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HLTENN005 Case study assignment
Course Intake: (Intake Number and Year)
Student Name:
Email Address:
Mobile Number:
Unit code and title: HLTENN005 Case study assignment
Date submitted:
Submission mode: v Online ? In-class submitted to assessor
Assessment conditions Assessment modality
Satisfactory rate – All questions must be answered in accordance with the assessment guide. If this is not achieved the student has the opportunity to resubmit work or re-sit exam as confirmed by their trainer/assessor
Assessment location: ? In-class ? Online Quiz
? Case Study Assignment
? Workbook lab activities
? Workplace Placement
Ref: as listed in the Course Unit Outline and Assessment Due Dates List for the course
Assessor Instructions
The assessment consists of a case study and questions related to the complex care of the patient. They are a mixture of diagrams and short-answer questions. The assignment is completed when all of the short answer fields in the template are completed. These are to be completed according to the assessment guide and decision making rules. Final decision is to be made and recorded on Assessment result below and on the results template via the Course Coordinator.
This can be done over the entire subject, however, it is encouraged that the students go through each section as it is discussed in class. The student is able to answer ahead of class however, it is encouraged to participate in class discussion relating to each topic.
Ref: Assessment Guide for the Assessment & Mayfield Education Assessment Guide: Planning & Conducting Assessment Policy
Student Instructions
Read each question carefully. In order to be deemed Satisfactory in this assessment task you must answer ALL the questions below. Write/type answers in the fields provided. This assessment is a combination of short answer questions and diagram answers. Short answers should consist of no more than five sentences. This can be typed and dot points can be used. This must be undertaken solely and individually by yourself and you are able to use your study notes to assist you with completing the answers. If you do not receive a ‘Satisfactory’ result, (NYS) you will be provided with an alternative supplementary assessment.
Ref: Student Information Handbook (5) & Student Assessment Policy and Procedure
Student Declaration
I, ……………………………………………… (Student to print name) state that the work I submit is my own and I have not copied this in any form except where due reference has been made to this. If you are completing this form electronically, please type your name as an acceptable form of your signature.
Student Comments:
Ref: Student Information Handbook (5.6)
Signature:
If you are completing this form electronically, please type your name as an acceptable form of your signature. Date:
Assessment Outcome (tick v): ? Satisfactory
? Unsatisfactory
? Resubmit
Ref: Student Information Handbook (5.6) Reassessment Appeals
NB: The rating of Competency can only be provided as a summative assessment at the end of a unit. Outcome recorded on Results sheet (tick v): ? Yes
Date entered:
By whom:
Results are entered into the electronic Results Sheet
Assessor Feedback and Comments to Student:
Assessor Name (printed): Date received:
Assessor Signature (signed):
Ref: Trainer and Assessor requirements as listed in the Sessional Trainers and Assessors Policy and the Policy – Guidelines for Planning and Conducting VET Assessment & Student Assessments Policy.
Outline: this case study is a major learning and assessment resource that you are expected to finish once the unit ends.
It has multiple test points in a variety of styles, including a continuing case study and short answer questions.
At different points you will also be prompted to refer to Essential Clinical Skills Enrolled Nurses, Tollefson, edn 3, 2016 in which you will be expected to practice the clinical skills learnt in the lab with your educator. When you have done this, ensure you get your Tollefson’s book/ paperwork signed off by your educator.
Skills must have been demonstrated in the workplace or in a simulated environment as specified in the performance evidence. The following conditions must be met for this unit:
? using suitable facilities, equipment and resources in line with the Australian Nursing and Midwifery Accreditation Council’s Standards including:
? analysed, planned and evaluated the healthcare of 3 people using health information and clinical presentation to determine possible nursing interventions, in consultation with a registered nurse in the workplace
? performed interventions in a simulated environment specific to care of a person with complex needs including
* monitoring of a neurological observation to recognise a deteriorating person
• recording of 12 lead ectrocardiogram (ECG)
• removal of indwelling catheter
• performing blood specimen collection (venepuncture)
? emptied and changed 1 urinary drainage bag in the workplace
? modelling of industry operating conditions including access to real people for simulations and scenarios in enrolled nursing work.
Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.
In addition, assessors must hold current registration as a registered nurse with Nursing and Midwifery Board of Australia.

Unit Descriptor
This unit of competency describes the skills and knowledge required to provide clinical nursing skills for a person with complex needs and to contribute to complex nursing interventions using critical thinking and problem solving
CONTENTS
Case scenario
Patient assessment
Fluid balance data
Urinalysis
Pathology results
Diagram of the heart
Differential diagnosis for chest pain
Myocardial infarction
Managing anxiety
Interviewing and communication
ECG
Drain tube management
IDC management
Confidentiality and duty of care
Met call and code blue
ISBAR communication
Deteriorating patient and family communication
Negotiations and conflict resolution
Progress notes
Case scenario
Patient Assessment
You are the Enrolled nurse working in the pre admission clinic. You are caring for Mrs Joyce Rogers a 82 year old woman from Doveton with a recent history of angina.
Mrs Joyce Rogers
UR 9876543 Unit dr:CTHR
Public admission DOB: 13/6/1936
41 Rowan Drive.,.Doveton 3177
Ph 9793 4621
Past History
• Hypertension
• Stroke 2007- some weakness and swallowing difficulties on the left side
• Dyslipidaemia
• Diabetes Type 2 controlled and management by the LMO
• #R)NOF from a fall 2010
• Total hip replacement June 2010
• Osteoporosis
• IHD
• COPD
Allergies
• Penicillin. She has brought in all her medications with her, which will need to be put away safely.
Medications
• Aspirin 100mg Mane
• Panadol osteo 1000mg QID
• Vitamin D 600 units Mane
• Caltrate 600mg BD
• Lipitor 40 mg Nocte
• Serevent I puff mane
• Pulmicort 1 puff mane
Joyce’s admission relates to being out in the garden this morning with her son Peter Rogers (NOK), when she suddenly complained of chest pain and collapsed on the ground. Previously that morning she had commented on feeling ‘dizzy and not herself’. She only lost conscious for approximately one minute and was responding shortly after her collapse but was notably short of breath when her son returned to the house to get his mobile to call an ambulance. The ambulance arrived and brought her to hospital.
Joyce had some blood and an ECG taken which showed abnormalities. It was decided that Mrs Rogers was to have an angiogram due to her known predisposing heart condition and the symptoms she was experiencing.
Outline what an angiogram is and why it is to be done?
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Angiogram results showed 70% occlusion to her left main circumflex artery and 80% occlusion to her Left anterior descending artery. It was decided she required Cardiac bypass graft surgery x2 due to the extent her heart was damaged from IHD. Joyce has a theatre time for 0600hrs tomorrow morning.
Head to toe assessment
1. CNS 2. CVS
• Alert and orientated to PPT
• PEARL
• GCS 14- limb strength: equal
• T 36.7
• Speech- clear • BP 150/100mmhg
• HR 86,
• ECG shows cardiac abnormalities,
• Magnesium and Potassium levels have been low.
• ST elevation noted on ECG,
• Angiogram stated as above.
• She has had a troponin rise so requires serial ECG and troponins every 6 hours. Last one was at mid day.
3. Respiratory 4. GIT
• 4L 02 via Nasal prongs.
• 02 Sats 97%.
• RR 20 rpm.
• SOBOE • NBM 12 midnight
• Chewing impairment
• She has her own teeth.
5. Renal 6. Integumentary
• Pt on 1.5 L fluid balance due to theatre admission. FBC.
• Using pan in toilet. • Skin dry and intact
• Pressure risk assessment
7. Endocrine/metabolic 8. Musculoskeletal
• BGL 6.5mml
• Blood tests pending • Ambulation with walking stick or assist with one person due to slight weakness on L) side
9. Psychosocial Plan
• Lives alone
• One son near by
• No pastoral practices • Future planned care
• D/C plan and date
• referrals
Fluid balance data
Mrs Rogers was admitted to your ward at 1000hrs this morning due to angina symptoms post angiogram. As soon as she arrived she was given a 500ml jug of water, she immediately drank 100mls and then promptly vomited 250 mls of green bile after feeling nauseas from the smell of the hospital.
At 1230hrs the MO was contacted re her vomiting and ordered an IM antiemetic and further ordered to be NBM. At 1245 hrs her water jug was removed and it was noted it had 275mls remaining.
At 1400hrs she used a bed pan and passed 100mls and 150mls of urine again at 1500hrs and provided a urine sample.
At 1600hrs IV 5% dextrose was commenced at 60 mls per hour
.
At the 1600hrs doctors round her NBM status was lifted and she was allowed to eat and drink
Mrs Rogers had 2 cups of tea at 1700hrs and 2000hrs. At 1715hrs a new 500ml jug of orange cordial was given to her and she drank 100mls of cordial. She also had some ice-cream 135mls and jelly 150mls as part of her dessert and refused dinner because it smelt funny. She went to the toilet at 22hours and voided 400mls.
Document Mrs. Rogers Fluid input and output on the chart provided.
Add up the total input and output for the 24 hour period. It is presumed she did not drink or void prior to coming into hospital. Calculate her fluid balance.
FBC see attachment
Urinalysis
Mrs Rogers requires a urinalysis.
Explain the significance of each component of the urinalysis.
1. Leukocytes 2. Nitrates-
3. Urobilinogen 4. Protein
7.
5. PH 6. blood
7. Specific gravity 8. Ketone
9. Bilirubin 10. Glucose

Pathology results
Mrs Rogers pathology results were not in normal range. Explain the significance of each of these pathology results
10. Troponin 11. CK-
12. CKMB 13. U&E
14. CMP 15. FBE
16. Group and hold

Label the following diagram of the normal heart
1
2
3
4
5
6
7
8
9
10
11
Chest pain does not always signal a myocardial infarction.
Name a differential diagnosis for chest pain.
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Outline your understanding of the pathophysiology of a myocardial infarction?
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Describe the tests that could be completed for a diagnosis of a myocardial infarction. Both immediately and as a follow up
1. _____________________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________________
3. _____________________________________________________________________________________________________________________
4. _____________________________________________________________________________________________________________________

5. _____________________________________________________________________________________________________________________
6. _____________________________________________________________________________________________________________________
Explain the PQRST algorithm and how you would manage a patient who was experiencing 7/10 chest pain whilst sitting.
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Mrs Rogers is feeling anxious. Name four strategies that you could discuss with Mrs Rogers to help manage her anxiety.
1.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

When interviewing and communicating with Mrs. Rogers, it is important to acknowledge the following communication skills in regards to your professionalism. Nonverbal, openness, sensitivity and non-judgmental attitude.
Explain why each is important to the patient.
1. Non-verbal cues
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2. _Dignity
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3. Sensitivity
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4. Non-judgmental attitude
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The doctor has requested a base line ECG to be conducted
Identify the PQRST wave on the following diagram of sinus rhythm.

Draw the location of ECG leads on the following diagram.

Write the location using correct terminology of the ECG electrode placements
V1
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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________V3
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________V4
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________V5
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V6
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Explain the difference between a 12 lead ECG and a telemetry monitor.
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Mrs Rogers may return to you with a drain tube. Outline the nursing requirements (at least 3 issues/ plan of care and goal) that will need to be completed for Mrs Rogers. Provide a rational for your nursing care using the following
ISSUE:
PLAN:
GOAL:
RATIONALE:
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Mrs Rogers may also return to you with a IDC Outline the nursing requirements (at least 3 issues/ plan of care and goal) that will need to be completed for Mrs Rogers. Provide a rational for your nursing care using the following
ISSUE:
PLAN:
GOAL:
RATIONALE:
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How would you ensure the following in regards to care you are providing for Mrs Rogers. Provide an example of how you could potentially breach these in regards to Mrs Rogers care.
Confidentiality
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Duty of care
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It is day 3 post surgery and Mrs Rogers has been achieving all her nursing care plan goals.
You are coming on for the morning shift and the nurse handing over to you mentions your patient remains on telemetry monitored due to having regular ectopics on her ECG.
You go to do your initial patient assessment, when the screen alarms rapid atrial fibrillation. Your patient has a heart rate of 150bpm.
Picture sourced July 2012 from: http://medicases.blogspot.com.au/2010/11/ecg-abnormalitiespart-13.html
Mrs Rogers ECG with rapid Atrial fibrillation with ectopic, HR 155 bpm.

You decide to check her blood pressure which is recorded at 90/60. While you are checking the blood pressure the nurse in charge walk into the room to review the situation. Together you decide to call a Metcall.
What is the difference between a Metcall and code blue?
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The Metcall team arrives:
Using the ISBAR communication tool explain what you would handover to a doctor or RN1 during a METCALL when the METCALL team arrives
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During the remainder of your shift Mrs Rogers condition is deteriorating
Although Mrs Rogers is not responding to you, conversation with the unconscious patient is very important. Mrs Rogers family should be made aware of her condition. Outline how you will approach the family in talking to them about Mrs Rogers condition?
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Mrs Rogers has an Advanced care directive outlining that she did not want active treatment, however the family are not happy about this and would like you to do everything possible to keep Mrs Rogers alive.
Outline how you will respond to their request? (You will need to consider negotiation and conflict resolution skill for this answer).
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Write detailed progress notes using a head to toe approach about your pts activities this shift.
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End of case study scenario