NRSG366: Partnerships in Chronicity

Georgie Smith is a 64 year old woman who has been referred by the local hospital to the Community Health Service for ongoing care. Georgie was discharged home two days ago. She was diagnosed with rheumatoid arthritis
10 years ago and chronic heart failure five (5) years ago. Georgie also has a cataract in her left eye which will be removed in three months. During her recent hospitalisation, Georgie has been diagnosed with Type 2 Diabetes and commenced on insulin. Her regular BGL’s have been high, ranging between
18.5 and 25.6 mmol/L.

Georgie lives with her husband John in a two bedroom, second storey unit. There is lift access within the building. John works full time as a builder and Georgie works in his business as the office manager. John and Georgie have four children, three sons and a daughter, all of whom live overseas.

Georgie is 170 cm tall and weighs 110 kg. She is short of breath on exertion. Her current observations are;
BP: 140/80

P: 100

R: 26

Sa02: 96% on 21% oxygen
Georgie’s current medications include:

• frusemide 40mg BD

• digoxin 250 mcg daily

• lisinopril 20 mg BD

• atenolol 50 mg daily

• aspirin 100 mg daily

• amiodarone 300 mg BD with food, to be reviewed in one month

• iboprufen 400 mgs TDS

• lantus 52 units daily

You are the registered nurse from the Community Health Service who has been assigned to visit Georgie and John at home to assess Georgie’s level of self-management of her BGl’ and insulin injections. The hospital had indicated John was reluctant to give his wife this injection or get involved in her care.

Assessment Requirements

You are required to construct a concept map that will assist in identifying and prioritising the clinical issues for Georgie. This concept map is then to become the basis of a comprehensive discussion of the identified health issues. This discussion should include:
• a comprehensive client assessment;

• identification of the impact of the health issues on Georgie and John;

• impact on their level of independence and functioning in the community;

• the nursing care strategies that will support and educate Georgie and John to promote their level of independent living. This is to include Georgie’s level of independence associated with her BGL monitoring and insulin administration

Please consult the marking criteria and see below for further direct in assessment writing.
Writing an essay about the nursing care of a client

Preparation beforehand

One: identify the person



• Understand the background of the person
• Understand all the details provided about the person
• Clarify all the symptoms, identified problems and diagnoses so you understand who you are dealing with and what problems they may have

Two: understand the pathophysiology of the diagnoses and the pharmacological principles of the medications the person is on

• Review the normal physiology of the body systems involved in the various diagnoses.
• Review the pathophysiology related to the diagnoses so you understand the variation from normal
• Identify the purpose of the medications in relation to the diagnoses
• Review the pharmacodynamics and pharmacokinetics of the medications
• Understand the effect of the medication on the pathophysiology of the diagnoses
Three: assessment

• Identify the information needed to care for the client and structure assessment to provide you with the information required to plan care for this particular client’s specific problems
• Identify all the domains of health to be assessed
• Identify the tools needed to perform the assessments in each domain
• Identify additional information needed and method to collect the required data, e.g. urine tests

Four: care planning



• Identify care needs in order of priority
• Construct a plan of care that meets the needs of the client.
• Consider care planning across all domains of health: physical, psychological, social, cultural, spiritual, intellectual and other domains you may identify
• Include method of evaluation in the care planning
• Review care planning from ethical perspective to include client consent, autonomy and adherence to nurses’ code of conduct, legal requirements etc
Five: implementation



• Identify possible obstacles to implementation and how you could address it

Six: evaluation and reassessment

• Identify how outcomes will be measured and identify reassessment or conclusion of activity
• Identify tracking of progress of long term care goals

Writing your essay

Construct a concept map based on the information you collected.

Identify the issues in order of priority and write in paragraph style about each identified issue, using the template on how to write academic paragraphs as provided in your ACU study guide.