Topic: Care for person with complex needs
Instructions to Student
Size 12 font, open book
Word count 1,000 for Q1-16
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Please answer all questions 1 – 32
Questions 1 – 16 relate to Ms Warral
Name: Sue Warral
Ethnicity: Aboriginal Torres Strait Islander
Marital Status: Divorced from children’s father. Currently in a defacto relationship with James Michaels (55)
Medical history: Chronic Asthma, hypertension, hypothryroidism, hiatus hernia, osteo arthritis knee’s, smokes – 1 pack per week, alcohol – social
weight 95kg, height 160cm, BMI 37
Previous history of deep venous thrombosis
Occupation: Part-time reception duties at local primary school
Next of Kin: James Michaels Defacto husband
Dependents: 2 children (Rebecca 12yrs & Nathan 10yrs)
Family: Children visit their father every other weekend. Beryl’s mum and a sister live nearby. The whole family gets together on a regular basis.
Interests: Socializing, gardening, reading
Ms. Sue Warral presents in your gynecological surgical unit for an abdominal hysterectomy tomorrow. Ms. Warral has had three consecutive abnormal PAP smears in the past four months.
The patient states she has noticed an unusual vaginal discharge over the past six months. On further investigation Sue was found to have stage II carcinoma of the cervix
She reveals to you she is anxious about the cancer and having young children to look after. She also confides that she is worried that her partner will still love her. Sue’s surgeon Dr Turner stated that they would make a decision following the findings of the surgery regarding radiation therapy.
On admission to your ward, the day of surgery, you take Ms Warral vital signs;
BP 155/85, Pulse 88 bpm, temperature 36.6 ,respirations 18 , weight 95kgs
O2 sa 97%
Allergic to Penicillin
The patient gives you a list of her current medications.
Serevent – one puff twice daily
Salbutamol 1-2 puffs every 3 hours as needed
Metoprolol- 50mgs daily am
Thyroxine – 50mcgs daily am
Omeprazole 20mg daily am
Panadol osteo – two tablets TDS
You have been asked to prepare Ms Warral for theatre. Discuss the following procedures in relation to the patient’s history.
1. The patient has been fasting from 2400. Sue states she was not sure whether to take her morning medications. State the reason why some of her medications may be given and some withheld on the day of surgery. (50-100 words)
2. Ms Warral requires blood taken for a Urea & electrolytes (U & E) before surgery.
Discuss the rationale for this investigation & type of consent required. (50-100 words)
3. Discuss how you will perform a venepuncture on Ms Warral using the vacutainer system, including any infection control precautions you would take. Include rationale for actions. (procedure may be written in list form. 100 – 150 words)
4. Discuss three (3) factors that make Ms Warral at risk of perioperative deep vein thrombosis. (50-100 words)
5. Mrs Warral is to have anti-embolic stockings fitted to assist in the prevention of deep vein thrombosis
Explain how to put anti-embolic stockings on a client (50-100 words)
6. You complete the pre-operative ECG, as ordered.
• Looking at Lead 2 Please discuss PQRST and the method for calculating rate and determining rhythm.
• State the type of rhythm shown in the ECG below.
7. Ms Warral is to use the incentive spirometer following surgery to prevent pulmonary complications.
a. Discuss your explanation of how to use the incentive spirometer to your patient. (50-150 words)
b. You are also asked to monitor Ms Warral’s oxygen levels (Spo2) how would you do this
Ms Warral returns from theatre following abdominal hysterectomy & bilateral salpingo-oopherectomy. She has insitu, a fentanyl PCA, oxygen 2l/min via nasal prongs, IV fluids, IDC – SD, bellovac drain & vac dressing.
During the evening, you notice Ms Warrals’ bellovac drain has filled to 400ml. You observe her wound & find a large collection of blood has formed under the vac dressing. In response to your questions she has become increasingly drowsy & having trouble speaking.
8. Review the attached ADDS chart, make an assessment based on her vital signs & discuss the actions you would initiate. Use the DRSABCD acronym as headings to explain your answer. (100 – 200 words)
Ms Warral stabilises following intervention of the Medical Emergency Team. Her surgeon orders her 1gm cephalexin IV QID.
9. Review Ms Warrals’ history & discuss your actions in response to this drug order. (50 – 100 words)
10. The medical staff order the removal of the Bellovac drain & her IDC. What infection control precautions are required for these procedures? (50 words)
Ms Warral fails her Trial of Void a requires re-catheterisation with an indwelling catheter.
11. Discuss how you will perform a female urinary catheterisation on Ms Warral, including any infection control precautions you would take. (procedure may be written in list form. 100 – 150 words)
After 5 days in hospital Ms Warral is discharged home into community care with an indwelling urinary catheter.
Access the document Working with People with Chronic & Complex Health Care Needs. (NSW gov)
12. Discuss two (2) resources that Ms Warral may be able to access to assist in the supply of urinary equipment. (50 – 100 words)
13. Explain the definition of a successful Trial of void according to the ACI TOV Clinical Guideline (Community) accessed through Working with People with Chronic & Complex Health Care Needs. (NSW gov) (50 – 100 words)
14. Ms Warral may require a bladder washout at some stage in the near future if she is to go home with a urinary catheter.
Under what conditions would a bladder washout be required
Identify 2 nursing interventions you may do in regards to a bladder washout .
15. Prior to Ms Warrals discharge you refer to her nursing history of osteoarthritis (OA) in her knee, What questions might you ask her to help determine the severity of her OA and how may OA impact her activities of daily living? (50-100 words)
16. Ms Warral is concerned over her children and what is going to happen to them as they have had to spend a lot of time at their father’s house, she is also feeling quite anxious about their care and has stated that she is feeling quite “down” following her surgery and isn’t sure how she will cope at home once discharged. She has also stated that she been arguing on the phone with her ex-husband in regards to her children’s care and she doesn’t know how to deal with this.
Outline 4 nursing interventions you can do to assist with the emotional, psychosocial wellbeing and conflict resolution support of Ms Warral, keeping in mind her cultural heritage
Questions 17-28 are multiple choice questions with case studies
17. An 84-year-old male patient has been admitted to day surgery for removal of a 5cm carcinoma from his back
What is the most dangerous type of skin cancer, often characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised?
? Basal cell carcinoma
? Malignant melanoma
? Squamous cell melanoma
? Verruca cell
18. Nurse Mary is caring for an elderly bedridden adult. To prevent pressure ulcers, which intervention should the nurse include in the plan of care?
? Turn and reposition the client at least once every 8 hours
? Slide the client, rather than lifting, when turning
? Provide a turning schedule of 2hrly to the nursing care plan
? Vigorously massage lotion into bony prominences
19. Mr Jack has been admitted to your ward for eye surgery. You are completing the patient’s history as part of the admission process and you see that Mr jack has clouding of the lens of his eyes, what would this condition most likely be given that Mr Jack is 78 yrs old
20. Mr Stevenson arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye, what is the initial nursing action?
? Perform visual acuity tests
? Apply an eye patch
? Irrigate the eye with sterile saline
? Remove the piece of wood using a sterile eye clamp
21. Molly Jones is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear?
? Serous otitis media
? Burning of the ear
22. Which instruction about insulin administration should the nurse give to a client?
? “Discard the intermediate-acting insulin if it appears cloudy.”
? “Always follow the same order when drawing the different insulins into the syringe.”
? “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
? “Shake the vials before withdrawing the insulin.”
23. A male client is admitted to your ward with suspected pulmonary tuberculosis, he is placed in a single isolation room. Choose the answer that best outlines the additional precautions required when caring for this client.
? Gown and gloves plus a mask only if there is a risk of the patient coughing when you are attending to his vital signs
? Standard PPE, mask and a shared room is fine as long as the patient doesn’t go near the other patients
? Standard PPE, any sort of mask, normal room ventilation is fine as droplets can’t be spread
? Standard PPE plus a well-fitting mask specific for tuberculosis, dedicated patient equipment, special room ventilation reequipments
24. You are caring for Mr Smith a 56 yr old gentleman who was admitted to hospital with a blocked suprapubic catheter and bladder infection requiring antibiotics. Which of the 4 answers below outline nursing interventions that may apply to the care of a suprapubic Catheter?
? Checking for kinks or bends in the catheter tubing
? Ensure that the catheter bag is taped to Mr Smith’s Chest
? Hand washing
? Keeping the catheter bag below bladder level
? Documenting the color of the urine
? Remove the catheter if it becomes blocked again
25. Mr Corn is a 68-year-old male with a past medical history of cancerous polyps in the bladder. For the past 5 years, he has undergone regular cystoscopy and bladder scrapings. He has now undergone a surgical procedure (cystectomy) to form an urostomy / ileal conduit. Once Mr Corn has recovered you are required to educate Mr Corn on how to empty his urostomy.
Which of the following educational points would you be able to inform Mr. Corn about when emptying his urostomy bag (there is more than one point to choose)
? No need to wash hands as it is not a sterile procedure done by a nurse
? Empty the Urostomy bag every 2 – 4 hrs or when 1/3rd full
? Wait until the urostomy pouch is completely full before emptying
? Empty the urine from the urostomy bag into the toilet
? Remove the urostomy bag before emptying
? Wash hands with soap and water before and after emptying
26. Mrs Robertson has recently had bowel surgery to her large intestine for carcinoma of the bowel and now has a colostomy. While Mrs Robertson is recovering, you are required to change the colostomy bag on day five, what is an important factor to consider when placing a new colostomy flange over the stoma
? Measure the stoma diameter using a wooden ruler and cut out stoma hole in the colostomy bag 5mm larger than the stoma size.
? Measure the stoma diameter using a measuring guide and cut out stoma hole in the flange 2mm larger than the stoma size.
? Measure the stoma diameter using a measuring guide and cut out stoma hole in the flange 10mm larger than the stoma size
? Take a guess at the stoma size and cut out stoma hole in the flange 5mm larger than the stoma size to ensure that you cover the stoma and 5mm of surrounding skin
27. Choose 3 answers that best reflect nursing interventions for nasogastric tube feeding
? Enteral feeding tubes must be flushed prior to, and after medication administration (as per facility policy)
? When preparing to administer feeds there is no need to confirm the position of the enteral tube as it should be in the correct position
? When preparing to administer feeds nursing staff must confirm the position of the enteral tube.
? A enteral feeding pump must be used for bolus feeds only
? the head of the bed should be elevated 30-45 degrees during feeding (or upright if able) and for at least 30 minutes after the feed to reduce the risk of aspiration
28. Choose 3 answers that best reflect nursing interventions for percutaneous tube feeding
? Due to the fact that the position of the tube has been confirmed by x-ray you only need to confirm its position every 72hrs
? By providing education to the patient on their percutaneous feeding tube the risk of complications is reduced
? Careful examination of the skin around the insertion site is required each shift (or as per facility policy) to ensure that the area is free from infection and irritation
? If the percutaneous tube becomes blocked it should be removed immediately
? Always check tube placement before administering feedings and medications
29. Match 2 conditions from the list below with the disorder
e.g. Osteoarthritis (condition) + Musculoskeletal (Disorder)
List of conditions: Diverticular disease, rheumatoid arthritis, Melanoma, Meniere’s disease, Pneumonia, Colorectal cancer, Bone fractures, Ovarian Cancer, Chronic Kidney, Disease asthma Alzheimer’s disease, Diabetes mellitus, Kidney Stones, Cellulitis, Glaucoma, Adrenal insufficiency, Otitis, Multiple Sclerosis, Enlarged Prostate, Gland Macular Degeneration
Condition 1 Condition 2 Disorder
respiratory system disorders
nervous system disorder
reproductive system disorders
urinary system disorders
30. Mr Jack Brown is a patient in your care and due to a small bowel obstruction, he is to have a nasogastric tube inserted.
30a. Please outline the process of insertion
Six days later once Mr Jack Brown has recovered the Dr orders for the nasogastric tube to be removed.
30b. Outline how this procedure is done
31a. Outline 5 characteristics of critical thinking
31b. Outline the differences between critical thinking, creative thinking and problem-solving
32. The core standards that are available to support individuals, families and carers with disabilities outline resources available.
Please use this weblink to access the core standards required http://www.adhc.nsw.gov.au/sp/delivering_disability_services/core_standards
Outline 3 resources available to each of the following
People with disabilities