NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx This assessment is relevant to two subjects and is divided into two parts: ? NSG2204 Professional Studies 4: Indigenous Culture and Health (Part A), and ? NSG2201 Nursing 4: Nursing Care B (Part B) Instructions for completing the Case Study Report You are required to carefully read through the Case Study attached to complete Part A and Part B questions relating to the case study and relevant to each unit of study. Part A must be submitted with its own coversheet and reference list for NSG2204 Part B must be submitted with its own coversheet and reference list for NSG2201. Each ‘Part’ is then individually assessed by the relevant subject coordinators. Part A for NSG2204 ? Weighting = 40% ? Word limit = 1500 words ? Due = Sunday 16 th October 2000hrs, 2022 Part B for NSG2201 ? Weighting = 35% ? Word limit = 1200 words ? Due = Sunday 16 th October 2000hrs, 2022 NOTE: If you are studying one subject only, you will only be required to submit the part of the case study report that relates to that one subject. For example, for NSG2204 you only complete Part A. For NSG2201 you only complete Part B NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx BACKGROUND HISTORY Hope Vale is a remote town in Far North Queensland (FNQ) on the Cape York Peninsula, about 46 Kms NW of Cooktown (the nearest town), 372 km from Cairns the nearest city and 2,029 km NNW of the Queensland capital city of Brisbane1 . The population of Hope Vale is 92% Aboriginal and/or Torres Strait Islander people2 , who make up thirteen clan groups who mostly speak Guugu Yimithirr and other related languages, as well English3 . The Guugu Yimithirr people are the traditional custodians of the land and are estimated to have occupied this area for approximately 100,000 years. The Aboriginal Shire Council proudly state that Hope Vale is located in ‘a valley surrounded by tropical native bushland, mountain ranges, pristine coast and diverse flora and fauna’ and it is the most Northern township on the Eastern seaboard that can be accessed by Bitumen (road). The town is remote, and the weather can be extreme due to tropical cyclones that can make movement in and out of the town difficult. There are a number of services available in Hope Vale for the 1500 or so residents, including education, health, community and social services4 . However, there are a high proportion of people who do not access services due to socioeconomic disadvantage as a result of low income, low educational attainment, high unemployment, and having no access to a motor vehicle5 . Furthermore, the remote Indigenous population experience poorer health outcomes than non-Indigenous people in the region including a higher burden of chronic diseases such as Cardiovascular disease, Diabetes mellitus, and Chronic respiratory diseases compounded by limited access to integrated team care6 . In addition, some services such as those available for mental health and social & emotional wellbeing have been identified as not culturally appropriate, meaning access and treatment outcomes are poorer for the Aboriginal and Torres Strait Islander people in the area7 . Dora Barnes is a 48 year old Guugu Yimithirr woman from Hope Vale who speaks a dialect of Guugu Yimithirr and some English. Dora was born small and premature at 33 weeks and had to be tube fed due to prematurity and then later bottle fed, as her mother had difficulty breast feeding and was unwell having gestational diabetes most of her pregnancy. Dora grew up living with her mother, father, grandmother and 3 siblings, making living conditions cramped and difficult and the transmission of infections common between household members. Dora recalls that ‘good tucker’ was scarce when she was a child due to the cost of food in town and the fact that there was very limited food choices at the local store. However, she remembers fondly that the best tucker was when someone had gone hunting and returned with some kangaroo, or even better when someone returned from the coast with some turtle which was her favourite (Turtle fat is highly desirable in many communities, but usually reserved for elders or special occasions). Dora does not remember visiting a 1 Hope Vale, Queensland https://en.wikipedia.org/wiki/Hope_Vale,_Queensland 2 ABS 2016 https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/LGA33830 3 Hope Vale Aboriginal Shire Council https://www.hopevale.qld.gov.au/ 4 ibid 5 Northern Queensland PHN – Health Needs Assessment 2019 – 2022 https://www.nqphn.com.au/about-us/reports-and-plans/healthneeds-assessment 6 ibid 7 Ibid. NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx doctor or nurse very often as a child or even as an adolescent, but when she did it was always strange and scary to meet a new ‘white stranger’ who didn’t seem very friendly. CURRENT MEDICAL HISTORY Dora has felt quite unwell lately with lack of appetite, nausea, shortness of breath, and feeling exhausted most of the time. Dora informs the nurse that she has also been ”passing water” less frequently over the past few weeks. Her sister took her to see the doctor at the local medical service who examined her, took some blood and a urine test and explained that she needs to see a nephrologist urgently for a renal biopsy, at the Royal Brisbane Hospital. Dora is alarmed (as is her family) as Brisbane is 2,045 km from Hope Vale and ‘a long, long way off country’ as Dora says. Dora has never travelled this far ‘off country’ or away from her family for any length of time and is very nervous about going to hospital so far away. After much discussion Dora understands she is very unwell, and the doctor organises to access funding for her sister to fly down to Brisbane with her. Dora’s blood tests show significantly elevated urea and creatinine. Her urine tests indicate albuminuria and haematuria. Dora’s provisional diagnosis is chronic kidney disease (CKD) PAST MEDICAL HISTORY ? Overweight ? Hypercholesterolemia ? Hypertension ? Diabetes (T2DM) – diagnosed age 30. ? Multigravida (2 live births) FAMILY MEDICAL HISTORY Mother – CKD, Gestational Diabetes – now Diabetes Mellitus (T2DM), Obesity, Glaucoma, Depression Father – Alcohol dependence, Hypertension, Mitral Valve replacement (secondary to RHD) Sister #1 – Diabetes Mellitus (T2DM), obesity Sister #2 – Hypertension, CAD, Brother#1 – Hypertension, Hypercholesterolaemia, CAD CURRENT MEDICATIONS Simvastatin 40mg (note) Atacand 32mg/d Lantus 20units/bd NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx PART A FOR SUBMISSION TO NSG2204 CASE STUDY REPORT INSTRUCTIONS Please read the case study carefully, so you have the context for Dora’s health condition and impending admission to hospital. ? Address each question below in 1,500 words +/- 10% ? USE HEADINGS to make it clear which question you are addressing. Note: headings are NOT counted in the word count ? Beside each question is a guide to the word limit to help you structure your report. This is a guide only, so you may be under or over the suggested word count, as long as you answer each of the questions sufficiently to meet the rubric criteria and do not exceed the 1,500 word +/- 10% ? Each response must be referenced appropriately with relevant and recent literature and a reference list with at least 10 references must be included with your submission. ? Please make sure that you proof read your work for spelling, grammar and syntax prior to submission ? You must use APA 7th referencing style for this submission. CONSIDERATIONS AND PREPARATION FOR HOSPITAL ADMISSION AND DISCHARGE Please respond to ALL the following questions described under EACH HEADING. Include a coversheet and reference list with your submission to the dropbox on Brightspace Diversity of Aboriginal and Torres Strait Islander cultures & causes of health inequalities Discuss the diversity and richness of Aboriginal and Torres Strait Islander cultures, and how this applies to Dora. Identify key causes of health inequalities, and how these impact Dora’s access health care and why these apply specifically for Aboriginal and Torres Strait Islander peoples. (150 words) Social Determinants of Health & Barriers experienced by the patient Discuss some of the social determinants of health experienced by Dora and the barriers to accessing health care, treatment and management (500 words) Cultural Safety & Impact of colonisation Critically analyse why travelling ‘off country’ so far away to Brisbane could be concerning for a Guugu Yimithirr woman. What can health care staff do to advocate for Dora in hospital to ensure she feels culturally safe? (500 words) Collaborating for safe, quality care A new medication regime has been prescribed to better control Dora’s blood pressure to sustain her kidney function. Describe the culturally appropriate and safe collaborative care the health care team will need to provide to Dora, to maintain good health in Hope Vale. Identify how Dora can be supported by the Registered nurse to ensure equitable health outcomes. (350 words) NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx PART B FOR SUBMISSION TO NSG2201 CASE STUDY REPORT INSTRUCTIONS Please read the case study carefully, so you have the background information regarding Mae’s health and current medical condition. ? Please complete Questions 1, 2 & 3 of this part of the assessment by referring to the case scenario. ? Once complete, submit PART B of this case study report into the allocated ‘Written Assessment task 2” drop-box on the NSG2201 Brightspace page ? You have been allocated 1200 words +/- 10% for PART B (approximately 400 words for each question). Assessment Submission Instructions ? Please complete and submit a coversheet (located in the ‘Assessment’ section of Brightspace for NSG2201). Submit coversheet separately (to your Assignment) into the allocated ‘Written Assignment 1’ drop box, so that it is not included in your Similarity Index ? Your writing must be consistent with academic writing. Please do not use dot points, however subheadings for each question are allowed. ? Ensure you edit your work to avoid errors in syntax, grammar and/or spelling ? A minimum of 10 evidence-based peer-reviewed references must be used for this task. Home – Nursing – LibGuides at Holmesglen ? Please ensure you use APA 7th referencing style (utilise Library referencing resources if you are unsure). Home – APA 7th Referencing Guide – LibGuides at Holmesglen Additional information obtained on admission to hospital Dora is given a provisional diagnosis of Chronic Kidney Disease (CKD). On Examination (Arrival at Royal Brisbane Hospital) ? Dora is sitting in her chair and she appears ashen in colour and exhausted. ? RR – 20bpm ? HR – 95bpm (regular) ? BP – 165/105 ? Temp – 36.9 ? O2 Sats – 98% RA NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx PART B FOR SUBMISSION TO NSG2201 Investigations/Diagnostic tests Pathology ? FBE (shows normocytic, normochromic anaemia) ? UEC’s (K = 5.2, Mg =0.95 mmol/L; Urea and Creatinine are both significantly elevated) ? LFT’s (within normal parameters) ? BGL = 18mmol/L ? HbA1C = 9 Renal Biopsy results are abnormal, showing, glomerulosclerosis, tubular atrophy, and interstitial fibrosis. Estimated Glomerular Filtration rate (eGFR) = 23ml/min/1.73m2 Please respond to ALL of the following questions. Utilise relevant, peer-reviewed, evidence-based literature to support your responses QUESTIONS: 1. Pathophysiology of Diagnosis Describe the pathophysiology of CKD and discuss how Dora’s past history of Type 2 Diabetes (T2DM) and Hypertension, may have led to this current diagnosis of CKD? What do the results of the above investigations tell you about her current presentation and prognosis? 2. Focused Physical assessments and Medications. Please note that this question consists of two sections (Assessment & Medications) a) Assessment Identify TWO relevant focused systems assessments that you would perform on Dora and provide a rationale for your choices. Describe TWO abnormal findings you may note on performing these focused systems assessments (please include TWO abnormal findings per body system). b) Medications Dora has been prescribed two new Medications (Ramipril & Frusemide) by the Nephrologist. Discuss the action, indication and common side effects of each of these medications; and identify the nursing considerations involved in their administration. 3. Complications and Clinical deterioration NSG2201 Nursing 3. Nursing Care A Written Assessment 2 – Case Study Report Due: NSG2201: Sunday 16 th October 2000hrs, 2022 NSG2204: Sunday 23rd October 2000hrs, 2022 OFFICIAL Holmesglen: FC NSG 24-Aug-2021 U:\Higher Education\BACHELOR OF NURSING\Subject Folders\NSG2204\Assessments\Assess 3 Case study report\Case Study Report 2204 & 2201 2021_FINAL_ version.docx Identify and discuss TWO potential complications associated with Dora’s diagnosis. What are THREE clinical cues (signs and symptoms) that would indicate deterioration (clinical deterioration) in Dora’s condition.