NURS90053 Theoretical Assessment Online
NURS90053 Assessment Requirements: Theoretical Component
Assessment Task 1: 2000 word written assignment (Essay)
Due Date: Weighting: Submission:
Word Limit:
Assignment Outline:
Saturday 4th May 2019 by 1800 hours
20%
Online via Turnitin (A link is available on this subject’s LMS Blackboard under assessments).
An overall word limit of 2,000 words with an allowance of +/-10% excluding intext citations and the reference list.
Case study analysis
Medication safety has been identified as major area for improvement by the Australian Commission on Safety and Quality in Health Care. Adverse effects to medications contribute to 2-3% of all hospital admissions and are most likely to significantly affect vulnerable populations of our society including young children, those aged 65 and older and people with complex comorbidities and medications. This assessment is designed to develop knowledge, skills and behaviours essential to undertake a safe and appropriate health care education implementation plan for an aged client. Further, this assessment will introduce the student to educational principles including building capacity to formulate and implement a teaching lesson plan. Critical thinking and application of knowledge in a safe, contextual and appropriate manner is essential to ensuring the wellbeing and safety of the client in this case study.
Past history:
Seventy-eight-year-old Mrs Gamble left school when she was 16, having completed her leaving certificate. She worked as a receptionist until she married 57 years ago. While her children were at school she was involved in the “Parents and Friends” group which ran fundraising activities for her children’s schools. Later she was president for the group. John her eldest is married with three children and lives in Dandenong. Eighteen years ago, Mrs Gamble and her husband moved into a small two-bedroom unit in a retirement village in Moonee Ponds. They had found it difficult to maintain the garden and cleaning of the family home. At this time, Mrs Gamble was diagnosed with hypothyroidism which was successfully managed with daily Oroxine 75 micrograms.
Eight years ago, Mrs Gamble slipped on wet bathroom tiles, fracturing her right neck of femur. After a total hip replacement and rehabilitation, she returned home. The Gamble’s divided household duties – Mr Gamble did the shopping and gardening, Mrs Gamble did the washing, cleaning and cooking. Around this time, Mrs Gamble was fitted with reading glasses which allowed her to enjoy reading books about ancient history, crime novels and the National Geographic, while also enjoying watching television.
Six years ago, Mrs Gamble developed abdominal pain and distension with nausea and vomiting. She was admitted to hospital acutely unwell with bowel ischaemia and infarction resulting in septicaemia. This required a partial colectomy and temporary colostomy which was closed six months later. Six weeks after the initial colostomy, Mrs Gamble developed severe pain in her right hip. Investigation showed she had developed an methicillin resistant staphylococcus aureus (MRSA) infection in the hip replacement. The infected prosthesis was removed and a pseudoarthrosis formed.
NURS90053 Subject Guide 2019
Since this time, she has needed to have her right shoe built up and walks with one crutch. While Mrs Gamble was still able to do her cooking and washing, Mr Gamble took over the cleaning duties to assist her. To manage the pain associated with the pseudoarthrosis, Mrs Gamble was commenced on oxycodone. Her dose has increased over time and currently, she is on 20mg twice a day. Mrs Gamble has had numerous falls since the removal of the hip prosthesis most of which have resulted in minor bruising and an occasional graze or cut.
Two years ago, Mr Gamble died of a stroke. John suggested Mrs Gamble move into a nursing home, however she was determined to remain in the retirement village. John (after discussion with his mother) organised for the council’s Home Care Service to come twice a week to do cleaning and shopping. The Home Care Service also drives Mrs Gamble to medical appointments and to the local library to borrow large print books, so she can continue with her reading. Mrs Gamble tried a meals-on-wheels service, however, found the meals were not to her liking so she continues to cook for herself.
Current history:
Three months ago, Mrs Gamble had palpitations, dyspnoea, and chest pain. When monitored in the ambulance, she was found to be in atrial fibrillation. In the hospital, Mrs Gamble was given a loading dose of digoxin and is now on a maintenance dose of 62.5 micrograms daily. Mrs Gamble was also commenced on warfarin therapy. She has 1mg, 2mg, and 5 mg strength Coumadin tablets. The warfarin dose is determined by weekly INR. A local pathology nurse takes blood each Tuesday morning and the local doctor rings through warfarin dosage each Tuesday evening.
Mrs Lillian Gamble was admitted to the ward five days ago with pneumonia. She has responded well to antibiotics and physiotherapy. Her discharge is planned in three days. On admission, Mrs Gamble’s INR was 1.5 which concerned staff. Mrs Gamble has told staff that she has been taking the tablets as per the doctor’s instructions each week and writes down the dose in an exercise book, so she doesn’t forget. When provided with her three bottles of warfarin and asked to select a dose of 4mg, Mrs Gamble says she will select two 2mg tablets, however, takes out two 1 mg tablets. John, who is visiting, observes this. Later that night, John uses the search term “Warfarin therapy patient information” on Google to look for ways to assist his mother in choosing the correct strength warfarin. John finds numerous resources via the Google Search and is confused by the literature available. Among the search results, a web page from the Government of Western Australia, Department of health: https://www.healthywa.wa.gov.au/Articles/U_Z/Warfarin and a 4-page journal article from a reputable American journal, Cardiology patient pages http://go.unimelb.edu.au/5gyn were found. The nurse also discovers that Mrs Gamble only remembers that she was told not to eat green leafy salads and broccoli and states she has “no idea why I am still taking the warfarin”. Furthermore, she wants to know more about the drug and why she can’t eat her favourite foods.
Fiumara, K., & Goldhaber, S. Z. (2009). Cardiology patient pages. A patient’s guide to taking Coumadin/warfarin. Circulation, 119(8), e220-222. doi: 10.1161/circulationaha.108.803957
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Assignment Requirements.
You are required to develop a safe and appropriate health education plan for Mrs Gamble. Utilising readings from the literature undertake the following steps to enable you to create this teaching plan.
Based on the information provided in the scenario,
1) Identify Mrs Gamble’s (a) knowledge deficit and (b) the aids and barriers to her learning.
2) List your goals of the teaching process.
3) Formulate learning objectives for Mrs Gamble using a Specific, Measurable, Achievable, Realistic and Time bound (SMART) approach incorporating Bloom’s taxonomy of learning objectives.
4) Describe the teaching aids and your preparation of the environment
5) Breakdown the content you intend to include and the sequence of delivery.
6) Critically appraise at least two published patient information/educational materials on Warfarin therapy and discuss which information material would be most suitable for Mrs Gamble with rationale.
Important Note: It is envisaged that a final year MNSc student, can recognise the differences between appropriate and inappropriate advice that could be provided in any health education session and avoids any inappropriate health education. Providing dangerous or potentially lethal education/information in your recommendations will automatically result in a FAIL GRADE in this assessment.
Resources:
Zaidi, S. H., & Nasir, M. (2014). Teaching and learning methods in medicine. Cham : Springer. Retrieved from https://ezp.lib.unimelb.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat0000 6a&AN=melb.b5760323&site=eds-live&scope=site
Krathwohl, D. R., Anderson, L. W., & Bloom, B. S. (2001). A taxonomy for learning, teaching, and assessing : a revision of Bloom’s taxonomy of educational objectives. New York : Longman. Retrieved from https://ezp.lib.unimelb.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat0000 6a&AN=melb.b2834704&site=eds-live&scope=site
Submission:
Submission is online via the Turnitin portal link on this subject on the LMS Blackboard. The document needs to be formatted and referenced as per current APA guidelines. By submitting your assignment through the LMS you will be agreeing to comply with the University of Melbourne assessment policy and policy on academic honesty https://academichonesty.unimelb.edu.au/plagiarism.html
