Nursing Care Plan, Communication and Cultural Competency.

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This is a 3 part paper. They do not need to be linked together.
Part 1 is a nursing care plan (1500 words) in an essay format.
Part 2 (2000 words) is a separate case study that need to be in an essay format
and answer each question with headings. Below are some of the things the writer needs to address (these are not the actual questions but a guide as to what the content requires):
-Skills in being able to communicate in appropriate language the pathophysiology behind presenting symptoms to patients and their family;
-Demonstrate knowledge of the significance of pathology results and vital signs for a given disease;
-Demonstrate an appreciation of the purposes of selected medications and;
-Indicate an understanding of the common side effects and potential drug interactions involving these medications.
Part 3 (2000 words) can be done in an essay format. Each Part can be dedicated a minimum of 10 references.
The order needs to use AUSTRALIAN based statistics.This is an Australian based paper so information about demographics/statistics from other countries hold little to no merit.
– REFERENCING.
Information provided on how to structure and style the referencing for this order:
Referencing: Author-Date (Harvard) found at:
http://uow.libguides.com/refcite/uowharvard
Be minded that this order requires absolute, strict adherence to the referencing format/style dictated by : http://uow.libguides.com/refcite/uowharvard
When including sources, navigate through the URL in relation to the type of source. Every comma, full stop, italicised entry, inverted commas, capital and small letters matters in these paper.
– No references older than 10 years (2007) from the date of order.
– All references need to be readily accessible, i.e I should be able to cross reference entire journals, its pages (not abstracts).
– Support every statement with a reference. Every sentence, unless already expressly linked to a reference must be supported with an in-text reference and a corresponding reference in the reference list.
– ALL Intext references must have the page numbers/range. ALL reference in the reference list needs to show this also.
– For JOURNALS: Capitalise all first letters of the main words in the Journal Title (not ‘and’ ‘of’ ‘in’ etc.), The title of the article is in quotes, The title of the journal is in italics. The volume number and Issue number need to be typed as “vol. 1” and “No. 1” respectively.
– All online sources need to follow the proper referencing format shown in the URL above. (Especially when including dates and URL links. See “Referencing: Online sources” at http://uow.libguides.com/refcite/uowharvard-web for more information).
– No jargons or advanced medical jargon to be used unless it is followed by a layman explanation.
– Avoid the use of “should” such as “the nurse should”. Avoid the use of “he/she”, refer to “the patient” or the patient’s name.
PART ONE: Care plan for person with history of an upper gastrointestinal bleed.
This is a nursing care plan report. No tables are to be used. This part has 2 scenarios, the first one is a back story about the patient and the “Immediate Scenario” is what this part is actually based on. (The first one is purely for additional information).
SCENARIO (Back story):
Mr Barker is a 48-year-oldmale with a history of a myocardial infarction (STEMI) 4 months ago. He was discharged home on the following medications: aspirin 100mg daily, prasugrel 10mg daily, Atorvastatin 40mg daily, Metoprolol 50mg bd. He is an ex-smoker, before his MI he smoked 15 cigarettes per day, he admits to drinking 3 units of alcohol (red wine) every night.
For the past two weeks Mr Barker has complained of vagueepigastric pain,he has felt nauseated and complained of indigestion which was worse at night and burning in nature.
During the night Mr Barker complains of lower abdominal pain and an urgency to move his bowels, early in the morninghis partner notices he has been missing from the bed for some time. When she checks the bathroom she finds Mr Barker slumped on the toilet. He was cool, pale and sweaty but rousable. There was faecal matter in the toilet mixed with a large volume of frank blood.
Mr Barker is brought to the ED by paramedics, on arrival his vital signs are:
BP 67/36
Heart rate 110bpm
Temp 35.1
SpO2 89% on room air
Respiratory rate of 29 breaths per minute.
GCS 14 – Eyes open to voice.
The paramedics have commenced IV fluids and the medical team urgently assesses Mr Barker, fluid resuscitation is commenced and Mr Barker is taken for an urgent endoscopy. During the endoscopy Mr Barker is found to have two actively bleeding peptic ulcers, these are injected with adrenaline and the bleeding has now ceased. Mr Barker was also found to have helicobacter pylori present in his ulcers.
IMMEDIATE SCENARIO:
Mr. Barker’s condition has been stabilised, he has returned from the Endoscopy unit to the ward under your care. He has been ordered a unit of packed cells to be started as soon as possible;followed by a litre of 0.9% Sodium Chloride over 8 hours. His current vital signs are:
BP 110/65
HR 95
T. 37.2
SpO2 98% with nasal prongs at 2L/minute
Resp. rate 22
GCS 15
Using a report format,(using headings and subheadings) discuss what needs to be included in a person centred nursing care plan, (client needs/problems, goals, implementation and evaluation), for the first 48hours of Mr. Barker’s stay on the ward, giving rationales for your decisions. Incorporate the information you have from assessment task 1 about Mr. Barker’s medical and social history and the risk factors for peptic ulcer into your discussion.
At least 3 problems must be discussed. For example:
Vital Signs
Diet
Fluids
There are other problems that can be taken into account considering his social and medical history outlined above and in the first scenario (backstory).
The writer does not have to discuss ALL the actual and potential problems, rather consider mentioning them and then discussing 3 in depth.
THIS PART CAN HAVE A MAXIMUM OF 1500 words.
PART TWO:
Ms Elise Wattle, 23 years old who has a history of asthma, presents to the Emergency Department (ED) with her friend Claire who drove her as she was experiencing an asthma attack. They were at the local bar and her friend has noticed that at first she could talk in sentences but now Elise can only use short phrases. Elise is complaining of chest tightness and has an audible wheeze. She is dyspnoeic and is coughing despite being in the high-Fowler’s position. Her vital signs in the ED are:
Blood pressure: 150/90 mm Hg
Pulse: 126 bpm
Respirations: 30 and shallow
Temperature: 37.3 C
Pulse oximeter reading : 92%
She is commenced salbutamol 5 mg in normal saline (NaCl) every 20 minutes via the nebuliser and IV therapy 5% dextrose is commenced at 100 ml/hour. An arterial blood gas (ABG) is done and her results are pH 7.49, pO2 74 mmHg, pCO2 22 mmHg, HCO3- 22mEq. Sputum and blood tests reveal elevated levels of eosinophils and elevated IgE. Oxygen via nasal prongs at 2 L/minute is commenced. Elise continues to complain of chest tightness so a stat dose of 500 mcg ipratropium bromide is administered via the nebuliser, 5ml of 50% magnesium sulphate solution in 100 ml of NaCL is commenced over 20 minutes, and then 100mg of IV hydrocortisone is commenced every 6 hours.
The patient progresses to status asthmaticus. Adrenaline 2mg/in 100 ml 5% dextrose is commenced through a central line at 5ml/hr, resulting in temporary relief of the symptoms. Ms Wattle is transferred to the Intensive Care Unit (ICU) in a stable condition. Oxygen is delivered via a venturi mask at 28%.
Her laboratory results in ICU are:
Serum glucose: 5.0 mmol/L
Blood urea nitrogen: 6.2 mmol/L
Serum creatinine: 68 micromol/L
Serum sodium: 136 mEq/L
Serum potassium: 4.5 mEq/L
WBC count 8,000/mm3
RBC count 4,400,000/mm3
Platelet count: 300,000/mm3
Haemoglobin: 132 g/L
Haematocrit: 34.7%
Pulse oximeter reading: 85%
Current arterial blood gas: pH 7.32, pO2 55 mm Hg, pCO2 60 mm Hg, HCO3- 27 mEq
FEV1/FVC: 65%
QUESTIONS TO BE ANSWERED WITH HEADINGS:
1. Use appropriate language to explain to her friend Claire what is happening that is causing Elise’s symptoms.
2. What is the significance of Elise’s vital signs, and pathology results in the Emergency Department?
3. What is the significance of Elise’s pathology results in the Intensive Care Unit?
4. What are the purposes of her prescribed medications?
5. What are the most common side effects of her prescribed medications, and what are the potential drug-drug, and drug-food/herbal interactions of her prescribed medications?
This sections needs to be able to show:
-Skills in being able to communicate in appropriate language the pathophysiology behind presenting symptoms to patients and their family;
-Demonstrate knowledge of the significance of pathology results and vital signs for a given disease;
-Demonstrate an appreciation of the purposes of selected medications and;
-Indicate an understanding of the common side effects and potential drug interactions involving these medications.
(2000 words for this section).
PART 3: Nursing Cultural Competency
“Achieving cultural competence in health care is everybody’s responsibility”.
(National Health and Medical Research Council (NHMRC) 2006, p. 3).
Identify your own cultural values and privileges (regardless of your culture,
race ethnicity) – the writer can use his or her own here.
– A reflection of your own cultural values and privileges including an explanation
of why self-reflection is essential prior to approaching diverse clients. Again the writer can use his or her own here.
– Application of a strengths-based approach to culturally competent care
including rationale, that demonstrates respect for diversity and celebrates
difference (can be integrated into the following discussion)
-Consideration of cultural needs when delivering culturally competent care to a:
A Lesbian, Gay, Bisexual, Transgender or Intersex (LGBTI) 18 yr. old
teenager, who has recently moved to the area, is single and lives alone and is preparing to undergo a general
health assessment. (the person is waiting to undergo the assessment, do not
complete the actual general health assessment):
The writer must refer to but not be restricted by the National Health and Medical Research
Council 2006, Cultural competency in health: A guide for policy, partnerships and
participation document accessed via the following link:
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/hp19.pdf
This section needs to have dedicated a total of 2000 words.
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