Posted: September 4th, 2023

APN108 Applying Nursing Practice (B)

ASSESSMENT 1A: Response Template
Student Name
Student ID
Date
Course HLT54115 Diploma of Nursing
Subject Code and Title APN108 Applying Nursing Practice (B)
Unit(s) of Competency HLTENN012 Implement and monitor care for a person with chronic health problems
Performance criteria, Knowledge evidence and Performance assessed PC:
HLTENN012: 1.1,1.2 1.3, 1.4, 1.5, 2.1, 2.3, 2.4, 2.5.
PE:
HLTENN012: 1,2
KE:
HLTENN012: 1.5 a, b, c, d, e. 2.1, 2.2, 2.5, 2.6, 2.7, 3.3, 3.7, 3.13, 4.1, 4.2, 4.3, 4.4, 4.5
Title of Assessment Task Case Study and short-answer questions
Type of Assessment Task Section 1: Case study with short answer questions
Section 2: Short-answer questions
Length 11 questions. See each individual question for word limit.
Submission Due by 11:55pm AEST Sunday end of Week 5 (module 3.1).
Task Instructions
To complete Assessment 1, Part A, you must answer Section 1 and Section 2. Section 1 includes questions based on the case study below and developing a plan of care for the client, on the response template provided. Section 2 includes other questions required for the subject, but which are NOT related to the case study. All questions must be answered in full. When responding to the questions, please pay attention to the entire question being asked, as well as the prescribed word count, if provided. Use the correct medical terminology when answering all questions. Your answers should be reflective, analytical and based on critical assessments and the Enrolled nurse standards for practice and Codes of Ethics for Nursing.

You will be assessed on the responses to the questions and will be deemed as either satisfactory or not satisfactory. All of the responses must be marked as satisfactory in order to pass the assessment. If your assessment is not deemed satisfactory, you will be re-assessed as per the THINK Education Assessment Policy for Vocational Education and Training (VET), before being awarded a Non-Satisfactory mark for the assessment.

Case Scenario:
Mr George McFarlane is a 53-year-old Caucasian Male, admitted to hospital after seeing his General Practitioner (GP) for an infected left (L) toe, caused by a blister/ lesion, possibly from ill-fitting shoes. When he realised there was a lesion present, he initially did not consider it serious and did not seek medical treatment straight away. After a week, the smell disturbed him, and he sought advice from his GP who prescribed oral antibiotics and stressed the importance of cleansing and changing the dressing on his wound regularly. Due to Mr McFarlane’s job which required being on the road for long hours at a time, these regular dressing changes did not occur.

Subsequently, due to irregular dressing changes and Mr McFarlane’s Methicillin-resistant Staphylococcus Aureus (MRSA) status and Type II diabetes, the lesion failed to heal and became larger and deeper. Mr McFarlane returned to his GP five (5) weeks later. The GP immediately referred him to a specialist wound clinic. Investigations included a full blood count (FBC). The white blood cell (WBC) count was 17x 10⁹/L, predominantly neutrophils. The erythrocyte sedimentation rate (ESR) was 75mm/hr. An x-ray showed changes consistent with osteomyelitis.

Mr George McFarlane was admitted to hospital for surgical debridement of his wound. A large amount of tissue was excised from his left foot, which resulted in amputation of all 5 toes. The wound was packed and placed on a suction wound dressing (negative-pressure wound therapy), to minimise the exudate at the wound surface and promote healing by granulation. Post-operatively, initially he did well. However, on the seventh day after surgery he became febrile and his diabetic control deteriorated. His left foot had swollen above the bandaging. The dressing was removed, there was tissue engorgement and cellulitis surrounding the wound and evidence of necrosis (as shown in the photograph below).

Mr McFarlane has a Past Medical History (PMHx):
• Type ll Diabetes needing close management
• Osteoarthritis in L) Knee
• Peripheral Vascular Disease (PVD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Methicillin-resistant Staphylococcus Aureus (MRSA) positive
• Peripheral neuropathy

Social History (SHx):
• Second marriage
• Occupation- Long Haul truck driver
• ETOH (Alcohol) usage on a regular basis
• Smoker, averages 15/20 cigarettes per day
• Often consumes take away/ fast food diet as away from home regularly

Mr McFarlane’s current assessment consists of the following:
• BP 135/85
• RR 18
• SpO2 92% Room Air (RA)
• HR 89
• Temp 38.2oC
• BGL 13.8mmol,
• U/A (Glucose ++, ketones+, protein +, SG 1010, PH 5)
• Pain score 7 at rest
• GCS 15
• Water low score of 15 (High Risk)

Reference:
https://www.gettyimages.com.au/detail/news-photo/amputation-due-to-diabetes-news-photo/151032672?adppopup=true

Section 1
This section relates to Mr. McFarlane’s case study

TASK Assessment Criteria
Question 1 A. Discuss the pathophysiology of each of the chronic illnesses of Mr McFarlane:
a. Type 2 Diabetes Mellitus
b. Osteoarthritis
c. Peripheral Vascular Disease
d. Chronic Obstructive Pulmonary Disease
e. Peripheral Neuropathy
B. What are the signs and symptoms of each condition?
C. Discuss how these signs and symptoms impact on the patient’s different body systems and how this can affect his quality of life and independence.

References required
(word limit 300-500 words)
Response:

A. Chronic Condition B. Signs & Symptoms C. Pathophysiology and Quality of Life/Independence
a.
b.
c.
d.
e.

References:

TASK
Assessment Criteria
Question 2 Outline the possible implications of a chronic illness on a client’s lifestyle using the headings below:
A. Social
B. Emotional
C. Physical
D. Psychological
E. Financial
Include in your answer how might this also impact on their family and loved ones?

References required
(word limit 200 – 400 words)

Response:

Implications to Patient and/or family and loved ones
A. Social

B. Emotional

C. Physical

D. Psychological

E. Financial

References:

TASK Assessment Criteria
Question 3 1. Outline five (5) rehabilitation strategies, techniques and/ or equipment that can be used to assist and provide a greater level of independence to Mr. McFarlane. Briefly discuss how each of these would be of benefit to the client and their family and assist with their care. Consider both community and hospital-based services.
Include, in your answer, strategies that include access to physiotherapy, occupational therapy, massage, music therapy (as a non-pharmacological approach to pain relief), use of a wheelchair and walking aids.
Discuss what members of the Multidisciplinary Team could be involved in Mr. McFarlane’s care.
(Word limit: 300-500 words total)
2. Please also briefly outline the use of the following rehabilitation techniques (50 words maximum per technique)
a. Hydrotherapy
b. Pilates
c. Art therapy
d. Prosthetics

References required

Response:
Part 1:
Five Strategies:
Strategy / technique / equipment Benefit Multidisciplinary Team Member / s

Part 2:

Technique Technique Use
a) Hydrotherapy
b) Pilates
c) Art therapy
d) Prosthetics
References:

TASK Assessment Criteria
Question 4 Discuss what further education and preventative strategies would be required to reduce the risk of this scenario re-occurring to Mr. McFarlane. In your answer you should discuss members of the Multidisciplinary Team that you could engage with in order to access information for Mr McFarlane. Also discuss appropriate community referrals after discharge for Mr. McFarlane.

Discuss, in your answer, areas including the following:
a. prevention
b. use of various treatments
c. principles of and practices for person-focused nursing practice
d. maintenance of positive life roles
e. enabling change of a person’s behaviour over time to improve health outcomes
f. establishing readiness for attitudinal and behavioural change
References required
(word limit 200-400 words)
Response:

References:

TASK Assessment Criteria
Question 5 Mr McFarlane has a past medical history of
• Type ll Diabetes
• Osteoarthritis in L) Knee
• Peripheral Vascular Disease (PVD)
• Chronic Obstructive Pulmonary Disease (COPD)
• peripheral neuropathy
Using the template below, plan your care, within the Enrolled Nurse scope of practice for Mr. McFarlane.

Include the following in your response:
• Specify three (3) nursing diagnoses associated with the client’s current health presentations. (Ensure each diagnosis chosen relates to a different chronic condition of Mr McFarlane).
You might consider poor diet, poor lifestyle, decreased activity, smoker, psychosocial effect of recent diagnosis, understanding of potential complications associated with a condition.)
• Record at least two (2) nursing interventions that could be applied for each diagnosis.
• Specify at least one (1) member of the multidisciplinary team who may be able to support your suggested interventions.
• Clarify how your planned intervention reflects the client’s interests, physical, emotional and psychosocial needs
Note at least one (1) expected outcome that you would hope for as a result of each intervention.
Response:
Nursing diagnosis Planning – (Nursing intervention) Multidisciplinary team member to provide support Link to personal needs Expected Outcome
1.

2.

3.

Section 2.
The following questions are not related to Mr. McFarlane’s case study

TASK Assessment Criteria
Question 6 Describe the World Health Organisation’s (WHO) focus on chronic illness, and provide a description of one of the following Chronic disease models/ programs:
• The Chronic Care Model
• The Flinders Model (program)
• The Stanford Model
• The National chronic disease strategy
• The Chronic Care for Aboriginal people model of care
References required
(Word limit 200 words)

Response:

References:

TASK Assessment Criteria
Question 7 A. Identify the 10 National priorities for chronic disease in Australia.
B. Provide a diagram for the continuum of chronic disease and briefly explain the model.
References required
Response:
A.

B.

References:

TASK Assessment Criteria
Question 8 For the chronic disease or chronic health condition listed below, state three (3) clinical manifestations for each (Signs and symptoms)
• Chronic asthma
• Chronic pain including back pain
• Chronic renal failure
• Congestive heart failure
• Eczema
• Incontinence
• Neurological injury
• Long- term unconsciousness
• Parkinson’s disease
• Rheumatoid arthritis
• Stroke
• Systemic lupus erythematosus

References Required
(100 words for each)
Response:

Disease/Chronic Health Condition Clinical Manifestation
Chronic Asthma
Chronic pain including back pain
Chronic renal failure
Congestive heart failure
Eczema
Incontinence
Neurological injury
Long-term unconsciousness
Parkinson’s disease
Rheumatoid arthritis
Stroke
Systemic lupus erythematosus

References:

TASK Assessment Criteria
Question 9 Regarding palliative care, what would be the nurse’s goal to manage chronic disease within the palliative care environment?

References required
(word limit 150 words)
Response:

References:

TASK Assessment Criteria
Question 10 Discuss three (3) sites within the human body for common cancer development for individuals from Australians.

References required
Response:

References:

TASK Assessment Criteria
Question 11 Discuss the purpose of a tracheostomy and why a person may have one.

Define both permanent and temporary tracheostomy procedures and explain why each one may be required.

References required
(word limit 100-200 words)

Response:

References:
===
Sample Answer
Student Name:
Student ID:
Date:
Course: HLT54115 Diploma of Nursing
Subject Code and Title: APN108 Applying Nursing Practice (B)
Unit(s) of Competency: HLTENN012 Implement and monitor care for a person with chronic health problems

Section 1: Case Study with Short Answer Questions

Question 1.1 (100 words)
Identify and discuss two (2) priority nursing interventions required for Mr George McFarlane on admission to the surgical ward, with rationales to support your response.

Answer:

Two priority nursing interventions required for Mr George McFarlane on admission to the surgical ward are:

Assessment and management of pain: Mr McFarlane has a pain score of 7 at rest, which may worsen with movement or dressing changes. Therefore, assessment and management of pain should be a priority intervention. Pain management can include administering analgesics such as Paracetamol or Oxycodone and the use of non-pharmacological interventions such as heat therapy or relaxation techniques. This intervention is essential to promote patient comfort, reduce anxiety and enhance patient outcomes.

Assessment and management of infection: Mr McFarlane has a history of MRSA, which puts him at risk of developing an infection postoperatively. Hence, assessment and management of infection is a priority intervention. The nursing interventions to manage infection include observing the wound for signs of redness, swelling or exudate, monitoring temperature and white blood cell counts, administering antibiotics as prescribed, and following standard precautions such as hand hygiene, personal protective equipment and isolation precautions. These interventions are essential to prevent wound infection and its associated complications.

Question 1.2 (100 words)
Develop a plan of care for Mr George McFarlane on admission to the surgical ward, including three (3) nursing interventions, and provide rationales for each intervention.

Answer:

Plan of care for Mr George McFarlane on admission to the surgical ward:

Assessment and management of pain: Regular assessment of pain score and provision of analgesics as prescribed, e.g. Paracetamol or Oxycodone, and non-pharmacological interventions such as heat therapy or relaxation techniques. This intervention is essential to promote patient comfort, reduce anxiety, and enhance patient outcomes.

Prevention of infection: Observing the wound for signs of redness, swelling or exudate, monitoring temperature and white blood cell counts, administering antibiotics as prescribed, and following standard precautions such as hand hygiene, personal protective equipment, and isolation precautions. These interventions are essential to prevent wound infection and its associated complications.

Mobilization: Encouraging and assisting the patient to mobilize as appropriate, e.g. sitting out of bed, standing, and walking with support. This intervention is essential to prevent complications such as deep vein thrombosis, pneumonia, and pressure ulcers, and promote early recovery.

The above interventions will be reviewed regularly and modified as needed, based on the patient’s response and changing condition.

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