Assignment Two- Written Assessment

Important note for students:

Plagiarism – the presentation of work, ideas or data of others as one’s own, without appropriate acknowledgement and referencing. Plagiarism is a form of intellectual dishonesty and in academic work is considered to be cheating. CQUniversity regards plagiarism as a serious offence and it can have serious consequences for you as a student. To understand more about CQUniversity's attitude to plagiarism and the consequences it may have, refer to CQUniversity's Policies on Academic Misconduct Procedures and Student misconduct.

The following written assignment is based on a scenario of Mr Cyril Smith. The video of the scenario is available on the Moodle site and is called ‘Cyril Smith and you as a first year nursing student'. You cannot complete this assignment without referring to the video.

In preparation for the assignment you will need to download the following documents:

• Fluid balance chart,
• QADDS vital signs chart,
• Nursing progress notes.

These will be available in the assessment section on the Moodle site. You are then to read the assignment task set out below and watch the video. This assignment has a focus on patient assessment, fluid balance charts, vital signs, stoma assessment and professional communication.

Each of these are linked to the following National Safety and Quality Health Service Standards:

Standard 3: Preventing and Controlling hospital Acquired Infections

Standard 6: Clinical Handover

Standard 9 Recognising and responding to clinical deterioration in acute health care

Setting the scene for your assignment;

You are a first year nursing student on your first clinical placement. You are on the medical ward at CQUniversity Hospital. It is the morning shift and you have been assigned the responsibility of looking after Mr Cyril Smith (with the supervision of a registered nurse).

Who is Cyril?

The following are Cyril’s demographic details taken from his patient chart. This is important information that you will require when completing patient charts for your assignment.

· Patient’s full name: Cyril Smith

· Date of birth: 21/03/1930

· UR number: 306925

· Address: 23 Waterloo Street Waterloo Queensland.

· Hospital name/ ward: Ward D CQU

· Doctor: Dr William Dash

· Height 142cm Weight 89kg

It is 0700 hrs and you have just started your shift. Clinical handover has begun. You receive the following information at Cyril’s bedside from the nurse who is about to go off duty. The nurse refers to Cyril’s care plan in the process of delivering the information to you.

Situation: Mr Cyril Smith was admitted to the ward last evening with diarrhoea and vomiting. He has been unwell for the past 4 days.

Background: Mr Smith has a history of COPD, prostatic hypertrophy and bowel cancer. He currently has a colostomy located in the sigmoid section of the bowel. Mr Smith lives alone.

Assessment: His vital signs are a QADDS score of 0 (stable). Cyril is tolerating diet and fluids and has had one episode of vomiting last evening. A small amount approximately 30 mls. Cyril is coded as A1 with mobility hence will require assistance with mobilising, toileting, managing his stoma appliance and hygiene.

Recommendations:

Contact precautions are in place. Cyril is on a fluid balance chart and we are measuring all input and output including content from his colostomy bag. Cyril requires vital signs observations QID. The medical team will review Cyril this morning at 1000 hrs but notify Dr Dash if you have any concerns before they get here.

Your responsibilities in looking after Cyril whilst under the supervision of the registered nurse includes:

ü Attending to his hygiene and toileting/ stoma needs,

ü Assisting with meals,

ü Mobilising Cyril safely,

ü Monitoring his vital signs and

ü Maintaining his fluid balance chart.

What do you need to do next?

The first part of your assignment

Open your assignment with an introduction then move into the required tasks as per instructions (allow 200 words).

Please contact ALC if you need assistance to ‘construct’ this assignment.

Explain in the written part of your assignment the following:

· What clinical handover is

· The parts of information about the patient that should be included in the handover

· What your responsibility as a student nurse is in maintaining confidentiality in what you have heard about Cyril.

You should allow 550 words for this part.

Please ensure your information is evidenced with creditable references using the APA format.

The second part of this assignment

Prior to caring for Cyril, you are conscious that you need to maintain hand hygiene.

Complete the hand hygiene package. Please refer to on-line hand hygiene package available at www.hha.org.au/home/student-health-practitioners.aspx.

Once completed you will need to print off the certificate. You will need to submit this in Appendix 1 of your assignment.

The third part of this assignment

You are also aware based on the clinical handover that Cyril has a colostomy and contact precautions are required.

Briefly explain in the written part of your assignment the following:

· What is a colostomy?

· What does a healthy stoma look like?

· Describe the faeces you would expect to see from Cyril's colostomy.

· How will you apply contact precautions in managing Cyril’s colostomy?

You should allow 550 words for this.

Please back up your information with credible references.

The fourth part of the assignment

Your shift progresses. You attend to Cyril’s care. It is now 1130 hrs in the morning. You realize that you have not completed the fluid balance chart so you go to Cyril to ask about his intake and output. Additionally at 1135 hrs you empty his colostomy bag which has 200 mls of faecal drainage.

Download the fluid balance chart from the Moodle site and document all input and output from 0800 hrs until 1130 hrs according to what Cyril tells you in the video. Please also include the colostomy bag drainage.

This completed fluid balance chart will be Appendix 2 of your assignment.

The fifth part of the assignment

Continue watching the video. At 1155 hrs Cyril states to you “I am not feeling very well. I am feeling dizzy, nauseated and I have abdominal pain”.

Cyril appears pale and lethargic with trembling in his hands and has facial grimacing.

You then take Cyril’s vital signs. It is 1200 hrs and your findings are as follows:

• Respiration 14 bpm
• Pulse 110 bpm
• Blood pressure 100/60 mmHg
• Temperature 37.9 c
• Oxygen saturation 95%
• Oxygen flow rate 0- Mode; room air
• Conscious state – Alert
• Pain 6/10

Record the vital signs on the QADDS form as downloaded from the Moodle site. Include all points of identification on the chart. You are to add the score. You will need to submit this as Appendix 3.

In the written section of your assignment you then need to explain,

· What action should be taken based on the criteria of the score you calculated.

You should allow 150 words for this.

The sixth part of your assignment

The shift continues, based on the above scenario you have sought the assistance of the registered nurse who then stays with Cyril. The registered nurse asks you to contact the doctor about Cyril’s current situation. You are to apply ISBAR in communicating to the doctor.

It is 1230 hrs and you contact the doctor who advises that they will review Cyril within 30 minutes. Doctor reviewed Cyril at 1300 hrs and asked for: hourly observations, to remain resting in bed, continue on the fluid balance chart and for the registered nurse to administer analgesia as per orders on the medication chart.

In the written part of your assignment you are to include the communication you gave under the ISBAR framework.

You should allow 300 words for this.

The final part of your assignment

You are now required to enter what has occurred in the nursing progress notes. Enter the situation assuming the time is now 1400hrs and the date is Tuesday 03/05/2017. Your documentation can commence from the point of Cyril advising you that he was feeling unwell. All events unfolding from that point should be documented on the downloaded nursing progress notes adhering to the principles of professional documentation.

You will submit this as Appendix 4 with your assignment.

You should close your assignment with a conclusion (allow 250 words).

Summarising what you need to do:

1. View the scenario of ‘Cyril Smith and you as a first year nursing student' in the Moodle site.

2. Open your assignment with an introduction then move into the required tasks as per instructions. Use headings in your assignment.

3. Explain in the written part of your assignment the following:

o what clinical handover is

o the parts of information about the patient that should be included in the handover and

o what your responsibility as a student nurse is in maintaining confidentiality in what you have heard about Cyril.

4. Complete the hand hygiene package. Please refer to on-line hand hygiene package available at www.hha.org.au/home/student-health-practitioners.aspx.

5. Briefly explain in the written part of your assignment the following:

o what is a colostomy?

o what a healthy stoma should look like

o the type of faeces that you would expect to see from the type of colostomy Cyril has

o how you will apply contact precautions in managing Cyril’s colostomy.

6. Download the fluid balance chart from the Moodle site and document all input and output from 0800 hrs until 1130 hrs including emptying the colostomy bag.

7. Record the vital signs on the QADDS form as downloaded from the Moodle site. Include all points of identification on the chart. You are to add the score.

8. In the written section of your assignment you then need to explain what action should be taken based on the criteria of the score you calculated.

9. In the written part of your paper you are to include the communication you gave to the doctor under the ISBAR framework.

10. You are now required to enter what has occurred in the nursing progress notes.

11. Make sure you have a conclusion at the end of your paper.

12. Complete your APA reference list for this assignment.

13. Submit you assignment for a Turnitin report. (Allow 5-7 days for a reply, it may be quicker).

14. Review the Turnitin report and make changes where required, attach the marking rubric.

15. Submit your assignment and appendices for marking per the instructions in the Moodle site.