Question One

Identifies anti-emetic medication prescribed during management of nausea and vomiting

Implements patient health assessment relevant to the case history

Applies the correct infection control policy during care of Mr Barber:eg standard, contact, droplet and/or airborne precautions.

Question Two

Documents patient identity information on the top of the ECG using the information in the case study

Notes the relevant patient signs and symptoms at the time of recording

Question Three

Accurately documents in the progress notes using SBAR format.

Question Four

Phrases questions appropriately to evaluate Mrs Barberssafety. Taking into consideration empathy, cultural or spiritual elements.

Question Five

Outlines requirements for patient consent prior to divulging personal information.

Demonstrates understanding of privacy policy

Gives an example of information that is appropriate to provide to the neighbour during the telephone call.

Question Six

Identifies type of consent required during the care of Mr Barber (eg implied, verbal, written)

Identifies abnormal vital signs prior to transfer to X-Ray

Interprets vital signs and evaluates requirements for transfer to X-Ray including:

o A list of vital signs that should be reviewed prior to departure

o Identifies appropriate escort based on acuity and manual handling

Implements safe manual handling techniques

Demonstrates knowledge of scope of practice.

Question Seven

Dons correct PPE during care of Mr Barber

Applies the DRABCD process to the case scenario

Describes the relationship between patient assessment and evaluation of blood loss 

Question Eight

Discusses pathophysiology of emphysema and relates this to the actions of seretide

Identifies the correct type of seretide inhaler

Uses patient education techniques to instruct Mr Barber on the correct use of his Seretide inhaler

Question Nine

Discusses the actions of at least three medications prescribed for osteoarthritis

Question Ten

Structures questions to evaluate the impact of osteoarthritis on activities of daily living.

Question Eleven

Describes nursing responsibilities after identifying the presence of the wound on Mr Barber's lower leg.

Question Twelve

Identifies medicolegal process to apply when Mr Barber refuses consent

Demonstrates knowledge of scope of practice.

Interacts with the health care team to provide optimal multidisciplinary treatment.

Question Thirteen

Identifies the role of various members of the health care team

Interacts with the health care team to provide optimal multidisciplinary treatment.

Case Study

You are working as an Enrolled Nurse in the Emergency Department (ED) when 82 year old Mr Barber (of Greek heritage - and Greek Orthodox religion) is brought in by ambulance at 8pm on the 6/3/2013. Handover from the paramedics is as follows:

• 6 hour history haematemasis and epigastric pain
• Vomited x 4 bright blood
• Mr Barber called the ambulance because he felt dizzy, sat down on the floor and was unable to get up
• Ambulance noted approx 150ml haematemasis in a bucket on arrival

Past History:
• Diverticulitis
• Emphysema
• Ischaemic heart disease
• Osteoarthritis
• Morbid obesity: BMI 42
`
Social History;
• Mr Barber is the sole carer for his 80 year old wife who has dementia. Mrs Barber has been left in the care of a neighbour.

You note that Mr Barbers clothes are blood stained on arrival.He states that he is feeling nauseous.

1. The nurse completes an assessment of Mr Barber's condition on arrival. Explain the following in relation to the assessment process.
a) Discuss the type of infection control policy would be implemented for Mr Barber?(50-100 words)
b) List the PPE precautions that the nurse would use during assessment.
c) Review the vital signs on the ADDS chart. Discuss how these parameters relate to evaluating the severity of blood loss? (50 words)
d) Review the medication chart and discuss the action of the drug prescribed for nausea. (50-100 words)

2. The RN asks you to complete a 12-lead ECG on Mr Barber. Use the information in the case study to label the ECG below. (include patient identity information as well as symptoms)

3. Use the information in the presenting history and patient charts to write your initial nursing report in SBAR format for Mr Barber. This report will be written 20 minutes after arrival when you have completed your initial assessment. (100-200 words)

4. Mr Barber is upset that his wife is unable to accompany him to the hospital because she isn't well. Give three questions you could use in your conversation with Mr Barber that would evaluate her safety to remain at home whilst he is in hospital. Ensure that your questions are phrased to take into consideration empathy, cultural or spiritual elements. (100-150 words)

5. The neighbour looking after Mrs Barber telephones the Emergency Department and asks how Mr Barber is going. How would you respond to this telephone call as the nurse caring for Mr Barber? (50-100 words)

6. Outline the preparation required to transfer Mr Barber to the radiology department for these tests. Include the following aspects in your answer:
a) What type of consent is required for this procedure? (50 words)
b) Review the categories on the ADDS chart and identify the number and qualifications of staff members that should accompany him to radiology. Base this answer on your evaluation of his level of acuity and manual handling requirements.(100-150 words)

7. Discuss the nursing interventions you would you initiate. Include the following in your answer:
a) Review the NSW rural emergency clinical guidelines for adults, non-traumatic shock guideline. List the assessments that you would complete in each of the DRABCD categories using the table below?

b) How do these assessments allow you to make a judgment on the severity of his blood loss? (100-150 words)

8. Discuss the information you would provide to Mr Barber. Include the following in your answer:

a) Explain to Mr Barber in simple terms how the actions of this drug relate to the pathophysiology of emphysema. (100-200 words)

b) Review the type of inhaler prescribed on the medication chart provided and list the steps to correctly administer this medication. (50-100 words)

9. Please read Mr Barber's medication chart. Identify which of these medications would be used to treat the pain from his osteoarthritis (OA) - briefly describe the actions of each one and explain why they are used for this condition. (200-250 words)

10. What questions might you ask him to help determine the severity of his OA and how the symptoms impact on his activities of daily living? (100-150 words)

11. You notice a bandage on Mr Barber's lower leg and he says that he cut his shin on a sharp piece of wood a few days ago. Summarize your duty of care in relation to this observation. (100-150 words)

12. What actions should you take now that Mr Barber has decided not to proceed with his gastroscopy? (100-150 words)

13. What community assistance would be available for Mrs Barber whilst Mr Barber remains in hospital? Give an example of an allied health care worker who would make these arrangements prior to Mr Barbers discharge. (100-150 words)