NUR250 Medical Surgical Nursing 1


Topic: Nursing care of a patient in a medical surgical setting

Assessment: Nursing care of a person in a medical surgical setting

Meet David Parker.

You have cared for him previously when he was admitted to your ward following a myocardial infarction.


Case study:

You met David Parker last month when he was admitted to the medical ward you are working on following a myocardial infarction. David initially recovered and was discharged with referrals to an outpatient cardiac rehabilitation program. David did not attend the rehabilitation program as he had too much work on the farm and driving into town takes up too much of his time.

David now experiences breathlessness which is no longer relieved by rest and gets worse when he lies down. He has also developed a cough and is becoming increasingly fatigued. David has continued to smoke 10 cigarettes per day as he states this assists him to cope with the stress. He also states he still has the occasional alcoholic drink but admitted he has “a few drinks with the boys at the local pub” every Friday night. David’s wife, Sophie, now provides David with low fat, low salt meals but he often refuses to eat them. He states his appetite has decreased over the past few weeks and he often feels nauseous however he has put on 6 kilograms during the past month.

David visited the cardiologist clinic today for his regular follow up cardiac appointment. The cardiologist has diagnosed David with Chronic Heart Failure (CHF) and has admitted David to hospital for further investigation of his cardiac function and symptom management.

David’s regular medication, Ramipril, has been documented on his medication chart and he has also been commenced on new medications, frusemide and digoxin. The cardiologist has ordered a 1000ml per day fluid restriction for David.

Vital signs on admission



Heart rate

118 beats per min

Blood pressure

102/84 mmHg


24 breaths per min

O2 saturations

92% on room air

David has been admitted to your ward and you will be caring for him today.

Task 1: Patient assessment

On admission to the ward, the nurse focuses on collecting specific cues and information relevant to the person’s condition at the time. This second step in the Clinical Reasoning Cycle assists the nurse to recognise patient deterioration and assists the nurse in planning care and to facilitate mutually established goals. The nurse will continually assess and re-assess the patient throughout the continuity of care.

In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice

  • Identify 3 specific nursing assessments that you would conduct as a priority on David’s admission to your ward to assist with planning his nursing care and identify potential problems and further deterioration of his cardiac function.


For each assessment you have identified explain:

  • How specifically you will conduct the assessment
  • Why the assessment is specifically relevant to David’s care during your shift.

Task 2: Care planning

Based solely on the handover you have received and using the template provided, develop a care plan for three (3) nursing problems identified and included in the template. These nursing problems cannot be changed and a care plan needs to be developed for each.

Your task is to identify for each of the 3 nursing problems:

  • The underlying cause or what the nursing problem is related to
  • Goal of care
  • Specific bedside nursing interventions you will do
  • The rationales for your nursing interventions and actions
  • Indicators that your plan is working

Task 3: Medication management

Three important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications, understanding the nursing responsibilities and how to monitor the patient to ensure they are responding to prescribed medications as they should.

In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice,

  • Briefly explain why David has been prescribed:
  • Frusemide orally 40mg twice daily o Digoxin orally 62.5 mcg daily

o  Ramipril orally 5mg twice daily


  • Identify and explain
  • The specificnursing responsibilities associated with administering each medication
  • How you will monitor David for expected, side and adverse effects of each medication.

Task 4: Patient education

Patient education starts on admission and continues throughout care. Patient education should be aimed at; improving or increasing the patient’s knowledge; influencing their attitude to alter their behaviours or attitudes; and/or to prepare the patient for discharge.

Health education should be focused on the individual patient and individual strategies to improve the patient’s health and wellbeing.

When caring for David you recognise David may need further education on the following topics in relation to maintaining his cardiac output:

  • Physical activity guidelines o Smoking cessation

o  Stress minimisation

o  Reducing excess fluid volume

Select one (1) of the topics above and, in grammatically correct sentences and topic paragraphs,

  • Identify thespecific information you will explain to David about the topic including recommendations on

what he needs to do.


  • Explain
  • Why the topic is an important aspect of David’s care
  • How you will ensure that David knows and understands why it is important and knows what he needs to do

Task 5: ISBAR handover

An important legal requirement of nursing practice is to effectively and succinctly communicate relevant information, actions and outcomes related to patient care and provide an accurate reflection of the health status of the patient, their responses to care and the patient’s perspective.

Using the ISBAR format and information from the handover:

  • Provide a writtenhandover that clearly and succinctly outlines the important information that staff need to know about David for continuation of nursing care.
Get a 10 % discount on an order above $ 100
Use the following coupon code :
Open chat
Hello, you can now chat with our live agent via WhatsApp +1 (347) 428-6774
Our professional nursing writers will work on your paper from scratch.
We guarantee a plagiarism-free custom-written nursing paper.