Assignment

Rob Fran is a 57 year old male who has been admitted to hospital with acute kidney failure secondary to dehydration.

History                                          Assessment

Patient       –        Rob Fran, 56-year-old male from Adelaide currently working in Darwin

Presenting problem      –   Oliguria, nausea, lethargy and confusion

Presenting diagnosis     –   Volume responsive Acute Kidney Injury secondary to dehydration

Background      –  Mr Fran had been concreting outside when he became ill with an increasing headache followed by dizzy spells and nausea.  He self-administered Ibuprofen for symptoms with little effect. The following day he collapsed at work and an ambulance was called to take him to hospital.  His work colleagues stated he had been irritable and confused at times during the day preceding his collapse but felt it was related to    not coping with the Darwin heat and humidity.  He also had not been eating or drinking due to nausea and feeling unwell.

Mr Fran was treated with IV fluids in the emergency department and transferred to ICU for 48 hours to monitor his renal function.

He has now been transferred to a medical ward.

Phx      – Hypertension, Type II diabetes (diet controlled), mild osteoarthritis in back, knees and hands

Medications     •          Perindopril 2 mg mane

• Ibuprofen 400mg PRN (OTC, self-medicates)

Diet/fluid intake           –  Mainly diabetic, with occasional “treats”, drinks 5 – 8 cups of coffee daily and occasion fruit juice/diet soft drink if he is thirsty

Alcohol use      –   Social drinker, 2 to 3 beers, 2 to 3 times per week

Tobacco use     –    5 – 10 cigarettes per week, usually when drinking alcohol

Drug use            –    Prescription medications only

Home/personal relationship     –   Married with 2 adult children, all living in Adelaide. Wife is arriving in Darwin today after hearing of her husband’s hospitalisation.

Career/work     –  Self-employed concreter

Education   –     Completed year 10 prior to working in the family concreting business

Economic background   –  Owns his own house and business, but states if he doesn’t work he doesn’t get paid. Wife is not employed and does home duties.

Ethnic background        –   AustralRob born to Greek immigrant parents

Language spoken          –  First language Greek, but educated in Australia with good understanding of English as a second language

Religion/spirituality      –  Catholic, attends church at Easter and Christmas and special occasions with a strong belief in God.

ADLs    –   Independent.

IADLs   – Drives both car and truck. Independent with finances. Wife attends to cooking, all housework and bookkeeping for their business.

Sleep    –  States he sleeps well 5 – 7 hours per night

Health maintenance     –  Visits a GP in Adelaide every few months for diabetic and blood pressure review. He states he is very rarely ill.

 

After 2 days of oliguria Mr Fran urine output has increased and he has been transferred to a medical ward.

Below is the information you have been handed over as you commence your shift on the medical ward.

Vital signs

Temperature    – 36 degrees Celsius

Heart rate        – 95 beats per min

Respiratory rate           – 22 resps per min

Blood pressure   –  160/95mmHg

O2 saturations    –    94% on room air

Pain score        –  0-2 / 10

Urinalysis

Specific gravity  – 1.030

pH        – 5.5

Leukocytes       – Neg

Blood   – Neg

Nitrite  – Neg

Ketones            –  Neg

Bilirubin – Neg

Urobilinogen    – Neg

Protein –           ++

Glucose  – +

 

 

Physical assessment

CNS      •          Alert and orientated

• GCS 15/15
• Lethargic, fatigued, tired
• Sometimes slow to respond

CVS      •          Nil oedema noted

• Peripheries warm and well perfused
• Serum urea and creatinine levels slightly elevated
• Regular pulse rate and rhythm
•           No abnormalities detected on auscultation of heart

Respiratory      •          Shallow regular respirations

• Chest expansion symmetrical
• No abnormal breath sounds on auscultation

Skin      •          Skin intact

• Dry
• Slight pruritus to arms

Gastrointestinal            •          Loss of appetite and slight nausea

• Nil vomiting
• Regular bowel movements but slightly constipated
• Low potassium diabetic diet
• Protein restriction to 60g per day

Urinary             •          IDC insitu

• Output 40 – 80 mls per hour
•           Strict hourly monitoring of input and output
• Fluid restriction 1 litre per day
• eGFR 59 mL/min/1.73m2

Charted medications:

• Ramipril 5mg mane oral
• Frusemide 20mg bd oral
• Paracetamol 1g PRN oral
• Ibuprofen 400mg PRN oral

 

Based on the information above, address the following tasks.

Task 1. Nursing Assessments (500 words)

Mr Fran will require the following nursing assessments during your shift.

• Fluid assessment
• Cardiovascular assessment
• Urinalysis

Under each of the assessment sub headings below: –

• Identify the goal of the assessments
• Explain why they are important in relation to Mr Hayne’s renal function and
• Describe specifically how you will conductundertake?  these assessments.

 

Fluid assessment

Write answer here……..

 

 

Cardiovascular assessment (blood pressure and pulse)

Write answer here…….

 

 

 

Urinalysis

Write answer here…..

 

 

 

 

 

 

 

 

Task 2. Plan and Implement Nursing care (1000 words)

You identify alterations in fluid volume related to acute kidney injury as a priority nursing problem for Mr Fran today.

Your care plan includes imbalanced fluid intake as the specific nursing problem.

• Identify the nursing actions/interventions you would implement to manage this problem today.
• Explain why each of your interventions are appropriate for this nursing problem today.

 

Actions and explanations must be evidence based

Write answer here………..

 

 

 

 

Task 3. Patient education (500 words)

If managed appropriately Mr Hayne’s renal function should improve rapidly during the recovery phase and then continue to improve for up to a year.

During hospitalisation, Mr Fran will have multiple learning needs in regard to acute kidney injury and maintenance of renal function on discharge.

Explain

• Identify specific education Mr Fran will require regarding acute kidney injury
• Identify any management strategies you will include in the information you give Mr Franto   assist him to maintain and improve his renal function after discharge
• Why Mr Fran requires the information you are providing.

 

 

Write answer here……………

 

 

 

 

 

 

Reference

Lemone, P., Burke, M. K., Levett-Jones, T., Dwyer, T., Moxham, L.,Reid-Searl,… Raymond,D.(2014). Medical-Surgical nursing: critical thinking for person-centred care. (2 nd ed.).French Forest, NSW: Pearson Australia.

 

Marking Rubric

Task 1 – Assessing

Consistently provides a succinct description of the purpose/goal of all assessments.

Clearly demonstrates the relevance of the assessment.

Clearly demonstrates how assessments are relevant to renal function.

Explains clearly, succinctly and specifically how to conduct the relevant assessments.

Task 2 – Assessing

Demonstrates high level ability and critical thinking to develop individualised, comprehensive nursing care relevant to the case study and nursing problem.

More than 15 actions/interventions identified.

All interventions are within the scope of the registered nurse.

All rationales are referenced and demonstrate high level ability to explain or justify each nursing action.

Task 3 – Assessing

Demonstrates a high level ability to provide relevant and comprehensive patient education including use of medications.

Education provided is based on current evidence and referenced.

 

Academic Integrity – referencing

Demonstrates high level ability to acknowledge the work of others. All ideas supported with appropriate and accurate in-text citations and there is a complete and accurate reference list.

Minimal direct quotes (<3)

No errors detected in APA 6th format.  Academic integrity standards met at a high level.

Evidence for practice – Assessing

Minimum of 10 peer reviewed journals.

No more than 2 current text books cited.

Journal articles and textbooks (Must use – Lemone, P., Burke, M. K., Levett-Jones, T., Dwyer, T., Moxham, L.,Reid-Searl,… Raymond,D.(2014). Medical-Surgical nursing: critical thinking for person-centred care. (2 nd ed.) ) are no more than 5 years old.

No inappropriate resources in reference list.

Academic Writing – assessing

Meets written communication standards for nursing practice and academic literacy at a high level.

Content is well organised with a coherent flow.

Assignment is free from spelling and /or grammatical errors.

No lists, abbreviations, diagrams, acronyms and/or nursing jargon.

                                                              SAMPLE SOLUTION

One of the primary responsibilities of registered nurses in the hospital settings is the delivery of hands-on care to patients via the assessment of the patient’s conditions, planning, and implementation of care, and the provision of patient education. Additionally, according to LeMone et al. (2014), registered nurses are tasked with the management of intravenous lines and the observation and monitoring of patients’ conditions. In the case of Rob Fran, dehydration has resulted in acute kidney injury. Although he has been transferred to the medical ward because of increased urine output, a need arises for the registered nurse to measure and maintain fluid balance. This paper provides a discussion of the nursing assessments that a registered nurse can do on Fran, how nursing care can be planned and implemented and the nature of patient education which should be offered to the patient.

Nursing Assessment

Fluid Assessment

Fluid assessment on Mr. Fran will entail the evaluation of his hydration status and the measurement of fluid balance which will result in actions being taken to ensure optimal hydration. The fluid assessment will aim to measure the balance of the input and output of fluids in his body which will allow for the proper functioning the metabolic processes. Notably, one of the issues that Mr. Fran faced when he was being admitted in the hospital was acute kidney injury resulting from dehydration. As such, the fluid assessment will be vital in evaluating the fluid balance as the presence of inadequate fluid or excessive fluid can adversely affect the renal function and cardiac functions (Prowle, Kirwan, & Bellomo, 2014). In the case of Mr. Fran, I would conduct the fluid assessment via capillary refill time and renal output and input. In specific, I will hold Mr. Fran’s hand at heart level and press on the pad of his middle finger for five seconds. I will then release the pressure and measure the time in seconds until the return of the normal body color. In the renal output and input, I will assess the volume of water he takes against the urine including its color and odor.

Cardiovascular Assessment

A cardiovascular examination will be vital for Mr. Fran is ensuring a healthy heart. Although the cardiovascular examination did show any abnormal pulse rates and rhythms nor were there any abnormalities detected in heart auscultation, his hypertensive condition will require a regular review of the heart. The primary goal of cardiovascular assessment will be to measure the heart sounds (auscultation) and pulse rate. Notably, according to Ostermann and Joannidis (2016), chronic kidney disease is one of the markers of cardiovascular risks. As such, there is a probability that Mr. Fran’s heart health is affected. Assessing his cardiovascular will seek to establish whether it has been affected by acute kidney injury. The assessment will be done via listening to the heart sound with a stethoscope. Additionally, the basic heart sound auscultation will be performed in the chest rates of the aortic, pulmonic, tricuspid, and mitral (Jin et al., 2017). Afterward, I will conduct a patient interview for any pain the chest which could be a manifestation of ischemia.