NUR246 Community Nursing Care 2 - Assignment Help

Case Study One

MANAGING THE CARE OF A CLIENT IN A RURAL LOCATION

(Thiscasestudyisworth40marks)

Case Study:

Jen is a Rural Area Nurse (RAN) working at a rurally based health service in the Kimberley area. She is called on Saturday evening to go and visit a farmer out of town. James Bird is 60 years old and lives on

a large 5000 ha property with his wife Sue, who is a teacher. Jen first visited James two days ago after he was referred to the community nursing team from the acute medical ward in the hospital for treatment of cellulitis in his lower left leg following a superficial laceration which he sustained after falling from his quad bike while checking cattle.

This was James's first experience of being in hospital. He was anxious being away from his farm and preoccupied with the risk of fire to his property due to the 'dry spell'. James had insisted on returning home and the doctors agreed to transfer him to the community nurses as he was well supported at home by his family. With this in place, he returned home on oral antibiotics and required a daily wound dressing to his leg. Sue calls Jen, worried that James in unwell and worried that he has developed a fever again and states there is a smell coming from the wound. The visit to James and Sue's property involves a 45km drive on an unsealed road taking an hour due to poor road conditions.

Jen arrives at the house at 9.30p.m. to find James in bed. He has not eaten since breakfast and appears dehydrated. He is shivering and has a temperature of 39.5C. James also appears to be in a low mood stating: "I'm useless. I can't even get to the toilet let alone take care of the farm". He is also experiencing significant leg pain. On discussing James's return home, Jen learns that Sue is working full-time as a teacher which is taking her away from the farm for long periods of time. This leaves James alone during the day. James and Sue have three sons who live and work on neighbouring properties with the closest being 30 km away. The farmhouse, built on stilts, is very old and has six steps up to the entrance. The toilet is also external to the house about 50 m away.

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Please use literature to support ALL of your answers (in and end-text APA referencing is required).

Question One (10 marks)

As a Rural Area Nurse visiting James, discuss four priority concerns regarding James's health and well being. Support your discussion with evidence from the literature.

Question Two (10 marks)

Considering the role of RAN, discuss two possible safety concerns for the nurse visiting James and detail two strategies for risk assessment and management. Refer to the literature to support your answers.

Question Three (10 marks)

You are working with Jen and she asks you to complete a Psychosocial assessment for James. Discuss the data this assessment gathers and give four example questions that you would ask James. Support your discussion with evidence from the literature.

Question Four (10 marks)

Discuss four cultural and language considerations when providing care to any client in their own home and how these could affect your ability to provide effective ongoing care as a RAN. Support your discussion with evidence from the literature and provide a link to any cultural considerations for James.

References

Please list in APA format all references used. Please note the indents used in APA are not transferable to PebblePad and it is therefore acceptable to not have an indent.

Case Study Two

MANAGING THE CARE OF A TYPE 2 DIABETIC PATIENT

(Thiscasestudyisworth50marks)

Nellie Evans is a seventy-four year old woman that has just been referred to the Community Nurse by the GP for management of a diabetic foot ulcer. Review the referral from the GP and answer the questions below using literature to support ALL of your answers (in and end-text APA referencing is required).

Referral:

Dear Community Nursing Team

Thank you for accepting the referral for Nellie Evans 12/05/1943 to receive wound care to right diabetic foot ulcer and management of unstable diabetes. As per our phone conversation this afternoon, please find attached health summary.

Please do not hesitate to contact with any further questions. I will review Nellie again in one month at the surgery.

Kind regards Dr P Boulton

Patient health summary:

Name: Nellie Evans Address: 65 Derby Road DOB: 12/05/1943 Phone: 089333444

Allergies/Adverse reactions: Penicillin allergy, adverse reaction to micropore tape and most adhesive dressings.

Current Meds: Insulin - Humalog 75/25, 33 units before breakfast and 23 units before supper; Pioglitazone (Actos), 30 mg daily; furosemide (Lasix), 80 mg every morning; diltiazem (Cardizem CD), 180 mg daily (per cardiologist consult); lanoxin (Digoxin), 0.25 mg daily (per cardiologist consult)

Active past Hx: Type 2 diabetic, hypertension, hyperlipidemia, coronary artery disease. Inactive past Hx: Left knee replacement

Observations:

Height: 153cm Weight: 136kg

Waist circumference: 98cm Pulse: 88bpm

BP: 138/88

HbA1C: 8%

Lower leg assessment: pedal pulses weak bilaterally, poor sensation (monofilament test), cap refill >3 secs

Question One (10 marks)

Consider your client’s medical history. Using your own words, explain in detail the underlying pathophysiological concerns for this client? Please use literature to support your answer.

Question Two (10 marks)

Calculate Nellie’s Body Mass Index (BMI) and summarise the education you would provide to Nellie about her BMI result and waist circumference measurement, including the associated health risk factors. Provide references to at least two resources you would use in your education to Nellie and why you have chosen these particular resources for Nellie.

Question Three (10 marks)

Using language and terminology that Nellie can understand, explain to Nellie what the HbA1C test is and how this differs from BGL readings. Then explain to Nellie what her result of 8% means in relation to her diabetes control and suggest three ways of improving this. Please use literature to support your answer.

Question Four (10 marks)

Nellie tells you she is unsure which of her medications are for her diabetes. From the health summary above, identify the medication used for management of diabetes and    explain to Nellie the mode/mechanism of action and any side effects and contraindications that she should be aware of. Please use literature to support your answer.

Question Five (10 marks)

Community Nurses often provide care to older adults who have peripheral vascular disease (PVD), discuss the pathophysiology, risk factors and symptoms involved in this condition and then provide a definition in your own words to explain the difference between Peripheral Arterial Disease (PAD) and Peripheral Vascular Disease (PVD) to your patient. Please use literature to support your answer.

References

Please list in APA format all references used. Please note the indents used in APA are not transferable to PebblePad and it is therefore acceptable to not have an indent.