Assessment Task

Assessment Task 2 – Scenarios.

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Choose one (1) of the following scenarios and develop your response, utilising the task booklet information and CRA for full instructions.

Address your responses from the Registered Nurse perspective involved in the patient(s) care. This task requires you to understand the NMBA Professional Standards for nurses and midwives, and the appropriate National Safety and Quality Health Service Standards (NSQHS) applied to the clinical situation as well as applied knowledge of the patient’s presenting condition, supported with relevant, contemporary literature. You will need to consider both clinical and ethical issues in your discussion.

Review the CRA carefully for expectations in your response.

Scenario 1:

Mrs. Joo Lan is an 82-year-old lady from China. Mrs. Lan has been in Australia for 8 years and speaks limited English. She had an abdominal hysterectomy and vaginal repair 2 days ago and states she has pain (8/10) and has been reluctant to mobilise. She is experiencing difficulty in voiding and has had a couple of episodes of incontinence and is upset and embarrassed. The RN handing over to you for the afternoon shift tells you that she inserted an indwelling urinary catheter (IDC) at 1500 hrs. to assess residual volume and to collect a specimen to test for white blood cells which could indicate a urinary tract infection. The residual was 80 mLs. The RN says that due to difficultly voiding and incontinence she left the IDC in until tomorrow to allow the patient to rest and embarrassment for the patient. Mrs. Lan is very happy with this treatment.

Answer the following questions from a Registered Nurse perspective.

1. Identify the main clinical/ethical issues and choose three to discuss in more detail from the scenario. Outline the evidence-based assessment and nursing care that is then required using relevant literature.
2. Briefly explain what information and advice is appropriate for the Registered Nurse to give to Mrs Lan?
3. What are your responsibilities with regard to NMBA Professional Standards and National Safety and Quality Health Service Standards to ensure Mrs Lan receives appropriate care, risk is managed and relevant follow up care given?

Scenario 2

Mrs Tessa Busteed is 68 and has had a laparotomy and partial colectomy to treat diverticulitis 2 days ago. She is still nil by mouth due to severe nausea and frequent vomiting and reduced bowel sounds. Her indwelling urinary catheter has not yet been removed, she is on intravenous fluids running at 12/24 rate and her post-operative wound is still intact. She has history of depression, mild heart failure, hypertension and stage one chronic kidney disease (CKD). She resides with her husband at home and they do not currently require any supports or assistance. She is two days post-operative and her husband, Arnold, has told you (the registered Nurse) that Tessa seems really off and is confused, and seems not to know him this afternoon. He asks you what is going on and has she got dementia? As you go over to speak with Tessa, she appears quite agitated, and you have to intervene as she is trying to get out of bed but is quite unsteady and seems unsafe. She denies having any pain and does not appear to be in pain. Arnold says he is going home as it upsets him to see her like this. You ask him when he will return, and he says he thinks he’ll leave it a few days as she’s not seeming that happy to see him and isn’t doing anything he asks her to do. After he leaves, Mrs Busteed pulls her IV out and resists having it re-sited.

Answer the following questions from a Registered Nurse perspective.

1. Identify the main clinical/ethical issues and choose three to discuss in more detail from the scenario. Outline the evidence-based assessment and nursing care that is then required using relevant literature.
2. Briefly explain what information and advice is appropriate for the Registered Nurse to give to Arnold?
3. Identify the specific National Safety and Quality Health Service Standards and NMBA Professional Standards relevant to this scenario and link to your role and responsibilities as a Registered Nurse.

Scenario 3

Becky is a 19-year-old mother of Ethan who is 8 months old. Ethan has been admitted with bronchiolitis and has been very unwell for 3 days. He is recovering now and is weaning off oxygen currently delivered by nasal prongs at 0.5 litres/minute.

Becky stays with Ethan and is a very attentive mother and shows appropriate nurturing care. Ethan’s development is normal for age. He settles with a bottle for his afternoon nap and Becky asks you to add chocolate milk to the bottle. You start to explain to Becky why this is not a good idea and she gets verbally aggressive saying “leave me alone, this is my child and I am sick of you do gooders telling me what to do; its not you who have to get him to sleep and cope on your own”.

Becky is also very interested in the other patients and asks you questions about them and their parents when they are not in the room. She comments on another child in the opposite bed saying “His mother hardly visits, I do not understand how a mother could leave such a young child”.

Becky asks you what shift you are on tomorrow and when you tell her you are on evening shift she asks you to collect some small grocery items on your way to work as she does not want to leave Ethan. She tells you she will give you the money tomorrow. You enter the patient lounge and find Becky eating another mother’s pre-packaged food. You have noticed that Becky and Ethan do not have any visitors.

Answer the following questions from a Registered Nurse perspective.

1. Discuss briefly some of the challenges in providing nursing care to a young woman like Becky and her child Ethan.
2. Identify the main nursing/ethical issues and choose three to discuss in more detail from the scenario. Outline the evidence-based assessment and nursing care that is then required using relevant literature.
3. Identify the specific National Safety and Quality Health Service Standards and NMBA Professional Standards relevant to this scenario and link to your role and responsibilities as a Registered Nurse to ensure Becky and her son receive appropriate care.