Developing Adult Nursing Practice: NURS 1593

Summative Assessment: Report of a case scenario 2000 words. 40% pass mark. Weight: 50%

Level 5: 30 Credits: Outcomes assessed 2 and 3 only.

2) Interpret and analyse information from the assessment process in order to develop person-centred
evidence-based care plans in partnership with others

3) Interpret and evaluate the effectiveness of Nursing care plans in order to make decisions on future care
and discharge

Bleeding should be monitored from the puncture site to assess patient recovery. If the patient
suffers from a violent coughing fit or vomits, immediately check for bleeding. Aim to immediately
apply pressure over the puncture site with gauze to achieve haemostasis; this will typically occur
within five to ten minutes. Then the patient’s pressure bandage should be reinforced and the
doctor should be notified.

Haematoma
The puncture site should be assessed for any swelling, redness, or pain. A haematoma can
suggest internal bleeding; therefore again manual compression should be applied to prevent
further bleeding. If the patient is being given any heparin infusions, they should be immediately
stopped. The patient’s signs of intravascular volume depletion should be assessed. If any signs
point towards insufficient cardiac output urgent medical help should be sought. Identification of
the bleeding source is essential for patients with continued hemodynamic deterioration. These
life-threatening bleeds are more frequent when the artery is punctured above the inguinal
ligament. Most patients are managed with a reversal of anticoagulation, application of manual
compression and volume resuscitation, and observation.

Arrhythmia

If the arrhythmia presents as something new for the patient, then a doctor should be notified.
The healthcare provider should also make sure to assess the patient’s cardiac output, however
even if the arrhythmia is already known yet cardiac output is insufficient, immediate medical
help should be sought. The patient should also be placed on continuous cardiac monitoring once
stable.

Pseudoaneurysm

Pseudoaneurysm Is a potential cause of important femoral bleeding and must be recognized. A

Small pseudoaneurysms of less than 2 to 3 cm in size may heal spontaneously and can be
followed by serial Doppler examinations. Large symptomatic pseudoaneurysms can be treated
by either ultrasound-guided compression of the neck of pseudoaneurysm or percutaneous
injection of the thrombin using ultrasound guidance or may need surgical intervention.
Allergic reactions

Allergic reactions can be related to the use of local anesthetic, contrast agents, heparin, or other
medications used during the procedure. Reactions to the contrast agents can occur in up to 1%
of the patients, and people with prior reactions are pretreated with corticosteroids and
antihistamines. The use of iso-osmolar agents decreases the risk compared to high osmolar
agents. When severe reactions occur, they are treated similarly to anaphylaxis with intravenous
(IV) epinephrine.

Patients should be kept lying flat for several hours after the procedure so that any serious
bleeding can be avoided and the artery can heal. It is advised that diagnostic catheterisation
patients are kept on bed rest for four hours,

The patient is free to move from side to side for their comfort. The head of the bed should be at
a maximum thirty-degree tilt. The patient should be allowed to eat and drink right after the
procedure if they wish to.

After the specified period of bed rest has been completed, patients may get out of bed.
The nurse will assist patients the first time they get up and will check blood pressure while lying
in bed, sitting, and standing. Patients should move slowly when getting up from the bed to avoid
any dizziness from the long period of bed rest.

Patients may be given pain medication for pain or discomfort related to the insertion site or
having to lie flat and still for a prolonged period.

Patients will be encouraged to drink water and other fluids to help flush the contrast dye from
the body. They may resume their usual diet after the procedure unless the doctor decides
otherwise.

Title: Report outlining the assessment and care planning required for the physical and mental
health of Adult patients

Students must:

1) Choose a patient case study from practice (the patient can be from a ward,
community, theatre, prisons etc..) and briefly explain their journey so far.
2) Identify the care pathway the patient is being cared under e.g., Acute
appendicitis
3) Discuss the nursing assessment process used to develop person centred care
plans for your chosen patient. Consider the patients physical and mental health.
4) Choose one care plan/element of care for your patient to evaluate. This could be
assistance with eating and drinking for example.
 5) Discuss the person-centred care delivered for this one element including
reference to the appropriate risk assessments e.g., MUST
6) Discuss which member/s of the MDT the patient was referred to for the chosen
care plan e.g., dietician
7) Interpret and evaluate the overall effectiveness of the nursing care given to the
patient for the chosen element only.
8) Discuss the discharge planning process in relation to the chosen element of care.

The student should remember:

 These are guidance notes and should be read in conjunction with the assessment
specification found in your module handbook and assessment lecture slides.

 For this module you will need to ensure you clearly cover all learning outcomes.
Remember to be critical in your writing at level 5. Seek support from the academic
skills / Studiocity as necessary.

 Do not breach confidentiality of your Trust or the patient.

 Make sure your arguments are underpinned by relevant and contemporary

 Do not copy the example text in this guidance, all work will be assessed for
plagiarism.

SUGGESTED LAYOUT

Introduction: Be clear and concise, briefly state what you are going to cover in your essay.

 This should include what the patient was admitted with. Briefly state the facts and
figures relating to the prevalence of the patient’s condition (i.e., how many people in
the UK and World experience this condition).
 Make sure you refer to both learning outcomes. Also make sure you state that the
patients name, and personal details have been changed in line with NMC
confidentiality guidelines.

Case Study: Introduce your chosen patient, including the description of patient’s biographic
data, explain how and why they presented to the hospital/community (remember your
chosen patient must have a medical or surgical condition and a reason for admission to
hospital/unit/prison/community nursing team).

Specify the following information (you should be able to derive this information from the
patient’s medical and nursing admission notes):
  What was the patient journey? Were they referred by their GP, via A+E, via
outpatients or another route? Did they come by ambulance or public transport?
 What was the patient’s presenting complaint and associated symptoms? Briefly
explain the pathophysiology of the patient’s presenting complaint/disease and how
this relates to the symptoms your patient is experiencing.
 Why do they need admission, what is the definitive diagnosis and medical plan of
care?
 What is the patient’s admission care pathway? E.g., ACS Pathway
 Who was involved in their admission process? Who were they admitted under? E.g.,
surgeon. What type of ward were they admitted to? Was this the correct clinical
area?

Main Discussion: State which nursing assessment tool was used to assess the patient on
admission, the most likely one you will see is Roper, Logan, and Tierney (2000)

 From the nursing assessment pick one element of care (activity of daily living) for
example eating and drinking that the patient required assistance with and a care
plan on admission and provide a rationale for this choice.

 critically analyse the element of care, discussing how it was delivered in accordance
to local policy/frameworks/procedures and guidelines, e.g. as the patient was
admitted and kept nil by mouth then you could determine that eating and drinking
was the most important element of care that needed to be immediately managed.
Make sure that you focus on the nursing rather than medical management as this
must be relevant to your sphere of practice.

 Consider the key evidence that supports the care you have provided in line with
research evidence/literature, as well as national and European guidance. Also
consider aspects of the NHS Constitution, Compassion in Practice (i.e., the 6Cs) and
the NMC Code.

 Your critical discussion should also consider the role of other members of the
Multidisciplinary Team involved in the patients care in regard to your chosen
element. Also discuss the implementation of national and local policy/guidance with
reference to contemporary literature. For example, if you chose eating and drinking
you may wish to discuss the importance of determining a MUST score and referring
the patient to the dietician to ensure their nutritional needs were managed
appropriately. Make sure you use contemporary references to support your
arguments and discussion.

 Apply insight into the discharge planning process in relation to both elements of care
you have identified (if relevant) whilst minimising harm and promoting health at all
times (e.g., NHS constitution, the 6Cs, etc.).
Conclusion: This needs to be a summary of your findings in relation to the nursing care
given to your chosen patient for the one element of care you have identified. There should
be nothing new here and no new references.