Case Scenario
Mrs Fisher is a 63 year old woman who has presented at the Medical Practice with her partner, feeling generally unwell, presenting with symptoms of Lethargy due to lack of sleep, extreme thirst & Polyuria.
The partner is reporting that Mrs Fisher has at times been confused and forgotten what she was doing, requiring prompting.
Mrs Fisher has a past history of:
- Hypertension
- Type 2 Diabetes
- Hypothyroidism
- Obesity
- Smoker – 20 per day
Current Medications:
- Metformin 10mgs BD
- Simvastin 20mgs nocte
- Candesartan 10mg mane
- Thyroxine 150mg mane
Following review with the General Practitioner (GP) Mrs Fisher was found to have:
- An exacerbation of her diabetes, BGL registered as ‘High’
- Severe infection – Urinary Tract infection
The GP requested that Mrs Fisher attend the nurse clinic for 2 reasons:
- Ongoing assessment including the following:
- Regular BGL recording
- Diabetes education and follow up
- Doppler evaluation of peripheral pulses
- Mini Mental Exam
Case manage referrals to:
- Podiatry
- Ophthalmology
- Diabetes educator
- Dietitian
| AT1 question 1 Discuss the scope of practice of a Division 2 (enrolled nurse) in General Practice (100 words). |
| AT1 question 2 Identify the multidisciplinary team members who would be involved in Mrs Fisher’s ongoing care and how the referral mechanisms work in general practice (150 words). |
| AT1 question 3 Develop a plan of care for Mrs Fisher, identifying expected outcomes and timelines – Nursing Care Plan & Progress Notes, a nursing care plan template is attached to the Assessment document. |
| AT1 question 4 Identify chronic disease management strategies to be developed for Mrs Fisher (200 words). |
| AT1 question 5 The provision of nursing care is predominately evidence based practice. Provide a definition of evidence based practice and give 2 examples (100 words). |
| Assessment criteria 1 Identify an interdisciplinary health care team in a primary health care environment |
| Assessment criteria 2 Links co-morbidities and interventions to care and expected outcomes |
| Assessment criteria 3 Recognise impact of a health problem on a person in the primary health care environment |
| Criteria 4 Perform nursing interventions that support a person’s health care needs |
| Criteria 5 Suggests appropriate referrals & follow-up care |
| Criteria 6 APA6 referencing style used correctly as per the) |
| Criteria 7 Academic writing skills as per the (Criteria include planning, academic writing skills/expression, paraphrasing and formatting. |
ASSESSMENT
Questions
- Discuss the scope of practice of a Division 2 (enrolled nurse) in General Practice.
- Identify the multidisciplinary team members who would be involved in Mrs Fisher’s ongoing care and how the referral mechanisms work in general practice.
- Develop a plan of care for Mrs Fisher, identifying expected outcomes and timelines – Nursing Care Plan and Progress Notes.
NURSING CARE PLAN The Care plan is to be completed for each assessment of the client and filed in the client’s history. All information gathered remains confidential | |
Family Name: FISHER Given Name: JENNIFER 2 1 0 3 1 9 5 7 Date Of Birth: Sex: F OR Use Patient identity Label | |
| DATE: 07/05/2020 | |
| Diagnosis: Exacerbation of diabetes, BGL registered as ‘High’ Severe infection – Urinary Tract Infection | |
| Past History: Hypertension, T2DM, Hypothyroidism, Obesity, Smoker- 20 per day | |
| Advanced Care Plan: Yes ☒ No | |
| MEDICAL PLAN Discuss with patient / carer | |
| MONITORING Frequency of Vital signs (circle the frequency) Daily Weekly Monthly BLG frequency □ BLG Record Book (circle the frequency) daily morning night 4hrly before meals & night □ Glucometer | Pulse _____ Respiration ____ B/P_____ Temp _______ Weight ____________________________________________ BLG ________________________________________________ |
| MENTAL STATUS | ☒ Alert/orientated date time ☒ year ☒ Memory impairment ☒ Short term Long term Speech: Normal Rapid ☒ Slow monotone Aggressive ☒ Recall Yes ☒ No State 3 words and ask the client to memorise – do not give any hints |
| CIRCULATION | Pulses present ☒ Arm – Radius ☒ Leg – Dorsal Plexus Doppler findings: Peripheral pulse R Leg: _____________________________ Peripheral pulse L Leg: _____________________________ |
| DIET & HYDRATION | Diet __________________________________________ Dietician Referral Referral date: |
| SKIN INTEGRITY / HYGIENE | Skin Integrity: Skin intact Skin breaks present – refer to progress notes ADL’s: Independent Assist Dependent |
| ELIMINATION | Urinary Incontinent: Yes No Faecal Incontinent: Yes No Aids _______________________________________________ |
| FALLS / MOBILITY | Independent Dependent with Aid Aid: ______________________ Falls Risk Home assessment required Occupational Therapist Referral – Date ___________ |
| RISK FACTORS potential or actual | |
| REFERRALS | Physiotherapist Date:_______________ Dietitian Date:_______________ Social Worker Date:_______________ Occupational Therapist Date:_______________ Diabetic Educator Date:_______________ Podiatrist Date:_______________ Ophthalmologist Date:_______________ Speech Pathologist Date:_______________ Consultant Date:_______________ |
| Referral follow up notes: Follow up referrals and document findings/recommendations Further investigations Treatment options Referral to another specialist No. of further visits required | |
| EDUCATION REQUIREMENTS Client and/or Carer | |
| PROGRESS NOTES | |
| ACCOUNTABLE RN / EN SIGN | |
| SIGNATURE: |
- Identify chronic disease management strategies to be developed for Mrs Fisher.
- The provision of nursing care is predominantly evidence based practice. Provide a definition of evidence based practice and give 2 examples.
References
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