Topic: acute care nursing essay

10 Summative Assignment Guidelines

For this assignment you are required to produce a 4000word essay on acute nursing care. The essay will be based on a given patient handover scenario, which you will choose from a selection of three,fictional,acutely ill patients representing your field of nursing (See appendix b).

Within this assignment you willdemonstrate that you understand the patient’s current condition, canidentify and prioritise risks, suggest how to focus a reassessment and subsequentlyprovide safenursing care for the duration of the shift (8 hours).

Your work needs to demonstrate safe practice by the following:

  • Interpretingthe given information, providing reasons for your arguments.
  • Identifyingand prioritisingthe problems and risks to the patient within the next 8 hours. You must give reasons for your arguments.
  • Predicting how ABCDE assessment would be used for the chosen patient.
  • Critically discussing the nursing care required to address the risks,during the immediate episode of care (8 hours).
  • Applying relevant literature to support your interpretation, arguments and discussion. This should include some reference to the disease pathophysiology

Essay structure:

Introduction (Approx 400 words)

Here you should include the overall purpose of the assignment, indicate the chosen scenario, giving a very brief outline of it, and provide rationale for the choice. You should then clearly highlight the planned structure and organisation of the assignment content and broadly what will be addressed. This should reflect the key areas identified in the assignment guidelines.Do not include a confidentiality clause, but do say that the patient is fictional.

Main body (Approx 3,200 words)

This should flow logically and developmentally to reflect the normal flow of events. It should be clearly linked to the fictional patient’s situation and sections should link to each other.

  • The initial section should clearly interpret all sections of the given handover information. This means explaining which factors in the background information have contributed to the current situation, and why this presents an acute situation. It is important to compare assessment findings to normal ranges and explain how abnormal signs link to the overall condition.
  • The second section should identify, discuss and prioritisethe presenting risks to the patient.
  • The third section should predict how an ABCDE assessment would be used to detect any anticipated changes for the chosen patient.  This should reflect the risks identified in the previous section.
  • The final section of the essay should focus on ensuring you fictional patient’s safety for the next 8 hours, by responding to the risks you identified. The aims of planned interventions should be explained using associated pathophysiology. Consideration must be given to the ethos of the Welsh Assembly Governments’ (2003) Fundamentals of Care.

Conclusion

The conclusion should briefly and succinctly summarise the salient points drawn from the assignment. This should clarify what has been learnt from this assignment. At this point you should avoid introducing any new ideas not already discussed in the main body of the work.(Approx 400 words).

Recommended subheadings and word distribution

Introduction  400 words
Main body3200 words 
 Interpretation of handover 1000words
 Discussion of risks   500 words
 Focus of reassessment   850 words
 Recommended response   850words
Conclusion 400 words

Handover scenario 1: Stroke

Situation

It is 2pm and you are working a late shift on the acute medical ward. You have been asked to care for Mrs Amita Singh who is 40 years old and was admitted to the ward at 9am today. She has reduced consciousness and has been diagnosed as having suffered a left lobar haemorrhagic stroke.

Background

Amita was brought to the Emergency Department by ambulance at 6.30am today after having been found collapsed at home. 

Amita lives in a large Victorian house with her civil engineer husband, Sandeep and their family.  They have two daughters: Surinder aged 16, Snatam aged 12 and a son, Dara who is 6 years old. Amita’s mother-in-law who also lives with them, helps with the household chores and with looking after the children. Amita works as a teacher at the local primary school where Dara also goes to school. She has had very little time for herself since her youngest child was born. This is more so since returning to full time work and since her husband’s promotion has meant that he now works away from home for periods of time on a regular basis. She spends a lot of time taking the children to and from school, for additional lessons and various sporting activities.  She drives to work to save time and has been putting weight on steadily over the past three years.  She now weighs 76 Kilograms and is 5 feet four inches tall. 

Amita has been seemingly fit and well until about six months ago, when she began to experience frequent headaches.  Her General Practitioner found her to have high blood pressure and wanted to commence her on medication to control it, but Amita declined, stating that she does not like to take tablets and she would try to rest more.  She felt the high blood pressure was probably related to the recent OFSTED inspection at school, coupled with Surinder doing her GCSE’s and her husband working away more often. Since then she has been monitored by the practice nurse, but she has missed her last few appointments as she has been too busy.

This morning when she got up at 6am her headache was really bad. She took 1gram of paracetamol and went to have her morning shower. Sandeep heard a bang and, on investigation, he found her collapsed on the bathroom floor and she had vomited.  He tried to rouse her, but found that whilst she was looking at him, she was only able to make groaning sounds and seemed unable to move.

 On admission to Accident and Emergency, following medical and nursing assessments and urgent Computerised Tomography Scan, it was concluded that Amita had suffered a left lobar haemorrhagic stroke.  The plan was to monitor her for the next 48 hours to maintain stability of her condition and with a view to assessing her suitability for rehabilitation at a later date.

Assessment

 Your colleague made the following nursing assessment of Amita immediately prior to handover

Airway –

  • Amita had an oxygen mask in situ.
  • She looked a little pale
  • Her chest was rising with no indrawing of her chest and no tracheal tug.
  • Breath sounds could be heard with no stridor, wheezing or rasping
  • There were slight gurgling sounds 
  • On lifting the oxygen mask, breaths could be felt on the back of the hand

Breathing –

  • She looked pale
  • There was bilateral chest expansion, but no signs of accessory muscle involvement
  • She was breathing through her mouth
  • Breaths were shallow and irregular with occasional deep sighs
  • Respiratory rate was 22 breaths per minute
  • Oxygen saturations were 96% on 28% oxygen via face mask
  • Only normal breath sounds could be heard
  • Chest movement could be felt over both apices

Circulation –

  • She looked pale but not cyanosed
  • Central Capillary Refill Time (CRT) was 2 seconds
  • Manual blood pressure was 180/90mmHg
  • Skin was warm to touch
  • Radial pulse was 102 beats per minute, regular with good volume
  • There was a urethral catheter in situ and Amita had passed 1800 millilitres of very pale urine  

Disability –

  • Amita responded to voice
  • Further assessment using the Glasgow Coma Score revealed a GSC of 10/15 (E3, V2, M5)
  • Pupils were unequal in size and reaction to light stimulus.It was difficult to see as Amita has brown eyes.
  •  L= 6mm and sluggish. R= 4mm and brisk
  • There was a deficit in limb movements, with the best motor response noted on the left and no movement noted on the right.
  • Blood glucose was normal.
  • Amita winced when disturbed, but did not respond when asked if she had any pain.

Exposure –

  • Temperature was 37.1° C tympanic
  • Amita had a bruise emerging on her left shoulder
  • She had an intravenous cannula in her left hand.
  • Her abdomen was round and soft with clear bowel sounds heard.
  • Her urethral catheter was draining well

Response

On approaching Amita, you notice her husband is sitting next to her bed. There is an oropharyngeal airway on the locker. Amita is in supine position with the head of the bed elevated by approximately 30 degrees. 

In line with the essay guidelines, assimilate all the information given above, prioritising risks and discuss the nursing responsibilities for further assessment.

Providing rationale, identify how you would formulate your response to this clinical situation for the remainder of your shift.

Type of service-Academic paper writing
Type of assignment-Essay
Subject-Nursing
Pages / words-11 / 3000
Number of sources-0
Academic level-Undergraduate
Paper format-APA
Line spacing-Double
Language style-UK English

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