Competency assessment programme case study

Document Type:Case Study

Subject Area:Nursing

Document 1

He stayed in the hospital for three days and he was using a wheelchair to facilitate mobility. He has also had another complaint of phantom pain in the limb. He had ceased smoking but he was, however, drinking beer though in little quantity. His height is 125kg and his height was 168cm. On examination, his heart rate was 104bpm; bp136/90; respirations 16 bpm; oxygen saturation 95%; blood sugar 16. He has six children who are adults and they live in an apartment found in Rotorua. He also has two grandchildren Physical: Te taha tinana (focussed) present the data you have been given relating to the physical components below This refers to the physical wellbeing • Cardiovascular Heart rate was 104 bpm Blood pressure was 136/90 • Respiratory Respiratory rate was 16 beats per minute Oxygen saturation was 95% • Urinary Glucose in the urine-glycosuria • Neurological Phantom limb pain • Integumentary There was swelling on the feet integument • Gastro- intestinal Gastro-intestinal tract was intact.

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• Muscular-skeletal Phantom limb pain and oedema of the leg • Endocrine Poor insulin production as he was diabetic • Immune Moderate immune • Fluid/Electrolyte Dehydration due to high levels of glucose • Nutritional Blood glucose level after fasting plasma test was 16. mmol/litre The patient had excess cholesterol i. e. There is also chronic hyperosmolarity that results in edema of the nerve trunks with the end result being an increase of fructose and sorbitol. The final result is the loss of sensation of foot and eventually there will be repetitive stress. This leads to amputation of many legs of diabetic patients. Amputations wounds however heal slowly or there are infections in the wound. Amputation of wound also present with pain that at times present with radiating properties (Mohanraj & Narayanan, 2016). Legally in New Zealand there are some existing laws upon which every nursing practitioner has to comply with such regulations and guidelines as stipulated in the law.

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These laws helps to ensure that the rights of the patients are not being violated in the course of treatment or the assessment done to the patient. The patient must first consent to any assessment before they are done failure to which it shall be a violation of their rights ("Faith and Ethics, Covenant and Code: The 2015 Revision of the ANA Code of Ethics for Nurses with Interpretive Statements. New Zealand", 2017). Doctors performing amputation procedures can be subjected to legal sanctions. mmol/l as normal is 5. mmol/litre, and an abnormal heart rate of 104 bpm while the normal being 60-100 bpm. From pain assessment it was discovered that the pain was getting worse with mobility from bed to the chair and it was a throbbing pain which was non-radiating, thus, he had an abnormal severity of 6-10 while the normal value should be zero (Chester & Rudolph, 2011).

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From the information given it’s prudent to note the condition of Mr. 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. e. if the patient is allergic to any medicines or if he had any contraindication. In the past, he used to smoke and also drink, with less exercises. This, contributed to being obese which resulted in type 2 diabetes that led to amputation of his leg, eventually leading to phantom limb pain (Fleming et al. Thus, the prognosis prediction will be good if he exercises regularly, and manages his blood sugar as well as hypertension. This should happen in a span of two weeks 3. To treat kidney problem observed by administration of drugs, and this should happen in a span of two weeks Taking Action Nursing intervention for your patient Rationale Citation (APA 6th edition) 1.

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Monitoring medications Review the medications given to the patient if they are effective in managing pain and if they are not then the medicines can be changed and the nurse informs the pharmacist on the need to change the treatment regimen (Watkins, Dewar & Kennedy, 2016). Watkins, S. Dewar, B. 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. j. ijnurstu. ijnurstu. Frequent assessments Assessment of the condition of the patient are done especially to the wound site to determine the healing status and also to monitor the effectiveness of drugs in managing pain Additionally, the swelling at the feet will be assessed continuously to ensure that renal problem is being treated well. Watkins, S. Dewar, B. Kennedy, C.

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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. j. ijnurstu. Seeking to understand the characteristics of the phantom limb pain The phantom limb pain will present as knifelike, squeezing and burning sensation and it’s not always radiating. The pain is persistent and it can be temporarily abolished by some transient changes of the somatic input. Watkins, S. Dewar, B. 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. j. ijnurstu. It’s also required that nurses promote honest and open communication with the patient. For our patient this applied in that we had to inform the patient of the outcome of the amputation and the possible complications that could arise ("Nursing scopes of practice", 2019).

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Another standard is ethics and this as specified in the New Zealand Nursing organization (NZNO code of ethics 2010), nurses should uphold autonomy, justice, confidentiality, veracity, fidelity, beneficence and guardianship with regards to resources and environment. I leant that despite what we want to do as professionals, we must observe the code of ethics and respect the rights of the patients and not put the life of patient at risk at all cost. For our patient we had to ensure that the benefit of the operation and medication to the patient had high benefits compared to risks. j. jvn. Te Wheke: Rose Pere – Hauora. Retrieved from http://hauora. co. 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. j.

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ijnurstu. Plüddemann, A. Maconochie, I. Mant, D. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.  The Lancet, 377(9770), 1011-1018. Phantom limb pain: a case of maladaptive CNS plasticity?.  Nature reviews neuroscience, 7(11), 873. Mohanraj, S. Narayanan, K. KEYWORDS Diabetic Autonomic Neuropathy, Diabetes Mellitus, Electrodermal Responses, Galvanic Skin Resistance, Sympathetic Skin Response, Skin Conductance Response. health. govt. nz/our-work/nursing/nurses-new-zealand/nursing-scopes-practice.

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