Case Scenarios help

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Hi there,

I have an exam that has 3 case scenarios that require the treatment utilising the Nursing Process.

THE 3 CASE SCENARIOS ARE:

1. 46yr old woman, married with 4 children under 12, Has been diagnosed with invasive lobular cancer, and has been admitted to the ward for surgery the following day. This is to be followed up with chemo and radiotherapy. She is tearful and anxious on admission.

2. 19yr old male suffers with Asthma. Had an exacerbation of asthma 2 months ago due to stress and lifestyle issues. He is now being monitored by the GP practice nurse However on this occassion he explains to the practice nurse that he is having trouble passing urine and is only voiding small amounts which is painful and "smells fishy". He has had these symptoms all weekend.

3. 58yr old male who had had a myocardial infarction 6months ago from which he has recovered. This morning he has been admitted to the medical investigation unit for an angiography. He has forgotten to bring his medication and cannot remember all the drug names. The nurse notices that his feet are swollen and that he is rather breathless while talking to you.

THE QUESTIONS ARE:

* Describe the assessment of each patient using the Nursing Process.

* Outline ways in which information is gathered during an assessment, discussing a range of assessment tools that may be used.

* Understand the physical, psychological, and social needs of the patient.

* Prioritise identified needs, highlighting the main priorities in the planning and implementation of care.

Thank you all in advance for your help.

Alfie

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I'm sorry, that is WAY too much work to do in answering your post, you might want to narrow your question a bit. It sounds like you want someone to do your assigment for you. No offense, I'm sure that's not the way you meant it!

Kelly

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Specializes in med/surg, telemetry, IV therapy, mgmt.

without actually answering this entire exam for you, there are several things you need to do to prepare your answers for each question.

first of all, remember that assessment is the first step of the nursing process. it is information gathering. since these are case scenarios and not live patients you will be gathering information from what you know about what to assess for in a normal physical examination and what the signs and symptoms are of the various diseased conditions that each patient in each scenario has. knowing those signs and symptoms is going to be crucial to determining each patient's physical, psychological, and social needs (question #3). the planning of the care (goals and nursing interventions) is based upon the signs and symptoms that each patient has (question #4). don't know how you have been taught to prioritize care, but generally it follows that the most serious symptoms are addressed and treated before the others. symptoms can range from mild to fatal. patient problems are often prioritized according to maslow's hierarchy of needs.

you can find lots of information on a general physical assessment on this sticky thread in the allnurses student section:

however, don't forget that as a nurse you also need to assess the patient for their ability to perform their adls (activities of daily living) as this is what nurses do above and beyond the same physical assessment that a doctor does.

1. 46yr old woman, married with 4 children under 12, has been diagnosed with invasive lobular cancer, and has been admitted to the ward for surgery the following day. this is to be followed up with chemo and radiotherapy. she is tearful and anxious on admission.
note that you are given some symptoms here: tearful, anxious. this is a surgical patient so she will need to have pre-operative teaching about her surgical experience and what to expect before, during and after surgery while she is in the hospital. you need to address her crying and anxiety. look up lobular cancer (of the breast) and check out the signs and symptoms of this condition. do you think this lady might need some teaching about it? do you think she might need some teaching about chemo and radiation therapy for it? do you think she might have some concerns about her children and family and how her role as wife and mother might change as a result of her diagnosis, surgery and follow up treatment? these are all potential problems that you would discover as part of your assessment of her.

2. 19yr old male suffers with asthma. had an exacerbation of asthma 2 months ago due to stress and lifestyle issues. he is now being monitored by the gp practice nurse however on this occasion he explains to the practice nurse that he is having trouble passing urine and is only voiding small amounts which is painful and "smells fishy". he has had these symptoms all weekend.
while the patient has asthma, the reason he is being seen is because of problems with his urine. i've highlighted his symptoms. you need to address those symptoms and develop nursing interventions for them. also, you need to be aware of what the doctor might order in response to this (probably tests for urinary tract infection and to rule out a kidney stone [10-year old having trouble passing urine].

3. 58yr old male who had had a myocardial infarction 6months ago from which he has recovered. this morning he has been admitted to the medical investigation unit for an angiography. he has forgotten to bring his medication and cannot remember all the drug names. the nurse notices that his feet are swollen and that he is rather breathless while talking to you.
you have two symptoms here to deal with. there may be a problem with the patient's memory as well since he forgot to bring his meds with him and can't remember them (a symptom of atherosclerosis?). you also need to look up information about mis and coronary atherosclerosis which is why most people have an mi in the first place and what the after effects of an mi are. know what goes on during angiography because the patient will need teaching about what is about to happen as well as after care.

this should get you started. the nursing process is a method of problem solving. the steps of the nursing process are:

  1. assessment (collect data)
  2. nursing diagnosis/determine problem(s) (group your abnormal assessment data, shop and match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use or just determine what the patient's problem/s is/are)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

if you follow these steps in this order (which, by the way is how your questions are also sequenced) you won't go wrong. the biggest part of this exam will be the assessment gathering. the entire nursing process (problem solving activity) is based upon the information you come up with during the assessment and then how you use it to determine the patient's problem(s), goals and interventions, or needs. this is why i gave you links to information about some of these patient's conditions and the procedures they will be having. this is information that is crucial to the assessment part of the assignment. here in the states we would call this entire activity for all three scenarios the writing of a care plan.

good luck on your exam!

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I'm sorry, that is WAY too much work to do in answering your post, you might want to narrow your question a bit. It sounds like you want someone to do your assigment for you. No offense, I'm sure that's not the way you meant it!

Kelly

Hi Kelly,

No offense taken, I just read my post back to myself and understand why you think that. I've basically done all the ground work for this exam, but just wanted to make sure that i'm sequencing the care for each patient scenario correctly, which i seem to doing. I think I may have to re-word my post..lol.

Take care

Alfie

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Hi Kelly,

No offense taken, I just read my post back to myself and understand why you think that. I've basically done all the ground work for this exam, but just wanted to make sure that i'm sequencing the care for each patient scenario correctly, which i seem to doing. I think I may have to re-word my post..lol.

Take care

Alfie

LOL I'm glad you weren't offended. That just seemed like an assignment I had to do last week that took me five hours! Daytonite gave you some great information though! I'm pretty much a beginner at this stuff myself (nursing process and all).

Kelly

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