Q.1) Mrs Soo Hui is a 46-year-old

Q.1) Mrs Soo Hui is a 46-year-old female ( identifies as she, her) admitted to your ward at St Elsewhere Hospital, following an incidence of blurred vision, numbness down the right side and a sharp pain in her head. The next-door neighbour found her on the ground outside her front door unable to move or speak. She has been diagnosed as having a left sided ischaemic cerebro-vascular accident. She was immediately commenced on anti-coagulant therapy. Family history Born to Thai parents in Australia Buddhist & speaks Thai & English Lives with husband & 2 children, Ty 13 years old & Grace 5 years old. Also her father who is a frail 82-year-old. Medical history Hypertension, Type 2 Diabetes, Asthma Depression Hearing aid left ear Bi-focal glasses (broken in fall) Upper dental partial plate Medication – Amlodipine, Metformin, Salbutamol. Admission observations BP 150/90 PR 85 regular RR 24 To 36.9 SpO2 96% on room air BGL 8.4 mmol Weight 69 kg Height 162 cm GCS (Glasgow coma scale) = 14 Eyes open to speech Oriented to time, place, and person (speech slurred, but able to be understood) Right hemiparesis PERL (Pupils equal reactive to light) Issues/impacts of the CVA Pain on movement, mainly right hip & shoulder stated as 7 /10 Large haematoma right hip 5cm skin tear right elbow Dysphasia Dysphagia Right sided facial droop Mild Right-side hemiplegia Initial Doctor’s orders and interventions Rest in bed (RIB) 2nd hourly Neurological observations Nil by mouth (NBM) until Speech Therapist review Physiotherapist review Full assistance with hygiene IDC insitu Intravenous Therapy via cannula in left forearm Discharge Information Mrs Soo Hui will remain in acute care for two (2) weeks and then be transferred to the Rehabilitation Unit for intensive physiotherapy and occupational therapy. Community Services and the Discharge Planning team have been contacted. Provide an answer for each of the questions below in relation to Mrs Hui. a) Explain how you would prepare the hospital room for Mrs Hui’s admission to the ward. b.) List 4 pieces of equipment you would need to conduct an assessment on Mrs Hui’s when she is admitted to the ward? c.) Identify 4 components of correct nursing documentation (this also includes electronic documentation? d) Why is it important to measure and record a person weight and height on admission? scenario: Q. 2) You are required to provide a clinical handover to the Enrolled Nurse and Registered Nurse who are coming onto the next shift. Using the ISBAR format, what information would you include when doing a verbal bedside clinical handover for Mrs Hui? I S B A R Q.3) Mrs Hui has had an Ischaemic cerebrovascular accident (CVA). Answer the following questions. a.) Explain the two types of CVA, including where it occurs and what causes it. b) Identify four (4) indications of a left sided CVA. (c.) Identify the other morbidities / co-morbidities that Mrs Hui has. (d.) Mrs Hui is 46 yrs of age, discuss how depression can affect a person in middle adulthood. Q.4) As the EN contributing to the nursing care plan, please provide the following for each of the four (4) care plans. Two (2) nursing implementations for each care plan. One (1) rational and one (1) evaluation for each Implementation a) Care Plan 1 Assessment (subjective and objective data) (completed by RN) Rest in bed, Actual identification of limited Immobility due to CVA Nursing diagnosis (Identification) (completed by RN) Risk of impaired skin integrity related to immobility resulting from CVA Planning (goal, expected outcome, what do you hope to achieve) (completed by RN) implement nursing cares to prevent risks of altered skin integrity Implementation (nursing care interventions, what action can you as the EN can do) Rationale (reason why) One (1) for each implementation Evaluation (did the plan of care work, how will you know) One (1) for each implementation 1. 2. b) Care Plan 2 Assessment (subjective and objective data) (completed by RN) Pain, limited movement, and bed rest Nursing diagnosis (Identification) (completed by RN) Inability to perform self-care hygiene independently Planning (goal, expected outcome, what do you hope to achieve) (completed by RN) Patients personal and oral hygiene needs will be met Implementation (nursing care interventions, what action can you as the EN can do) Rationale (reason why) One (1) for each implementation Evaluation (did the plan of care work, how will you know) One (1) for each implementation 1. 2. c) Care Plan 3 Assessment (client has/has not, data) (completed by RN) Mrs Hui has been placed on a puree diet by the Doctor, she is noted to have difficulty eating due to Right hemiparesis Nursing diagnosis (Identification) (completed by RN) Risk for aspiration related to impaired swallowing reflex resulting from CVA Planning (goal, expected outcome, what do you hope to achieve) (completed by RN) Nursing staff to provide supervision and assistance with eating and drinking where there is clinical risk To minimise risk of aspiration while maintaining optimal nutritional and hydration status. Implementation (nursing care interventions, what action can you as the EN can do) Rationale (reason why) One (1) for each implementation Evaluation (did the plan of care work, how will you know) One (1) for each implementation 1. 2. d) Care Plan 4 Assessment (client has/has not, data) (completed by RN) Mrs Hui is expressing feelings of powerlessness and loss of control over her limited mobility due to CVA and being away from her family Nursing diagnosis (identification) (completed by RN) Risk for impaired emotional, psychological, and social function related to depressed mood and impact of major health event (CVA) Planning (goal, expected outcome, what do you hope to achieve) (completed by RN) Reduced feelings of depression and creating adaptive measures Implementation (nursing care interventions, what action can you as the EN can do) Rationale (reason why) One (1) for each implementation Evaluation (did the plan of care work, how will you know) One (1) for each implementation 1. 2. Q.5) Scenario) Later in the week following admission, Mrs Hui has had her IDC removed. You are looking after Mrs Hui and she states she feels a burning and stinging sensation when she passes urine, you perform a urinalysis, and these are the results. Colour Odour Glucose Bilirubin Ketones Specific gravity (SG) Blood pH Protein Urobilinogen Nitrite Leucocytes Cloudy Offensive Nil Nil Nil 1.025 Nil 8.5 Nil Normal range yes yes a) Identify which of these results are outside normal range and what might these abnormalities indicate? Q.6) Scenario) Mrs Hui is now able to sit out of bed and be taken to the toilet on a commode chair, however, remains incontinent of urine and faeces at times. Provide four (4) nursing care interventions you can do to promote continence and manage incontinence for Mrs Hui. Intervention 1 Intervention 2 Intervention 3 Intervention 4 Q 7) Provide three (3) examples of urinary and faecal incontinence aids (other than an Indwelling catheter) for both men and women. Q.8) Provide a nursing action for each personal care listed in the table. Personal hygiene care need Identify one (1) nursing action you would do for each Personal hygiene care need. Basic eye care Cleaning Mrs Hui ears Cleaning Mrs Hui’s hearing aid Mrs Hui requires you to clean her upper denture Q.9) Outline three (3) reasons why it is important for the nurse to ensure Mrs Hui’s hygiene and grooming needs are met. Q 10) You are working night duty and when you go into see Mrs Hui, she is wide awake, she tells you that she has a lot of trouble getting comfortable and sleeping at night. List two (2) factors that impede sleep, comfort, and rest and two (2) factors that promote comfort, sleep, and rest. Factors that impede (state 2) Factors that promote (state 2) Comfort Sleep/rest Q.11) Mrs Hui will be in hospital and rehabilitation for an extended period of time. Assessments will need to be done to ensure that her environment is safe to assist in her recovery. a.) Outline two (2) nursing actions that can be implemented to maintain a safe environment for Mrs Hui during her lengthy stay in hospital and rehabilitation. Q 12) State the documentation required to assist in the prevention of falls for Mrs Hui. Q.13) Outline two (2) actions to promote and encourage active and passive exercises for Mrs Hui while on bed rest. Q.14) Outline two (2) actions to promote and encourage effective breathing for Mrs Hui while on bed rest. Q.15) Scenario) Mrs Hui has been the main person who cares for their two children and her father as Mr Hui works long hours. Now that Mrs Hui is in hospital, Mr Hui has taken leave from work to assist at home and support his wife. Mr Hui however is unsure what daily activities and nutritional needs he should be providing for his children and father-in-law. a) Identify two (2) recommendations to Mr Hui in regard to physical activity requirements for 5- and 13-year-old children. Q 16) Identify two (2) recommendations to Mr Hui in regard to physical activity requirements for his 82-year-old father-in-law. Q.17) Scenario) Mr Hui would like to ensure that he is providing nutritious meals to his daughter, son, and father-in-law. Identify two (2) nutritional facts for pre-schoolers, adolescents and elderly that Mr Hui may use to ensure that he is providing nutritious meals to his children. Group Two (2) nutritional facts for each group Pre-schoolers Adolescents Elderly Q.18) Scenario) On one particular day when Mr Hui is visiting his wife, he indicates to you that he feels the need for physical & emotional support as he is feeling overwhelmed with his wife being in hospital and caring for his children and father-in-law. a ) What advice could you provide for Mr Hui and other family members or carers in similar situations that may assist both emotional and physical needs to improve wellbeing. Q.19) Mrs Hui is being prepared for discharge. a) When should the discharge plan for Mrs Hui begin? (b) Outline three (3) elements that should be part of the discharge summary form? (c) Identify to (2) community support services or resources that can assist Mrs Hui’s discharge. Q.20) Olivia a 49-year-old female patient (identifies as she, her) is day 2 following a laparoscopic cholecystectomy (removal of Gallbladder). She has a 25-year history of Type 1 Diabetes Mellitus. She remains hospitalized for observation following a decreased urinary output and a temp of 38.6 on her first post-operative day. She received her routine morning dose of Insulin as per her medication chart before her breakfast arrived at 7am. At 9am Olivia uses her call bell, you respond, and she states she is feeling nauseated and dizzy, you also note she appears to be sweating, she states she had not eaten her breakfast as she felt nauseated. (a) What are the signs and symptoms of Hypoglycemia? b) List three (3) nursing actions you may take as a student Enrolled Nurse. c) How soon do you report Olivia’s situation and who do you report to? d) How soon after taking vital signs do you document them on the observation chart? ALL INFORMATION REGARDING ALL QUESTIONS ARE AT ABOVE SCENARIO SCIENCE HEALTH SCIENCE NURSING NUR 37

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