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Original Question

Patricia Burn is a 58-year-old woman who has been living with Type 2 Diabetes Mellitus, COPD and Obesity. She has 2 adult children and 3 grandchildren all who live interstate, but she has regular phone contact with them. Patricia divorced from her ex-husband 20 years ago now and is living in a same-sex relationship with her long-term friend Andrea. Andrea is very supportive of Patricia’s care needs but is compromised by her own disabilities of advanced Rheumatoid Arthritis. Patricia’s current & past medical history T2DM Obesity (BMI 33) COPD for the past 14 years HT R) Foot ulceration Peripheral neuropathy Constipation Hypertension MI (10 years ago) PSH: Appendectomy 20 years ago PFH: Mother T2DM Patricia’s current weight is 93kgs and as a result, her mobility and functionality has steadily decreased making her reliant on Andrea for support and management. Andrea has become concerned about Patricia today as she has rapidly deteriorated, complaining of fatigue, listlessness, generally feeling unwell, irritable, productive cough, shortness of breath on exertion. She is particularly short of breath walking to the bathroom. She has been sitting in her reclining chair all day without any improvement. Your observations of Patricia include: Vital signs Pulse: 142 beats per minute BP: 175/98 mmHg Respirations: 32 breaths per minute Temperature: 38.8oC SP02: 93% Visual observations Slight cyanosis around lips. Patricia is needing to sit forward and lean on the table. She has increased anxiety as she is concerned about how Andrea is managing with her deteriorating health. Current medications include: PO Enalapril 10mg BD PO Acarbose (Glucobay) 100mg TDS Subcutaneous Lantus 18 units nocte Inhalation Salbutamol MDI 2 Puffs 4 hrly PRN Inhalation Aclidinium Bromide 2 puffs BD PO Coloxyl & Senna 2 BD PO Movicol 1 sachet Part A – Short answer knowledge-based case study questions Performance criteria Record of results Q1 List three (3) strategies you could use as an Enrolled Nurse to help alleviate this patient’s anxiety. S NYS Student to add answer here Q2 Discuss at least six (6) observations you would include in your respiratory assessment of this patient. S NYS Student to add answer here Q3 Discuss how Patricia’s comorbidities impact her health. S NYS Student to add answer here Q4 Applying a critical thinking and problem-solving approach, discuss the education you could provide Patricia and Andrea regarding her managing exacerbations of her respiratory condition in preparation for discharge. Include a brief explanation on the use of incentive spirometry and peak flow. S NYS Student to add answer here Q5 Discuss the procedure for obtaining a sputum specimen, and the test this would be sent off for. S NYS Student to add answer here Q6 As you are attending to other patients in the ward, Patricia indicates she is increasingly short of breath while lying in the bed. Her respiratory rate has increased to 33 breaths per minute, and her pulse is 112 beats per minute. List your four (4) immediate nursing actions in priority for the management of her acute dyspnoea, and include the rationale for these nursing actions. S NYS Student to add answer here Q7 Reflecting on your previous clinical placement experience, discuss an area of clinical practice that you have observed. Make at least one (1) recommendation for a change to that practice that would result in improved quality of the patient experience. S NYS Student to add answer here Q8 Patricia would like you as her nurse, to explain to Andrea what T2DM is. Outline below how you would explain T2DM to Andrea. S NYS Student to add answer here Q9 Discuss four (4) complications of T2DM. S NYS Student to add answer here Q10 Discuss two (2) health professionals you could refer Patricia to in the community setting to assist with her ongoing management of her Diabetes. S NYS Student to add answer here

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