NUR250 Medical Surgical Nursing 1


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.

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.

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:

a.Frusemide orally 40mg twice daily
b.Digoxin orally 62.5 mcg daily
c.Ramipril orally 5mg twice daily

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:

a.Physical activity guidelines
b.Smoking cessation
c.Stress minimisation
d.Reducing excess fluid volume

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

 Identify the specific information you will explain to David about the topic including recommendations on 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 written handover that clearly and succinctly outlines the important information that staff need to know about David for continuation of nursing care

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