Assessment Two written assignment: Read the clinical scenario (download attached task sheet) and the answer the assessment questions in an essay format. · Due date: Friday 22nd April 2022 – 15:00 ACT...

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Assessment Two written assignment: Read the clinical scenario (download attached task sheet) and the answer the assessment questions in an essay format. · Due date: Friday 22nd April 2022 – 15:00 ACT time · Length: 2000 words +/- 10% (excluding reference list)   · Referencing: At least 5 high quality, current resources (published within the last 5 years), integrated using the APA 7th style · Relevance: High quality care is dependent on a holistic and integrative approach to patient assessment and care planning inclusive of aged related changes/requirements. Assessment two is designed to meet the learning outcomes: 1,3,4,5,6  Assessment Questions Part 1: Assessments (recommend 1500 words) Hospital policy requires Flo to receive the following assessments completed on admission to the ward. · Falls assessment · Functional assessment · Pressure injury risk assessment Students must: · Detail the goal or purpose of each assessment · Provide an example of a tool used in Australian hospitals including the frequency it should be completed · Explain how each assessment relates to Flo’s presentation · Explain how abnormal findings are managed by the nurse Part 2: Plan and implementation (recommend 500 words) The following four (4) factors have contributed to Flo’s current fall and health status: 1.  Normal age-related changes 2. Comorbidities 3. Acute illness 4. Medication Students must choose one (1) of the factors (above) and identify the health promotion or education you as the nurse would provide in preparation for discharge. This must include two (2) referrals to support services and your rationale for each referral. Please note: if a student details more than one factor, the marker will address and mark only the first factor outlined. Please download or print: NUR341 Assignment 2 Task.pdf Read the clinical scenario and the answer the assessment questions in an essay format. Clinical Scenario Ms Florence ‘Flo’ Ljukuta 70year old female admitted to hospital post fall with soft tissue injury to right hip still unable to ambulate. Flo can not recall the event and up to 2-3mins post fall. Parameter Assessment data Patient profile Florence ‘Flo’ Ljukuta 70-year-old female from Alice Springs Presenting complaint Pain to right hip unable to ambulate. No facture on x-ray History of complaint Tripped on the back steps leading into the house after hanging cloths on the line. Landed on the concrete pathway on her right side. Following the fall, Flo experienced pain on movement and unable to ambulate independently. Assisted to community health clinic and referred to hospital. Phx Hypertension, Type 2 diabetes, Angina, Hypercholesteremia, Asthma, Osteoarthritis. Complete hysterectomy 30years ago for treatment of endometrial cancer. Allergies Nil Known Allergies Medications · Aspirin 100mg mane · Perindopril 2mg mane · Metformin XR 2g mane · GTN 600mcg tablets S/L prn · Osteo paracetamol 1330mg TDS · Salbutamol inhaler 2-4 puffs PRN Ethnicity/language Aboriginal. Speaks Waramungu, Walpiri, Eastern and Western Arrentre, English Alcohol use Few wines or beers with family and friend 3-4 times per week Tobacco use Smoker ½ packet per day/ whole family smokes. Regular exposure to campfire and passive smoke Drug use Nil Home environment Currently lives in town camp in 3brd house with extended family. Approximately 13 family members staying at the house. Flo’s husband who requires assistance due to physical deficits from a stroke. Adult daughter and her 4 teenage boys Adult daughter and her 2 toddlers Adult son and his partner and their new baby Adult son Work environment Retired 10 years. Previously manager of community health clinic Stress Currently eldest daughter has been diagnosed with breast cancer Education VET level certificate Economic status Family land and house in remote community but staying in town to be with children and support needs for husband Religion/spirituality Baptised Catholic by missionaries when young ADLs Independent prior to fall IADLs Does not drive anymore due to decreased vision (diabetic retinopathy). Starting to develop cataracts. Had glasses a few years ago but they don’t help much now. Cognitive function No concerns identified Diet Diabetic diet when able Sleep 7-8 hours per night but currently broken sleep due to caring for others Health check ups Regular check ups every few months with diabetic doctors/clinics. Physical Assessment Parameter Assessment data Vital signs Temp: 36OC, HR: 100bpm regular, RR: 22bpm, SpO2: 94% RA, BP: 150/95, BGL: 7.8mmol/L, Pain: 7/10 CNS GCS 13 Pupils equal and reactive to light Lethargic, eyes open when spoken to, follows commands, orientated to place and person not time/date Unable to test muscle strength due to pain from injury CVS Both feet pale in colour No sacral or ankle oedema Feet bilateral cool skin temperature/ hands warm Peripheral pulses present, dorsalis weak bilaterally Capillary refill feet and hand >3seconds Resp Shallow and regular Palpation: no pain Chest expansion symmetrical Percussion: bilateral resonance in all areas Auscultation: mild wheeze on exhalation MSK Blue/red coloured haematoma to right hip extends to right buttock Swelling evident Skin intact Decreased range of movement Very tender on palpation Reluctant to walk or move due to pain GIT Loss of appetite and mild nausea over last few days No vomiting Regular bowel movements, constipation last 2 days Generalised distention Bowel sounds present Mild tenderness lower abdominal area Urinary · pain on passing urine · 3 days increased urinary frequency/urgency Passed cloudy, malodorous urine approx. 1hour prior to fall Assessment Questions Question 1: Assessments (recommend 1500words) Hospital policy requires Flo to receive the following assessments completed on admission to the ward. · Falls assessment · Functional assessment · Pressure injury risk assessment Students must: · Detail the goal or purpose of each assessment · Provide an example of a tool used in Australian hospitals including the frequency it should be completed · Explain how each assessment relates to Flo’s presentation · Explain how abnormal findings are managed by the nurse Question 2: Plan and implementation (recommend 500words) The following four (4) factors have contributed to Flo’s current fall and health status: 1. Normal age-related changes 2. Comorbidities 3. Acute illness 4. Medication Students must choose one (1) of the factors (above) and identify the health promotion or education you as the nurse would provide in preparation for discharge. This must include two (2) referrals to support services and your rationale for each referral. Please note: if a student details more than one factor, the marker will address and mark only the first factor outlined. Presentation guidelines · Complete the footer with last name_student number_NUR341_ Assessment 2 · Format your assessment with size 12 Arial/Calibri or similar font, 1.5 spacing · Complete spelling and grammar check using English (Australia) default · A minimum of 10 peer reviewed journals or texts no more than 5 years old · Use APA 7th referencing style · 2000word limit: recommend Part 1 (1500 words) and Part 2 (500 words). The end-of-text reference list is NOT included in the word count. · Save the final version of your paper using the filename of last name_student number_NUR341_ Assessment 2 and submit as a word document NUR341 Assessment 2 Marking Rubric.pdf Presentation guidelines · Complete the footer with last name_student number_NUR341_ Assessment 2 · Format your assessment with size 12 Arial/Calibri or similar font, 1.5 spacing · Complete spelling and grammar check using English(Australia) default · A minimum of 10 peer reviewed journals or texts no more than 5 years old · Use APA 7th referencing style · 2000 word limit: recommend Part 1 (1500 words) and Part 2 (500 words). The end-of-text reference list is NOT included in the word count. · Save the final version of your paper using the filename of last name_student number_NUR341_ Assessment 2 and submit as a word document
Answered 1 days AfterApr 18, 2022

Answer To: Assessment Two written assignment: Read the clinical scenario (download attached task sheet) and the...

Dr. Saloni answered on Apr 19 2022
102 Votes
2
A Case Study: Flo
Contents
Question 1: Assessments    3
Falls assessment    3
Goal    3
Tool    3
Relates to Flo’s presentation    3
Management of Abnormal Findings    4
Functional assessment    4
Goal    4
Tool    5
Relates to Flo’s presentation    5
Management of Abnormal Findings    6
Pressure injury risk assessment    6
Goal    6
Tool    6
Relates to Flo’s presentation    7
Management of Abnormal Findings    7
Question 2: Plan and implementation    8
References    10
Question 1: Assessments

Falls assessment

Goal
A fall risk assessment is utilised to understand wheth
er someone is at a moderate, high, or minimal risk of falling. When this assessment reveals that Flo is at serious risk, the health care personnel or caregiver may prescribe action to prevent the fall and reduce the adverse effects. Individuals who have fallen without hurting themselves ought to have their stride and equilibrium analyzed; those who have balance anomalies and gait deviations ought to be assessed extensively. A record of falling without injuries or locomotion or stability issues does not require further investigation than a fall risk assessment annually (Clark et al., 2020).

Tool
Fall risk assessment tool
FRAT (The fall risk assessment tool) can appropriately determine fall risk and also establish a credible foundation on which to build decisions concerning interventions that can minimise the risk of falls. Numerous directed intervention strategies depending on comprehensive risk assessment have culminated in substantial improvements in falls throughout interventional studies performed in care facilities. Similar outcomes have been identified in subacute clinical settings. This risk assessment is a four-item assessment tool developed for utilisation by nurses throughout residential as well as subacute clinical settings. It evaluates who is not vulnerable to falls and who is highly vulnerable, with a lower limit of error (Sun & Sosnoff, 2018).

Relates to Flo’s presentation
FRAT, in Flo's case, can lay the foundations for the array of fall risk-associated variables. The questionnaires correspond to having seen or validated risk variables or behavioural patterns of Flo, including age and chronic conditions that the admission nurse might define instantaneously upon admission. Flo's ongoing prescriptions and physiological risk variables need to be investigated in this instance. These work as medical indices for the predominance of fall risk and the fundamental variables that drive it, which can support the development of an action plan. All information ought to be reviewed by Flo's carer or a close relative (Wabe et al., 2022).

Management of Abnormal Findings
A new alternative for when patients are diagnosed with anomalous findings is a nursing practise strategy that encompasses prevention-focused therapy. A strategic plan incorporates professional judgement and experience while defining core interventions to assure Flo's safeguard from falls, comprising an individualised care plan depending on actual falls along with harm risk factors (Clark et al., 2020). These interventions often include acknowledging in the clinical notes as well as on Flo's doorway that the patient is at greater risk for falls, shifting her to another place close to the nurse's station to strengthen assertion, reviewing clients after novel episodes of illness or prescription modifications, curtailing bed height, as well as supplying side rails for the client who steps out of bed, or supplying fall prevention education to the patient and staff. As per research, utilising restraints on a routine basis does not minimise the incidence of falls (Wabe et al., 2022).
Furthermore, the usage of a trunk restraint is implicated in the occurrence of the fracture and fall in the patient. Delivery of support aids for ambulation as well as client relocation. Wheelchairs must be utilised as little as practicable as they may be employed as a means of restraint. Medications and training in the employment of adequate mechanical aids can serve to minimise the risk of falls, or even the related injuries and dearth of self-confidence (Clark et al., 2020).

Functional assessment

Goal
Functional assessment is an efficient method for systematically evaluating a client's functioning state, advancing through the therapeutic period, and validating a homebound stance. The functional assessment analysis is also utilised to rationalise undergoing physical therapy services. The aged client's evaluation needs to incorporate the functional assessment (Maddux et al., 2018). This analysis is often undertaken throughout history, and it may surface as an aspect of contemporary illness history. The analysis of activities of daily life delivers detailed details regarding the patient's competencies and the implications of the ailment. In essence, the functional assessment serves as a benchmark against which the implications of illness or interventions can be evaluated (Kimura, 2021).

Tool
The Functional Independence Measure
The non-diagnostic method, FIM, is utilised to assess malfunctioning in a range of populations. This approach is an instrument. Functional enhancements are an influential independent indicator for rehabilitative operations. The FIM tool is comprised of 18 objects that are assessed on a seven-pointe ordinal range, with the stronger the grade for an object, the more it signifies that the client can undertake the tasks indicated by that item autonomously (Kimura, 2021). The FIM is anticipated to take 30–45 minutes to...
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