the assessment will be available after three weeks via the assessment 2 campus dropbox. Assessment criteria: Please see Assessment 2: Oral presentation criterion reference rubric in the unit outline and consult assessment tile in LEO for further information. 2. Detailed instructions This assessment requires you to: Plan the nursing care of an older adult using steps 5, 6, 7 and 8 of the Clinical Reasoning Cycle (CRC) (Levett-Jones, 2018).Base your plan of care on the first 4 steps of the CRC which are provided as part of a detailed case scenario.In Step 4 of the CRC the client health issues have been identified and the task is to select one of these health issues and create a detailed plan of care to address the selected health issue, with an emphasis on health promotion strategies to enhance the client’s quality of life.Document this plan of care in a 5 minute powerpoint presentation.Using Kaltura Capture software, create and record your presentation. Detailed Instructions: Read the provided case scenario which outlines the client situation using steps 1 – 4 of Levett-Jones (2018) Clinical Reasoning Cycle (CRC).Select one of the identified health problems from the list provided.With reference to the related nursing diagnoses, complete steps 5, 6, 7 and 8 of the CRC which focus on identifying appropriate nursing actions to address the nursing diagnoses.CRC Step 5 – Establish the (SMART) goals of nursing care which will promote the health of the patient and enhance her quality of life.CRC Step 6 – Identify detailed interventions and associated rationales to address the chosen problem and meet the identified goals.CRC Step 7 – Evaluate – identify what you would expect to see if the goals of care are achievedCRC Step 8 – Reflect – on what you have learned from this process, including what might have been done differently Note: Steps 5, 6 and 7 may be presented in a table 3. The case scenario CRC Step 1: Consider the patient situation Lina Liaw is an 75-year-old woman who lives in Brisbane, and has done for the past 40 years, since moving to Australia from Singapore to live with her long-term partner, Margie. She has never married nor had children. She has 2 younger sisters who live in Singapore. She has close relationships with her siblings and her sees her sister’s two granddaughters, both of whom live in Brisbane, every few weeks. Lina lives alone in a single-story house with a small garden in a retirement village. Lina moved to the village shortly after the death of her partner Margie 5 years ago. She knows her neighbours and some of the other residents of the retirement village but mostly keeps to herself, socialising within the retirement village only occasionally, such as the village Christmas function. Lina trained as an accountant when she moved to Brisbane and has worked throughout her adult life. She is financially independent, having no debts, savings in the bank and income from investments. Lina was healthy up until her late 50s when she was diagnosed with hypertension, and then osteoporosis in her early 60s. After Margie’s death, she became quite anxious and socially withdrawn, lost a lot of weight and just stopped looking after herself. Eventually she was diagnosed with depression and commenced on anti-depressant medication, which she continues to take. Recently she has suffered with lower back pain, which is worse when moving about and does interfere with her sleeping. She wears glasses for both reading and long distance and has done so for most of her adult life. Lina has few hobbies but enjoys watching TV and chatting on the phone to her siblings in Singapore. She enjoys sitting outside in her garden when the weather is good. This morning, Lina’s young grand-niece, Eliza, arrived to take her for a haircut. She found Lina lying on the bathroom floor, conscious, clearly distressed. Relieved to see Eliza, Lina burst into tears, sobbing while she told her niece that she had fallen when going to the toilet this morning and she had not been able to get up. Eliza quickly pressed the duress alarm and help arrived in the form of one of the nurses from the hostel and a security guard. The nurse did a brief assessment and an ambulance was called. Lina was transferred to the local hospital for assessment following a fall, management of a suspected vertebral fracture and possible pneumonia. CRC Step 2: Collect cues and information Subjective: Pt reports a “bit of a headache”Pt reports pain in lower back and both legs; rated 9/10 on verbal numerical pain rating scale when moving; 6/10 when lying stillReports worsening productive cough over the past few daysReports fatigue “since I’ve had this cough” Objective: On observation pt looked pale and unwellLow BP (95/50)Rapid shallow respirations – 28 per minHR 88 bpmTemp 37 degrees COxygen saturation 95% RAWeight 44kgHeight approx. 160cm A large but shallow skin tear on her right lower legSwelling in her lower limbs – bilateralGCS of 14/15Eye opening (to spoken request – 3)Verbal Response (oriented to time place and person – 5)Motor Response (obeys commands – 6)spine x-ray reveals lumbar (L2) compression fracturechest x-ray reveals minor consolidation right lower lobe ADLs: Maintaining a safe environment –impacted by biological (low BP); psychological (depression); sociocultural (social isolation); environmental (risk for falls)Communication – diminished ability to summon assistance when needed due to impaired mobility, pain, unfamiliar environmentBreathing – impacted by pain, cough, fatigueEating and drinking – independence impacted by impaired mobility and self careEliminating – impacted by impaired mobility, pain, possibly new environmentPersonal cleansing and dressing (hygiene and grooming) – impacted by impaired mobility, pain; currently uses a shower chairControlling body temp – impacted by new environment, reduced mobilityMobilising – impacted by pain, fractureWorking and playing – impacted by fracture, pain, reduced mobility, new environmentExpressing sexuality – impacted by widowhood and social isolationSleeping – impacted by pain, reduced mobility, new environmentDying – still grieves for her partner; advancing age and activity limitation has made her more aware of her own mortality IADLs: Cooking – can prepare simple meals at homeCleaning – has a cleaner; can attend to everyday tidying upTaking medications – uses a Webster pack but states she doesn’t always remember to take her tablets and sometimes just gets fed up with having to take so many tabletsLaundry – she can load the washing machine and transfer wet washing to the clothes dryerShopping – one of her nieces take her shopping each fortnight for food and other essentialsFinances – pays her own bills by phone; accesses cash when shoppingTransportation – no longer uses public transport and does not drive anymore; relies on her nieces or the village bus. Current medications (data provided by niece): Metoprolol succinate SR 25 mg dailyAlendronate 70mg weekly (Monday) mane acFrusemide 80 mg bdSlow-K (KCl) 600mg bdOstelin (Ca carbonate 600mg and Vit D3 500IU) bdMirtazapine 30 mg nocteSenna 2 tabs nocteNurofen 200mg x 2 tds prnParacetamol 500mg x 2 qid prn Summary Following a comprehensive assessment, Lina is admitted to hospital for treatment of: Stabilisation of lumbar compression fractureManagement of painAssessment and stabilisation of BPTreatment of coughAssessment of functional independence CRC Step 3: Process information a) Interpret – differentiate between normal and abnormal results Abnormal findings from assessment include: Pt reports pain in lower back and both legs; rated 9/10 on verbal numerical pain rating scale when moving; 6/10 when lying stillReports a “bit of a headache”looks pale and unwelllow BP (95/50)Rapid shallow respirations – 28 per minOxygen sats 95%Productive cough last 3 daysA large skin tear on her right lower legSwelling in her lower limbs – bilateralPt is underweight according to BMI b) Discriminate – between what is relevant to the client’s condition or treatment and what is not, and what is important and what is less important to the client’s condition or treatment at this time. Most important: Vital signs – esp. low BP given she is on antihypertensive medicationPainLumbar fractureMental healthActivity limitationLeg woundCoughLow body weight c) Relate – cluster data cues and identify relationships within the data set: Low BP – on antihypertensive medication; lower limb swelling; coughPain – rating scale scores; L2 fracture on x-ray; mobility limitation; diagnosed osteoporosisPolypharmacy – see medications list; states “doesn’t always remember to take her tablets and sometimes just gets fed up with having to take so many tablets”Depression – no current signs or symptomsImpact of fracture on ADLs and level of dependence/ independence and implications for future d) Infer – make inferences or conclusions based on the data about the patient’s health issues BP could be low due to effects of anti-hypertensive medicationFall could have been due to low BP, pain, effects of medication CRC Step 4: Identify problems and issues Based on the data priority health issues can be identified for nursing management and action. Care Priorities Identified: Stabilise BP and fluid status anIdentify possible cause for low BP (consider possible causes)Manage pain effectively using both pharmacological and non-pharmacological techniquesPrevention of further compression fracturesAddress polypharmacy issuesAddress mobility issuesPlan for the impact of future health issues and needs, including Advanced Care Planning Client problems identified as Nursing Diagnosis 1. Hypertension Risk for ineffective health management Risk for decreased cardiac output 2. Osteoporosis Risk for falls Risk for disturbed body image Knowledge deficit Chronic pain related to osteoporosis, lumbar spine compression fracture Risk for compression fracture 3. Cough Ineffective airway clearance rt increased mucous secretion, decreased ciliary function, decreased energy and fatigue, pain Impaired gas exchange rt retained secretions, air-trapping, inflammation of airways and alveoli Imbalanced nutrition: less than body requirements rt dyspnoea, fatigue Ineffective self-health management 4. Compression fracture at L2 concurrent with osteoporosis Acute pain rt lumbar compression fracture Impaired physical mobility rt pain, fracture, osteoporosis Risk for ineffective tissue perfusion Knowledge deficit rt lack of information Risk for impaired urinary elimination (reduced mobility, infection) 5. Self care deficit – hygiene and grooming rt osteoporosis, lumbar fracture, pain 6. Self care deficit – mobilising 7. Self care deficit – maintaining a safe environment 8. Skin tear right lower leg Impaired skin integrity rt skin tear Potential for infection rt altered skin integrity Pain rt injury Risk for ineffective tissue perfusion 9. Disturbed Sleep Insufficient sleep and rest rt acute and chronic pain, cough, osteoporosis Risk for social isolation Risk for depression 10. Polypharmacy Therapeutic regime: inefficient management rt disease states, lack of knowledge Risk for physical injury (falls, burns, skin lacerations) related to effects of multiple medications Risk for fluid volume deficit rt medication side effects/ drug interactions (Lasix, Slow K) Risk for constipation rt medication side effects Risk for altered thought processes rt medication side effects and lack of knowledge Potential for medication interactions related to polypharmacy Potential for altered level of function related to therapeutic effects of medications Potential for altered physiological function related to side effects of medications 11. Depression Risk for ineffective coping Risk for impaired social interaction Risk for self care deficit
