Read the following documents carefully prior start your research and writing: • Assessment requirements and Detailed instructions for completing the task; • Assessment Task 1 Workbook Mr Dwight; and • Dwight First Hour Simulation Medical Documents Note: W

BB233 Integrated Nursing Practice

Assessment 1: SIM workbook: Summer semester Bachelor of Nursing BB233

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Mr. Dwight Simulation Setting the scene Refer to your simulation documents

Epidemiology / pathophysiology of disease processes The National Health Priority Area of Cancer Control was established with the aim of improving health outcomes in this area. The most common diagnoses for cancer in men are prostate (1 in 5 males), colorectal (1 in 11 males), melanoma of the skin (1 in 13 males) and lung (1 in 13 males). For women, the most common diagnoses are breast (1 in 8 females), colorectal (1 in 16 females), melanoma of the skin (1 in 23 females) and lung (1 in 22 females). Cancer screening programs have been large public health initiatives in this area aimed at reducing illness and death resulting from cancer through an organised approach to screening. It would be of benefit for you to research the three cancer screening programs of Breast Screen Australia, National Cervical Screening Program and the National Bowel Cancer Screening Program to understand the importance of these programs and the benefits obtained. The World Health Organisation defines palliative care as: ‘An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Your own values and beliefs about death and dying may impact on your interactions with a dying person, reflect on your own self-awareness as an important strategy in palliative care nursing.

Now we shall step through the CRC in relation to Mr. Dwight’s’s case to prepare you for the workbook assessment questions.

BB233 Integrated Nursing Practice

Assessment 1: SIM workbook: Summer semester Bachelor of Nursing BB233

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Based on your reading so far:

Gain an initial impression of your patient

Consider Mr. Dwight’s situation, both socially and health wise. What is your initial view of this patient and potential issues for him? How has this changed between the acute admission and the palliative care admission?

(a) Review current information (b) Gather new information (c) Recall knowledge (A&P, ethics,

law, cultural safety)

Consider the disease process and the assessment data you have been provided with.

§ Interpret data – what does it all mean?

§ It is important to consider the potential inter-relationships between mental health, cardio vascular, obesity, musculoskeletal problems and injury prevention.

What is your understanding of the cancer that Mr. Dwight presents with? What is your understanding of the psycho-social effects for a patenit and family faced with a diagnosis of cancer? How does this change when a patient transitions into a palliative care setting?

Synthesize all information that has been collected and processed.

You need to consider Mr. Dwight’s priority problems and any actual or strong potential problems he is experiencing, based on your assessment of him and your knowledge of the pathophysiology of his presenting condition, psych-social needs and disease progression at two stages of his illness.

As a nurse, what are your desired outcomes for Ivan?

Now you have identified his problems, you need to identify your goals of care for each problem using the SMART acronym.

BB233 Integrated Nursing Practice

Assessment 1: SIM workbook: Summer semester Bachelor of Nursing BB233

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What action/interventions will you do?

The next step is to consider what you will do and ensure your nursing interventions suit the context and are evidence based. Also consider who else should be involved.

Assess the effectiveness of actions

Now think about your interventions and how you will evaluate them.

What have you learned from this experience?

Now consider what you have learnt and what you need to follow up with.

WORK BOOK QUESTIONS

1. a. What are strategies that assist with the early detection of bowel cancer? Name and describe two (2) in relation to bowel cancer screening. (2 marks) b. Name two (2) barriers for patients accessing these and why? (2 marks)

2. Mr. Dwight is to have a Hartmann’s procedure with the formation of a colostomy. With

your knowledge of the anatomy and physiology of the procedure: a. Name four (4) essential pre-operative topics of education you should provide to

Mr Dwight. (2 marks) b. Explain how you will approach this education- name two (2) specific

educational strategies will you use? (2 marks) c. How would you evaluate effectiveness of your education? (1 mark)

BB233 Integrated Nursing Practice

Assessment 1: SIM workbook: Summer semester Bachelor of Nursing BB233

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3. a. Name four (4) observations of the skin surrounding the stoma that would alert you to

problems in the post-operative phase. (2 marks) b. What treatment should be provided if the skin problem in the stomal area occur?

(2 marks)

4. a. Mr. Dwight presents with with symptoms that indicate a bowel obstruction. Explain why this can occur in the context of bowel malignancy. (1 mark)

b. Identify three (3) signs/symtoms that indicate a bowel obstruction and explain why these may have occurred in the context of a large bowel malignancy linked to the pathophsiology. (3 marks)

5. Mr. Dwight might require a blood transfusion because of post-operative bleeding, intra-

opertaibe blood loss or later, during his chemotherapy treatment.

a. Name four (4) adverse effects you might see when administering blood products and justify why these may occur? (4 marks)

b. Review Standard 7 of the NSQHS. Using the NSQHC standard and relevant

literature, and state (6) actions required of the registered nurse if an adverse or suspected adverse reaction to blood products occurs. (3 marks)

6. Review and recall your knowledge on nasogastric tubes.

a. Provide a rationale for why Mr. Dwight required a nasogastric tube inserted? (2 marks)

b. The RN you are working with checked the position of the nasogastric (NG) tube by injecting 20mLs of air and auscultating the stomach using a stethescope. This is an outdated method that is no longer considered safe or definitive for checking the position of an NG tube. Utilising an evidence based approach and referring to the evidence and literature on this subject, what is considered a definitive check for the position of the NG that the RN can perform in the ward? (1 mark)

Choose ONE of the following sections. Provide responses to either questions 7-11 or 12-16.

Questions directly related to Mr. Dwight’s Acute Admission in Emergency Department (ED)

7. Effective and accurate clinical assessment skills are imperative for the nurse working

with Mr. Dwight at all times. Identify two (2) clinical priority problems for Mr. Dwight during his admission to the ED with regard to fluid and electrolyte balance. (2 marks)

BB233 Integrated Nursing Practice

Assessment 1: SIM workbook: Summer semester Bachelor of Nursing BB233

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8. From your identified clinical priority problem in the emergency department, state one (1) goal for Mr. Dwight’s management using the SMART framework. No reference required for this response. This should be a sentence or two that contains all the elements of the SMART goal (2 marks)

9. Based on your goal in Q8, state and describe (2) interventions (nursing, collaborative or

pharmacological) which would assist to achieve Mr. Dwight's goal. (4 marks)

10. Provide and justify two (2) methods of how you would evaluate the outcomes for your interventions in Q 9. (4 marks)

11. You have cmleted the module on cancer in your NSB335 BB site. Mr Dwight has had

cancer for 6/12 at the time of his ED presentation. Consider the time of his diagnosis and using a patient centred approach, identify two (2) psycho-social issues that may present at the time of a cancer diagnosis and discuss the issues briefly. Outline why it is important to address these psycho-social issues for treatment outcomes. (4 marks)

Questions directly related to Mr. Dwight’s Palliative Care Consultation

12. Effective and accurate clinical assessment skills are imperative for the nurse working with Mr. Dwight at all times. Identify two (2) clinical problems that could occur for Mr. Dwight during his admission to the palliative care unit with regard to fluid and nutrition that are commonly seen in the palliative care setting. (2 marks)

13. From your identified clinical problem, state one (1) goal for Mr. Dwight’s management

using the SMART framework. No reference required for this response. This should be a sentence or two that contains all the elements of the SMART goal (2 marks)

14. Based on your goal in Q13, state and describe (2) interventions (nursing, collaborative

or pharmacological) which would assist to achieve Mr. Dwight's goal. (4 marks)

15. Provide and justify two (2) methods of how you would evaluate the outcomes for your interventions in Q 14. (4 marks)

16. a. name four (4) members of a multi-disciplinary team (MDT) who may be involved in

the care of a palliative care patient like Mr Dwight. (2 marks)

b. What are benfits for the palliative care patient to have a MDT involved in planning and delivery of care? Note: this question does not ask you to define specific team member’s roles but use the literature about MDT to consider the role of such a team and the benefits. (2 marks)

Marks allocated as per marking rubric in task assessment booklet • All answers should be justified and referenced appropriately unless otherwise

indiacted (5 marks). • All answers should be written in academic format (5 marks).