Students will assess, prioritise and plan the care of the case study patient using the CRC. The information will be presented within a PowerPoint presentation using the provided template on LEO (NRSG265 Assessment 1 Template Slides), which you will then record as a video.
Instructions on how to record your video for submission are available on the LEO assessment tile.
Appropriate evidence-based literature must be used to support your presentation.
The key components of Assessment 1 are:
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Step 1 and 2: Consider the patient situation and identify the key elements of assessment by:
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Providing an initial impression of the patient and identifying relevant and significant features;
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discussing in detail, the pathophysiology of the disease and how Mr Kowalski’s signs and symptoms reflect the underlying pathophysiology;
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Identifying the key elements of a comprehensive nursing assessment;
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Including evidence to support your discussion.
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Step 3 and 4: Process patient information, identifies relevant activities of
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living impacted, and identifies nursing issues for the patient:
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Interpret and analyse the information you have been given about his condition;
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Identify and prioritise 3 nursing issues you must address for Mr Kowalski, and justify why they are priorities and support your discussion with evidence;
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Discuss the potential impact of the disease on Mr Kowalski’s 3 most important activities of living. Link your discussion to the Roper-Logan and Tierney model.
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Steps 5 and 6: Establish goals and take action:
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Identify 3 SMART goals (1 per nursing issue identified) with comprehensive discussion of the desired outcome, within a suitable time frame;
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Identify interventions to achieve the above goals. The interventions should be nursing based;
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consider both pharmacological and non-pharmacological management;
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recognise strategies to empower and educate Mr Kowalski.
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Steps 7 and 8 - Evaluation and Reflection:
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Consider what strategies/aspects would determine that the interventions have been successful or effective for Mr Kowalski?
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Include your conclusion here, and part of that should include an overall statement of what have you learned from doing this case study (what has been learnt, what went well, and what could have been improved)
Case Study:
Mr Jan Kowalski is a 54 years-old male who presented to the emergency
department (ED) due to crushing chest pain (pain score 8/10) that was
associated with nausea, dyspnoea and diaphoresis. He stated that the pain
came on suddenly this morning while he was watching TV at home, and
resolved spontaneously after 30 minutes, but started again 2 hours later and had
gotten worse since. Mr Kowalski stated that he had never experienced chest
pain like this before and delayed coming into hospital as he thought the pain
would subside again. His wife brought him in as he was looking pale, and the
pain was moving to his jaw and left arm.
Mr Kowalski has a past medical history of hypertension (diagnosed in 2014)
which is managed with Perindopril, and he has been advised by his GP to
reduce his salt intake and lose weight to help reduce his blood pressure.
The ED registrar has requested an ECG, continuous cardiac monitoring, blood
tests (total cholesterol, cardiac troponin, FBC and UEC), and has ordered a
STAT dose of aspirin 300mg, and sublingual glyceryl trinitrate (GTN) 300-
600mcg every 5 minutes for a maximum of 3 doses.
Patient history:
Mr Kowalski migrated from Poland over 40 years ago with his family, and he currently lives with his wife and son (age 18) in the regional city of Ballarat in Victoria. He works full time as a civil engineer and is currently working overtime most weeks, averaging 50-60 hours/week. He states that “work has been incredibly busy” and that he “needs to look after multiple work sites due to ongoing staff sick leave”.
He usually smokes 1 pack of cigarettes per week, but recently this has increased to 2 packs per week. Due to his and his wife’s long working hours, the family eat takeout most days and he states he has gained “some weight” over the past few months.
FAMILY HISTORY:
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Father passed away in 2015 due to an acute myocardial infarction (AMI).
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Mother had breast cancer in 2020 and is in remission currently. She lives in Poland with her sister.
Current medications:
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Perindopril 4mg daily
Initial vital observations:
Initial vital observations:
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BP 138/95 mmHg
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HR 106 bpm
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RR 22 bpm
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SpO2 95% on RA
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T 37.2ºC
Health assessment findings and laboratory results:
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Height 1.67m, Weight 89kg, excess abdominal fat evident. Waist circumference 101cm
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Alert and orientated to time, place, and person. GCS 15
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Cool, dry hands and feet. Moist mucous membranes
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CRT 2 seconds
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Total cholesterol level - 8.0mmol/L
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Cardiac troponin – elevated
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FBC and UEC – results NAD
Following the review of his laboratory tests and assessment results, Mr Kowalski has been diagnosed with a NSTEMI. He is to have serial cardiac troponin done 4-8 hourly, repeat ECG with changes to pain level or cessation of chest pain, and continuous cardiac monitoring. Apply supplemental oxygen if SpO2 < 93%.="" administer="" gtn="" for="" chest="" pain,="" and="" consider="" iv="" morphine="" if="" pain="" not="" controlled="" with="" gtn="" (please="" consult="" with="" medical="" staff="" prior="" to="" administration).="" he="" also="" needs="" to="" be="" prepared="" for="" an="" angiogram="" +/-="" pci="" this="">
You are the nurse looking after Mr Kowalski, and you are required to plan his care using the CRC and the provided case study information.