Competency assessment programme case study

Document Type:Case Study

Subject Area:Nursing

Document 1

This results in the formation of atheroma's which presents as hardened arteries. Over time there will be blockage of the arteries, weakening and narrowing of the arteries. This mostly affects the blood vessels found in the legs (Lovell, 2007). Collect Cues / Information Review Mr Siliva is 59 year old grandparent and a husband. He lives in NewZealand with his wife and works at the local forestry mill. He has a past medical history of hypertension, diabetes, and hypercholesterolemia. He had an advanced peripheral vascular disease which resulted to the amputation of his right leg 10 days ago. Mr. Silva was under the following medications; paracetamol, ibuprofen, atorvastatin, dialtizem, metroprolol, and lantus. Gather DEMOGRAPHICS Mr. This shows that he may not highly educated and informed that alcohol and smoking causes diabetes and hypertension.

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Spiritual: Te taha wairua Nothing has been mentioned about his spirituality. However, spiritual nourishment is important in the healing process. It helps a patient not to lose hope ("Te Wheke: Rose Pere – Hauora", 2017). Heritage: Te tūrangawaewae. The disease will then present with emboli or thrombi which ends up compromising the perfusion. The disease affects about 12-14 % of the population in general and the prevalence increases up to approximately 20% with the age above 75 years (Lovell, 2007). The emboli that is formed will cause ischaemia and this is mostly of the cardiac origin. Type 2 Diabetes arise from the inability of pancreatic beta cells to produce insulin and with time the insulin production capacity ceases. It’s also brought about by obesity. These are also specified in the New Zealand code of ethics that governs the clinical practice in New Zealand.

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Such principles include ethical principle of autonomy and beneficence. Thus, the Silva ought to receive all knowledge regarding his condition as well as the treatment options available. The code of conduct and ethics as per the New Zealand Nursing council, it offers the public enough knowledge on their rights and what to expect from nurses professionally ("Faith and Ethics, Covenant and Code: The 2015 Revision of the ANA Code of Ethics for Nurses with Interpretive Statements. New Zealand", 2017. Just like many other interventions amputation is considered prima facie and an amputation is legal if it’s reasonably performed. There are sociocultural considerations within the code of conducts that stipulates how nurses are to communicate socially to the patients for example through the use of electronic communications or the social media.

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The guideline explores more on the importance of and the pitfalls of the social media involvement. With this Nurses are called upon to ensure privacy of their patients throughout their social relationships. There are social stigma that comes with amputation and that affect their social life and interactions and this has affected.  BNF. London. Atovostatin Arvaz Statins Tablet 20mg Oral OD The patient had hypercholesterolemia and atorvastatin by inhibiting 3 HMG-COA reductase enzyme that catalyses the rate limiting step in the biosynthesis of cholesterol thus lowering cholesterol levels (BNF, 2011). Drug interaction: alcohol intake Side effects: GIT disturbances Educate the patient on the toxic interactions of drug with alcohol and thus advise them not to take alcohol British Medical Assoc.  BNF. Silva and his presenting condition which is basically phantom limb pain and this will help to influence the choice of treatment plan that he is put under in.

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since he is diabetic, there are chances of decreased healing rate to the patient after leg amputation (Flor, Nikolajsen, & Jensen, 2006). This is what contributes to the pain. It will be vital to discriminate other conditions such as varicose vein, DVT, and flat foot. However, the presenting condition could be related to sciatica; a condition that cause extreme pain at the leg especially during movement. , 2011) Thus, the prognosis prediction will be good if he exercises regularly, and manages his blood sugar as well as hypertension. Other than that, he may end up with a wound that does not heal, hence, constant pain. Identifying the priority problems/issues Problems need to be prioritised and developed from the processing of information Problem Related to (cause) Evidenced by (assessment findings) 1.

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There was pain that was worsening with time The phantom limb pain came as a result of amputation of the patient’s leg. This pain was evidenced by the patient complaints on how the pain would get worse when he was being moved from his bed to the wheelchair. , Dewar, B. , & Kennedy, C. Nursing intervention to change nursing practice in in-patient settings: An integrative review of patients with PLP.  International Journal of Nursing Studies, 60, 179-190. doi: 10. ijnurstu. Nutritional care The nurse offers nutritional guidance to the patient on the diet to take since the patient was diabetic and he needed to watch on the sugar intake. Additionally, he should limit salt intake and high protein diet, until the kidney problem is resolved.

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(Watkins, Dewar & Kennedy, 2016). Watkins, S. , & Kennedy, C. Nursing intervention to change nursing practice in in-patient settings: An integrative review of patients with PLP.  International Journal Of Nursing Studies, 60, 179-190. doi: 10. 1016/j. 1016/j. ijnurstu. Educating the patient about his condition Educating the patient on the amputation process and the possible complications that may arise and the pain expected. Explaining to them that oedema is caused by a renal problem and counsel them on how to effectively manage it (Watkins, Dewar & Kennedy, 2016). Watkins, S. , Dewar, B. , & Kennedy, C. Nursing intervention to change nursing practice in in-patient settings: An integrative review of patients with PLP.  International Journal Of Nursing Studies, 60, 179-190. doi: 10. ijnurstu. 017 Evaluate outcomes Describe how you would evaluate that the goals have been met Assess the patient by taking history from him and ask him about the pain whether the pain is still throbbing when he is being moved from the bed to the chair and if it’s radiating or not.

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Also observe and assess the legs to look out for oedema if it has been managed effectively Reflection Diabetic patients experience difficulty in wound healing and most end up having amputations which have both social and legal complications depending on the patient. Amputation results in pain that is radiating and the wound may fail to heal if the patient is diabetic and this presents with oedema and infections at the wound site which complicates the wound further. Based on the Nurses scope of practice standard one: Accountability and responsibility is key in the nursing profession in Newzealand. For our patient we had to ensure that the benefit of the operation and medication to the patient had high benefits compared to risks.

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Fourthly nurses are called to provide leadership in the course of their service delivery and this this should be done by offering and promoting best nursing care plan to the patients. When dealing with many cases nurses should be in a position to delegate where it is appropriate and act as examples to others in inspiration, knowledge and expertise. They should also be quick to take actions and provide fast relief to patients ("Nursing scopes of practice", 2019). In our case we had to offer pain relief by offering best analgesics to him and treating his wound perfectly. co. nz/te-wheke-rose-pere/ Faith and Ethics, Covenant and Code: The 2015 Revision of the ANA Code of Ethics for Nurses with Interpretive Statements. NewZealand.  Journal Of Christian Nursing, 34(4), E60-E61.

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