Case study Mr. Johnson is a 75-year-old man, was brought to the emergency department (ED) by his daughter with concerns about his increasing levels of pain, intermittent periods of acute confusion and deteriorating overall general health. Initial

ASSESSMENT INFORMATION

Assessment Title

Written assessment

Purpose

The purpose of this written task is to engage students with the application of theory into practice and how this needs to be flexible to meet the needs of the person requiring health care assistance.

Weighting

40%

Length

1500 words +/- 10% (includes in-text citations, excludes reference list)

Assessment Rubric

Refer to Extended Unit Outline Appendix 2

LOs Assessed

LO1, LO3, LO5

Task

Students will assess, prioritise and plan the care of the guided case study patient using a clinical reasoning framework in hospital and community setting. Introduction and conclusion not needed.

Case study

Mr. Johnson is a 75-year-old man, was brought to the emergency department (ED) by his daughter with concerns about his increasing levels of pain, intermittent periods of acute confusion and deteriorating overall general health.

Initial Assessment

Mr. Johnson is alert but disorientated to time and place. He appears dishevelled and malnourished, with a strong odour of urine. He was brought in a wheelchair and was guarding his L knee. Daughter stated Mr. Johnson took two (2) Ibuprofen (neurofen) tablets couple of hours ago with minimal effect.

BP - 140/93

HR - 96 bpm and regular Peripheral pulses - Present RR - 18 rpm

Temp - 37.0C (tympanic) Sa02 - 98% RA

BGL – 9 mmol/L Height -170 cm

Weight - 74 kg (weighed 80 kgs six months ago)

ECG - NAD

MMSE – 23/30

L Knee Xray- NAD

Urinalysis - dark concentrated yellow, clear urine, SG 1.010, pH 7, Leukocytes and nitrite- positive.

Medical history

Mr. Johnson has a history of multiple chronic medical conditions, including osteoarthritis, osteoporosis, hypertension, and diabetes. He is on several medications and has regular visits with his primary care physician.

Medications Ibuprofen Panadol osteo

Alendronate (Fosamax) Norvasc Cholecalciferol Calcium supplements

Metformin Hydrochloride Gliclazide Hydrochlorothiazide Patient history

Mr. Johnson lives independently in his own home and usually cooks his own meals at home. His daughter visits him couple of times each week. Mr. Johnson walks for an hour daily and catches up with his friends at the nearby park once a week. He enjoys spending time with his grandchildren. He never smoked and drinks a bottle of beer after dinner while watching TV. He wears glasses for long distance and bilateral hearing aids.

Recently the daughter noticed Mr. Johnson increasingly neglecting his personal hygiene, nutrition, and household upkeep. Mr. Johnson has been socially isolated. and had multiple falls at home recently.

Admitting diagnosis: Early signs of dementia.

You are the registered nurse looking after Mr. Johnson, and you are required to plan her care guided by a clinical reasoning framework and the provided case study information. Sections you need to respond to include:

1.      Patient assessment (500 words)

·        Provide an initial impression by identifying relevant and significant features from Mr. Johnson’s current ED presentation.

·       Discuss the possible causes for Mr. Johnson’s intermittent cognitive impairment.

Do you agree or disagree with Mr. Johnson’s diagnosis of an early onset of dementia. Justify your opinion and support your discussion with evidence from the case study.

·        Evaluate the impact a misdiagnosis may have on the care provided for Mr. Johnson.

Mr. Johnson’s intermittent confusion resolved after 3 days. He was assessed by the Aged Care Assessment Team (ACAT) and was eligible for a community care package. Mr.

Johnson was discharged home with regular codeine for his chronic pain.

2.     Physiological changes of ageing and identify patient issues (500 words)

·        Discuss how the normal physiological changes of ageing may increase Mr. Johnson’s risk of falls. Identify three (3) evidence-based nursing interventions with rationales that should be implemented for Mr. Johnson to reduce the risk of falls. (Do not include referrals in your answer).

·        Evaluate how Mr. Johnson’s chronic pain would impact on his capacity to complete two of his activities of daily living (ADL’s) ensuring you have justified your choice of ADL’s.

3.     Pharmacological management and nursing considerations (500 words)

·        Discuss why Mr. Johnson, as an older adult, is more vulnerable to adverse drug effects. Ensure you include factors related to the anatomical, physiological and behavioural considerations associated with ageing.

·        Identify with rationale two (2) nursing interventions you would consider when

caring for Mr. Johnson who takes multiple medications (polypharmacy). (Do not include referrals in your answer.)

Submission

The assessment must be in word document format and is to be submitted to the relevant campus Turnitin assessment drop box located on NRSG266 LEO Assessment Tile

FORMATTING

File format

Please submit as a .doc or .docx (not .pdf files)

Margins

2.54cm, all sides

Font and size

Use 11-point Calibri, Arial or Times New Roman

Spacing

Double spacing

Paragraph

Aligned to left margin, indent first line of each paragraph 1.27cm

Title page/images

No cover pages, bullet points, numbering, tables, or diagrams are to be used.

Introduction/Conclusion

Introduction or concluding paragraphs are not required.

Additional Info

This is an academic piece and as such, third person writing is required. Headings must be used, such as Question One and Question Two and so on.

Structure

Direct quotes

Always require a page number. No more than 10% of the word count should be direct quotes.

Footer

Name _ Student Number_ Assessment _ Unit _ Year (9-point Calibri or Arial)

REFERENCING

Referencing Style

APA 7th Edition.

Minimum References

There is no set number of references that must be used as a minimum for this task, but as a rough guide only, if you have utilized less than 12 unique quality peer-reviewed sources then you have not read widely enough.

All arguments must be supported using a variety of high-quality primary evidence. Avoid using any one source repetitively.

Age of References

Most references for this task should be published within the last 5 years, however the appropriate use of older evidence sources (e.g. seminal theoretical ethical work) is acceptable.

List Heading

“References” is centered, bold, on a new page (14 point Calibri or Arial).

Alphabetical Order

References are arranged alphabetically by author family name

Hanging Indent

Second and subsequent lines of a reference have a hanging indent

DOI or URL

Presented as functional hyperlink

Spacing

Double spacing the entire reference list, both within and between entries