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ask Description: Proposal Value: 45% Due Date: Thursday 12 September

NUR331 Assessment Case Study 2 • Situation: • Tarni is a 65-year-old indigenous female who lives 2 hours west of Brisbane. • Tarni has been transferred to your hospital after being reviewed by the community and telehealth teams. They reviewed her case due to an acute deterioration in her health in the past few days and recommended she be transferred for investigations and acute care. • She has presented with shortness of breath, reduced urine output, decreased appetite and worsening fatigue over the past 3 days. • Background: • Past medical history: Type 2 Diabetes Mellitus, hypercholesterolaemia, and frequent urinary tract infections. • Medications: Atorvastatin 40mg daily and Metformin 500mg TDS. She has had three prescriptions in the past 12 months for urinary tract infections. • Tarni lives in a remote community and has not had a diabetic/medication review for over 2 years. She prefers to manage her diabetes herself and does what she can with her diet to control her blood glucose levels. She does not monitor her blood glucose levels, but rather monitors her symptoms. She still regularly takes her medication. • Tarni has been experiencing fatigue for the past few months. She assumed it was due to her age and spends more time resting when needed. On arrival in ED at 1100hrs: Airway • Airway clear • Feeling nauseous Breathing • RR 26 breaths per minute • SpO2 94% on room air • Reports feeling breathless • Bilateral chest expansion, no accessory muscle use • Auscultation: bilateral lower lobe fine crackles heard. Circulation • Heart rate – 85 bpm • BP – 155/90mmHg • Capillary refill 3 secs • Peripheral oedema present • Urine output – has not urinated today. Last urination was prior to going to bed last night. • Weight: 80kg • Temp: 37.1 • Haematology results: WBC: 11.1 109/L, Hb: 135 g/L, Urea 18 mmol/L, Creatinine 180 micro mol/l, Na (sodium) 134 mmol/L, K (potassium) 5.1 mmol/L Disability • Alert but may have some evidence of mild confusion – she keeps asking where she is (ACVPU – Alert, confused, voice, pain, unresponsive) • Blood glucose 13.2 mmol/L • Pain: mild flank pain noted bilaterally. Patient reports a score of 2/10. NUR331 Assessment Case Study 2 Exposure • Skin mostly intact, an abrasion noted on her right ankle. No signs of infection • Temp: 37.1 • Peripheral oedema present The ED team have referred Tarni to the renal team due to her worsening renal function and associated symptoms. There is a diagnosis of an acute kidney injury, and she is being transferred to a renal ward when a bed becomes available. Instructions • Discuss the pathophysiology of the presenting condition (giving consideration to the previous risks e.g. past medical history) • From the assessment information provided, explain the assessment findings including your further secondary assessment actions (e.g. systems based assessment) • Using the assessment findings, discuss your nursing care (further investigations, nursing interventions, implementation and evaluation of care) • Explain how you have addressed relevant NSQHS and NMBA standards (minimum expectation: one of each), and social justice principles

 
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