Written Assignment NUR2203– Nursing the Surgical Patient: Task overview

Assessment Nursing the Surgical Patient
Assignment Objectives 1.       Demonstrate the use of research evidence for nursing practice applied to the care of a surgical patient

2.       Augment skills in clinical decision making and reasoning through synthesising and analysing information required to care for a surgical patient

3.       Apply appropriate assessment, problem solving, planning, prioritising of interventions to care for the selected client scenario chosen

4.       Demonstrate the nurse’s role in monitoring and implementing prioritised nursing interventions in response identified patient needs

5.       Demonstrate the ability to communicate specific patient care issues succinctly according to scholarly writing and referencing conventions

Assessment Purpose Standard 1: Thinks critically and analyses nursing practice.

RNs use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks.

Standard 4: Comprehensively conducts assessments. RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.

Standard 6: Provides safe, appropriate and responsive quality nursing practice.

RNs provide and may delegate, quality and ethical goal directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.

Standard 7: Evaluates outcomes to inform nursing practice.

RNs take responsibility for the evaluation of practice based on agreed priorities, goals, plans and outcomes and revises practice accordingly

 

(NMBA 2018) Registered Nurse standards of practice Retrieved from: http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards/registered-nurse-standards-for-practice.aspx

Due Date September 14, 2020 2355 pm (week 10)

1.       Submit via Turnitin

2.       Late submission penalties will apply unless written extensions requests have been approved (see 4.2.4 https://policy.usq.edu.au/documents/14749PL#4.2_Assignments )

3.       Work submitted more than ten (10) University Business Days after the due date without an approved extension will have a Mark of zero (0) recorded.

Length 2000 words +/-10% (including headings) (word length includes in-text referencing and excludes your reference list)
Marks out of:

Weighting:

A total of 40 marks = 40% (refer to Marking Rubric)
Formatting Style Assignments should be presented using:

  1. Double Line Spacing
  2. Times New Roman, 12 point font
  3. Use APA 7th formatting style. The first line of each paragraph is indented. The reference list starts on a new page with the heading References. References are listed alphabetically and have the second and subsequent lines indented)
  4. Subheadings are required for each question
Essay Presentation Use the following points in your assignment. Penalties will apply if these conventions are not adhered to.

1. You are expected to present your assignment in a scholarly fashion i.e. academic writing conventions in essay format

2. Must be written in the format of an academic assignment and in third person.

2. Bullet points, numbering, use of tables or figures are not appropriate in the essay. Bullet points may be used in the care plan template

3. Subheadings are required for each question

4. Reference according to USQ APA 7th edition

(https://www.usq.edu.au/library/referencing/apa-referencing-guide)

5. Rule of thumb for references: 1 reference per 100 word

7. Use a separate page for references. The reference page is not included in the word count.

8. Use size 12 font and double line spacing

9. Indent the first line of each new paragraph

10. Marking RUBRIC sheet attached as a separate document

11. Academic staff assistance is provided to answer questions but we are not in a position to review drafts – but we will help with clarifying assignment instructions.

 

Submission information

What you need to submit One Microsoft Word document that contains the following items:

·         Your assignment document.

·         No coversheet but footer must include: surname_initial_studentnumber_coursecode_A1_page no

·         Please use the Assessment 1 Marking Rubric to guide you, and submit the Marking Rubric as a separate document

Submission requirements This assessment is to be submitted electronically via Assessment 1 Submission link on NUR2203 Study Desk. It must be submitted in electronic format as a Microsoft Word document via Turnitin. The Turnitin process may take up to 24 hours to produce a report. Therefore, allow adequate time to do this and address any issues of plagiarism detected by Turnitin before final submission.
File Name Conventions Save your document with the following naming conventions: surname_initial_studentnumber_coursecode_A1.doc/docx

e.g. Jones_S_001789789_NUR2203_A1.doc

Marking and Moderation ·         This task will be marked against the marking Rubric available on StudyDesk;

·         All staff who are assessing your work meet to discuss and compare their judgements before marks or grades are finalised. A rigorous moderation process is undertaken for this course, hence no remarking of assessment pieces will be considered.

·         Final release of grades will normally be within three weeks of submission. This same timeframe applies for any approvals for an extension of time commencing at the time of submission.

Academic Integrity Students should be familiar with USQ’s policy on Academic Integrity: https://policy.usq.edu.au/documents/13752PL

 

Completion of the Academic Integrity learning activity is highly recommended.

Turnitin has been enabled so that students can check for similarity matching within their assessment and make amendments prior to the due date to demonstrate academic integrity.

Late Submissions Penalty ·         Students are encouraged to access the USQ assessment policy: https://policy.usq.edu.au/documents/1357PL

·         Applications for an extension of time will only be considered if received in accordance with the USQ Assessment procedure https://policy.usq.edu.au/documents/14749PL and the Assessment of Compassionate and Compelling Circumstances Procedure: https://policy.usq.edu.au/documents/131150PL

·         Note that USQ’s procedures requires applications are made for extensions PRIOR to the due date of the assessment.

Resources available to complete task USQ academic writing style is provided in links on the course Resources Tab.

https://www.usq.edu.au/library/study-support/assignments

Referencing

https://www.usq.edu.au/library/referencing

 

Case Study Sarah Brown a 66 year old retired teacher has been admitted for an open right hemicolectomy. Sarah presented to her GP with a three month history of generalised abdominal pain and occasional diarrhoea.  A colonoscopy found a mass in the ascending colon. Initial pathology of the biopsy showed a poorly differentiated adenocarcinoma of the ascending colon. Please refer to the following pre and post-operative assessment data to answer the assignment questions.

Pre-operative clinical data

 

Objective Data Past Medical History Social History
  • Weight 92kgs
  • Height 165 cm
  • BP 140/95
  • HR 86
  • RR 18
  • Temp 36/8
  • Urinalysis – normal

Current Medication

·         Simvastatin 40mg nocte

·         Ranitidine 150mg BD

·         Captopril 150 mg/day

·         Aspirin 100mg daily (ceased 5 days prior to surgery)

·         Hypercholesterolemia

·         Hypertension

·         Obstructive sleep apnoea (OSA) confirmed with sleep study March 2019

·         Myocardial infarction (MI) in 2007 with left coronary artery stenting.

  • Married with 2 grown children
  • Retired
  • Smokes 15 cigarettes a day
  • Minimal alcohol use
  • Independent with daily cares and mobility

Family history

·         Father RIP heart failure

·         Mother RIP bowel cancer

Postoperative clinical data

Sarah returned from theatre at 1700 following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis in two out of 28 dissected lymph nodes.  You are the nurse looking after Sarah on the night shift.  You have arrived on the ward at 2100 and will be looking after Sarah on the night shift.

 

Observations 2100 Medications Post-operative orders
·         BP 90/54

·         Pulse: 116 and regular Respiratory rate: 12/min shallow SaO2 95% 2 litres via nasal prongs, Temperature 36.8°C Axilla,

·         Sedation score = 1-2

·         Vacudrain in-situ 400  ml in bag

·         Estimated blood loss (EBL) in OT 400ml

·         Urine output via a Foley IDC: 15-20 mls/hour <1ml/kg/hour last three hours

·         Pain score 6 on a scale of 0-10

·         Midline abdominal dressing (minimal ooze)

 

·         Simvastatin 40mg nocte

·         Captopril 150 mg/day

·         Ranitidine 150mg BD

·         Aspirin 100 mg mane

·         Morphine PCA 1mg bolus: 5 minute lockout

·         Regular paracetamol 1G QID (PO/IV)

·         Oxygen 2L via nasal prongs

·         Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 100mls/hour

·         IV Cefoxitin 2gms.

 

·         Midline abdominal dressing. Reinforce as required.

·         Mobilise day 1 with physiotherapist

·         Sips of fluid only

·         Remove IDC 0800, day 1

·         DVT prophylaxis –TED stockings

·         Pain management

·         GP follow up 2/52

·         OPD appointment 6/52 with Dr Bryan

·         Sarah will have 20 doses of adjuvant chemotherapy as an outpatient over the next three months.

 

 

 

 

 

 

 

Task description This assignment requires you to consider the case scenario of Sarah Brown who has undergone a laparotomy.

Your answer will concentrate on the first 24 hours of post-surgical care.

Subheadings are required for each question

 

1. Provide an INTRODUCTION (approximately 100 words)

An introduction will provide clear scope about the direction of your assignment.  This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.

 

Part A : Use template provided at the end of this document: Maximum 2 pages (10 font)

This section will focus on the first 24 hours of post-surgical care. Prioritisation of care is required.

This part of the assignment asks you to formulate a plan of care including the following 4 elements:

·         Assessment

·         Potential clinical issues

·         Interventions (independent nurse initiated interventions and collaborative interventions)

·         Rationales (supporting the interventions)

Using the provided plan of care template, identify priority clinical issues, and nursing interventions (refer to the example provided)

1.       Gather ASSESSMENT: Analyse the case scenario and document appropriate assessment data from the case study.  Consider the clinical data you have been given BP, RR, urine output and the data that is missing e.g. Respiratory rate = 12 but what is the depth / quality/ breathe Sarah’s breathing

2.       Identify FOUR (4) PRIORITY clinical problems for Sarah. Justify each problem based on the data collected and analysed from Sarah’s clinical assessment data. e.g. at risk of severe pain

3.       Identify NURSING INTERVENTIONS related to the clinical issues. For each of the FOUR clinical issues provide nursing interventions (with rationales) e.g. Encourage deep breathing exercises hourly

4.       Provide RATIONALES to support your interventions along with supporting relevant referenced literature / research.   For the intervention: Encourage deep breathing exercises including use of the spirometry hourly; provide a rationale: further promotes normal lung expansion and increases oxygen levels, is useful in preventing pneumonia and atelectasis

 

Part B: Analysing and discussing the case to identify potential clinical issues (1100 words)

 

1.       Discuss Sarah’s co-morbidities including smoking, cardiac heart disease, obstructive sleep apnoea (OSA) (previous MI, hypertension and hypercholesterolemia) in the context of having a general anaesthetic (GA) and specific to the 24 hour postoperative period.

2.       Choose TWO (2) potential clinical complications related to the co-morbidities that could arise in the 24 hour period.

3.       Discuss the relevant assessment/s and interventions the nurse would initiate to identify and prevent clinical deterioration. Provide rationales for your actions/ interventions and support with academic literature

 

 

Part C: Discharge planning (700 words)

1.       Plan and prioritise discharge advice and a plan for Sarah

2.       In the discharge plan, consider the appropriate post-operative education for Sarah including the surgical procedure.  Concisely provide a discharge plan and education around medication, prevention of post-operative complications, psychosocial issues, and lifestyle modification

3.       Refrain from merely providing generic information.  Be succinct and appropriate in your advice but also critically evaluate the information in the case and specifically relate this to your discharge plan.

 

Provide a CONCLUSION (approximately 100 words)

Your conclusion succinctly summarises the main points of your assignment but this section is not an opportunity to introduce new information.

 

Submission information

Assignment Tips  

ASSIGNMENT DETAILS
Introduction

(approx. 100 words)

 

Provide an overview of the structure of the assignment. Provide a brief overview of how you will approach each section. Outline examples in your essay that will be used to respond to the assignment question.
Part A – Table format – (2 pages approx. – 10 font)
Plan of Care (assessment, identification of issues) using the provided template. Refer to the example provided
  • This section needs to include the relevant assessment data including, the data you have been given in the patient scenario above and also other assessment criteria you would need to collect in order to care for Sarah
  • Demonstrate how to prioritise care based on the potential issues arising from the clinical assessment data. You will need to take into consideration the Sarah’s co-morbidities. Please base the care identified within the first 24 hour post-operative period
  • It is expected that the information in this section will be referenced from academic literature.
Prioritised interventions supported with researched rationales
  • Choose four (4) prioritised potential clinical issues. Be aware of the timeframe (i.e. 24 hour post-operative period) and the relevant interventions the nurse would initiate for the issues / potential issues identified.
  • Utilising published literature on postoperative surgical care articulate why your rationales support your interventions and why you have prioritised these over other potential interventions. (Academic sources 5-6 would be reasonable for this section and related to pathophysiological processes)   
Part B – Analysing and discussing the case to identify potential clinical issues (1100 words) Essay Structure
 
  • Based on the four (4) prioritised clinical issues,  consider the Sarah’s co-morbidities in relation to the type of anaesthetic, age of the patient, pathophysiology of the co-morbidities, current medications and clinical observations.
  • Evidenced based nursing interventions should relate to pathophysiological processes that respond to early signs of deterioration and thereby improve clinical outcomes.
  • Be careful to only use the information provided in the case in rather than writing inferences.  Avoid using rhetorical questions.
  • It is expected to be written professionally – with complete sentences and paragraph structure. You are asked to make a point beyond ad hoc writing.

(Academic sources 3-6 would be reasonable for this section)   

Part C  – Discharge planning (700 words)
 
  • Consider both physiological and psychosocial aspects in discharge planning. (Academic sources 1-3 would be reasonable for this section)   
Conclusion (100 words)
  • Provide a critical review and summarise the main findings of the assignment.

 

 

 

 

Assessment Potential problems / issues Interventions Rationales
 

 

 

 

 

 

 

     

 

 

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