Fundamentals Clinical Makeup Assignment

Summer 2021

Student Name:

Assessment

1. Make a list of variables that may impair a nurse’s ability to gather data that are complete, accurate, factual, and relevant.

2. In a brief report, describe the purpose of the four types of nursing assessments (initial assessment, focused assessment, emergency assessment, time-lapsed assessment), and give an example of a case in which each would be conducted.

Diagnosing

3. Explain the following statement: The etiology of the problem directs the nursing intervention.

4. Case Study: A 16-year-old girl delivers her baby at home in her bedroom. Her parents find her and bring her and her baby to the emergency department. The baby is premature and in respiratory distress, and the mother has uncontrolled bleeding. The mother blames the situation on her daughter’s boyfriend, a fellow classmate, who denies any responsibility for the baby.

Make a list of one of the following areas:

(a) patient strengths:

(b) patient problem areas:

(c) potential patient problems:

Outcome Identification and Planning

5. Read the following situation and respond in writing to the accompanying questions:

A client is a 49-year-old homemaker seen in the emergency department to rule out fractures. She states that she lost her balance and fell down her basement stairs. Her husband is constantly at her side, and she appears fearful. You recall previous admissions for lacerations, bruises, and a fracture.

· How would you develop and prioritize the patient’s nursing diagnoses?

· What would be appropriate long- and short-term goals for the priority nursing diagnosis?

· What would be appropriate nursing orders for the priority nursing diagnosis?

Implementing

6. Using the Internet (must be a credible source- include citation and reference list), research a new nursing strategy or practice that has proven effective and write a paragraph about how you could incorporate this into your own nursing practice.

Evaluating

7. Describe how you use your weekly clinical experiences to develop self-awareness of your clinical strengths and weaknesses. What would be your plan for self-improvement? Then, discuss the value of reflection and self-awareness.

8. Discuss the following statement and its implications: We owe it to our patients to be the best nurses we can be.

Case Studies, Urinary Elimination

1. You are a hospital nurse caring for a 62-year-old accountant who was admitted following a motor vehicle accident. During her hospitalization, a significant lack of urination was detected. Her primary care physician has ordered significant testing while the patient is recovering from her injuries.

a. What circumstances could be causing her infrequent urination?

b. How can infrequent urination negatively impact a patient’s health?

c. Outline how urination may be affected by the effects of aging.

d. Describe the effects of decreased bladder and sphincter tone on urination.

e. What can cause decreased urinary structure muscle tone?

2. You are a urologic nurse whose patient has voiced concern over his kidneys losing their function within the past few weeks. He has maintained a log of the past week, recording his urination and fluid intake. He has a history of diabetes mellitus and hypertension, which are treated with medication.

a. In your patient interview, how would you define renal failure for your patient?

b. Which diseases could be included as possible etiologies for renal failure?

c. What data should be included in a complete urinary system assessment?

d. How might an accurate urinary output measurement be obtained?

e. What is important to remember when collecting a 24-hour urine specimen?

Case Studies, Bowel Elimination

3. You are a visiting nurse checking in on your patient, a 93-year-old retired steelworker who lives alone with his two cats. You visit him on a weekly basis to monitor his blood glucose levels and refill his insulin syringes for his self-medicating throughout the week, as he is visually impaired. During your interview, he indicates that he has been experiencing irregularity and is quite anxious over developing a bowel obstruction.

f. How would you assess his bowel elimination patterns?

g. Describe foods that impact bowel elimination either positively or negatively.

h. What activities could you recommend to maintain adequate bowel function?

i. Outline how fiber and fluid intake facilitate bowel elimination.

j. Which mechanical function of the bowel causes constipation?

4. You are a nurse in a medical-surgical hospital unit caring for a patient who had an open cholecystectomy 3 days earlier. Subsequently, the patient developed a paralytic ileus. Additional complications require continued postoperative antibiotic infusions.

a. What nursing assessment finding could indicate the presence of a paralytic ileus?

b. Which medical interventions could have contributed to the development of your patient’s paralytic ileus?

c. How long would you expect the paralytic ileus to last?

d. In what ways would you expect a paralytic ileus to resolve?

e. List possible nursing diagnoses for this patient related to the surgical procedure and postoperative complications.

Case Study: Death and dying- Read and review Chapter 43- (Loss, Grief, & Dying).

Simulation Scenario: Patient is wheezing, Sats drop to 89%, skin is mottled, patient is full code. You will need to apply oxygen and titrate the amount of oxygen up from nasal cannula, to simple face mask, to non-rebreather mask. You will then give an S.B.A.R. report to the provider. You will administer a nebulizer treatment. While the nebulizer is going, your patient’s family has a care conference with palliative care providers and they decide to back off on aggressive cares and move to a comfort care approach. You will need to use what you learned in Chapter 43- Loss, Grief, and dying along with other resources to alter your plan of care for your patient once the family and patient have decided to switch to comfort care.

Review the signs of impending death. Review the likely goals a person will have when changing from acute care to hospice/comfort care or palliative care according to Maslow’s Hierarchy of Needs.

What is the difference between hospice and palliative care? ___________________________________________________________ ______________________________________________________________________________________________________________________

What happens physiologically in each major body system when a person dies? _____________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the rights of a dying person?

____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

“It is well within the scope of your professional practice as a competent nurse to provide counseling and death education, especially when the patient asks for it and indicates an unmet need for such information” (Taylor, Lillis & Lynn, 2015, p. 1618).

When should you call in family and notify them of impending death?

What is involved in post-mortem care?

Caring for the body- _______________________________________________________________________________________________________________________________________________________________________________________________

Caring for the family- _____________________________________________________________________________________________________________________________________________________