Identify two (2) health care professionals within the multidisciplinary team who need to be consulted in regards to Heather’s care.

Case Study 1 – Mr. Frank Hardy
Mr. Frank Hardy has been in hospital for three (3) days. He was admitted because of high blood pressure (hypertension) and a possible stroke (cerebrovascular accident). After further investigations during his admission, it has been identified that Mr. Hardy has had a cerebrovascular accident affecting his left side.
Mr. Hardy has a significant medical history:
• Current smoker, with a fifty year history of smoking 30 cigarettes daily
• Weight 135kg
• Height 180cm
• Hypertension
• Type II Diabetes, 30 year history
Social History:
• Mr Hardy is a widow and lives alone
• Mr Hardy is 68 years old
• Mr Hardy has no children or current support systems
• Mr Hardy has no current services in his home (such as home help, meals on wheels)
Mr. Hardy is currently reluctant (unenthusiastic) to mobilise and has declined hygiene cares since admission three (3) days ago. When you review Mr Hardy’s care plan you note that the following cares need to be completed:
• Hygiene cares
• Assist with mobility
• Observations

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In relation to the above scenario, please answer the following seven (7) questions regarding Mr. Hardy’s care both in and out of the hospital and your role as the Enrolled Nurse (EN) providing care for Mr. Hardy.

1.1 Mr. Hardy has ‘hypertension’ which means high blood pressure. List the parameters for blood pressure ‘in normal range’ and the range/s for hypertension. (50 w0rds) (1 mark)

https://heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf

1.2 You have performed vital signs on Mr. Hardy. Mr. Hardy has a respiratory rate of 26. This is a significantly high respiratory rate.

Answer the following questions:

a) What reporting structure would you need to follow in order to ensure that this information is relayed appropriately? (50 words) (1 mark)

b) Identify your scope of practice in this situation. List your role responsibility in comparison to a Registered Nurse (RN) role. (1 mark)(50 words)

1.3 Explain and discuss the following three (3) health care professionals’ scope of practice/role in the care and management of Mr. Hardy. (60 words each) (3 marks)

• Diabetic Educator
• Physiotherapist
• General Practitioner

1.4 Mr. Hardy has a significant medical and social history. List four (4) factors that could have contributed to his cerebrovascular accident (stroke). In your answer ensure that you provide each factor with a brief explanation of how/why it could impact on Mr. Hardy’s condition. (200 words)
(2 marks)

1.5 The term pathophysiology explains the processes within the body which result in the signs and symptoms of a disease/s. The ‘relationship’ is the causative factor/s that work together in our bodies. Mr. Hardy has a history of hypertension and has now suffered a cerebrovascular accident. Complete the following prompters to describe the relationship between these conditions, their pathophysiology, and the role that hypertension has possibly played in the development of the stroke. (3 marks each = 15 marks)

-Within the cardio vascular system, high blood pressure (hypertension) can damage blood vessels by(60 words)

-This damage to the blood vessel walls may cause: (60words)

-Untreated high blood pressure can: (60words)

-When a stroke, caused by cerebral haemorrhage within the central nervous system (the brain) occurs, effects depend on(60words)

-And it can affect which functions of the patient(60words)

1.6 A functional deficit is a sign or a symptom of illness in a body system or as a whole. Mr. Hardy has several functional deficits. In at least 50 words, summarise two (2) deficits Mr. Hardy has that necessitate nursing care. (1 mark)

1.7 Mr. Hardy is your client for this shift. Mr Hardy’s care plan highlights the nursing interventions that need to be implemented on your shift. Outline two (2) nursing interventions that you need to provide Mr. Hardy and discuss possible barriers to performing these. (100 w0rds) (1 mark)

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Case study 2 –
Mrs. Heather Bishop
Mrs Heather Bishop is a fifty-nine (59) year old mother of five (5) children; she has been admitted to your ward after her husband expressed concerns for her health. She presented with the following symptoms:

• Tiredness – even after rest and especially after a meal
• Occasional blurred vision
• Increased thirst
• Frequent urination

On entering her room you introduce yourself and ask if, before you admit her, she would like the hot lunch that has just arrived. Heather tells you that she has gained a lot of weight over the past 2-3 years and worries that it is the weight gain that is making her so tired all the time. Her weight has begun to impact upon her mobility levels as well. She declines the lunch, stating that she isn’t hungry and just wants to rest.

You have been instructed by the shift coordinator to takes Heather’s admission observations and perform a ward test urinalysis and a blood glucose level (BGL) blood test. Heather informs you she had her BGL tested two (2) years ago and it was elevated then, but she had not returned to her GP for a follow up.

You perform the observations including the blood and urine tests and find the following results:
T – 37.1 (oral)
HR – 72bpm
RR – 18
BP – 175/95
BGL = 17.2mmol/L
Ward test urine results:
Large amount of glucose
Positive for protein ++++

If the observations parameters (range) given for adults in the Health Assessment and Physical Examination text (Estes et al, 2016) are as below, identify and list Heather’s abnormal observations. (50 words0 (1 mark)

T: 36.0 – 38.0 degrees celsius per orally
HR: 60 – 100bpm
RR: 12 – 20bpm
BP: 120/80mmHg
Blood glucose Level (BGL) normal range 4-8mmol/L
Ward urinalysis: a normal urine specimen would be negative for glucose and protein.

2.2 In relation to Mrs Bishop’s admission observations, identify the reporting line you would follow to notify of her abnormal results. (50 words)

2.3 Given Mrs Bishop’s recent weight gain, her two (2) year reported history of high blood glucose levels, her symptoms on admission and her observations, what do you consider to be her condition? (1 mark) (50 words)

2.4 Discuss the inter-relationship between Mrs Bishop’s two (2) year history of hyperglycaemia (elevated blood glucose) and the impact that would have on the following body systems(50 words each) (5 marks)

Body System Prolonged hyperglycaemia

Cardiac system

Cardio vascular system
– Hypertension

Nervous system

Urinary system

Sensory systems, the eye

2.5 Identify and briefly explain the role of three (3) health professionals who would be involved in Mrs Bishop’s care. (100 words or less) (3 marks)

2.6 List two (2) contributing factors that may have impacted upon the development of Heather’s condition – Type ll Diabetes (100 words or less) (2 marks)

2.7 The term pathophysiology explains the processes within the body that result in the signs and symptoms of a disease. In relation to Heather, what caused her elevated blood glucose levels and what occurred as a result? Why does she have blurred vision, increased thirst, increased urination, glucose in the urine and tiredness? (200 words or less)
(5 marks)

2.8 Summarise two (2) main functional deficits (signs and symptoms of illness) in Heather’s body systems necessitating nursing care and or monitoring (50 words or less). (2 marks)

2.9 Within your scope of practice as an EN/Division 2, outline two (2) appropriate nursing interventions that would be indicated in this scenario (20 words or less). (1 mark)

2.10 Identify two (2) health care professionals within the multidisciplinary team who need to be consulted in regards to Heather’s care. Summarise the roles they play and include how their roles differ to the EN role (150 words or less). (4 marks)

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