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Sylvie a 32 year old woman with a long history of cardiac and other health problems and surgery, mainly related to congenital heart anomalies associated with Down Syndrome. She was admitted yesterday afternoon via the Cardiac Outpatient Clinic following a referral by her local GP for a review of her cardiac status.
On admission Sylvie was dyspnoeic, tachycardic, peripherally cyanotic and easily fatigued. She also had peripheral oedema and some central cyanosis. Oxygen @2Litres/min via nasal prongs was commenced in the outpatient clinic and has continued since admission. Sylvie reports an increased weight gain over the last few weeks despite not eating well. She also reports being too tired and breathless to shop and cook for herself. Sylvie states she has been taking her medications as prescribed but admits to being a bit confused and forgetful lately.
Overnight her observations have been stable but she remains dyspnoeic and tachycardic. This morning her heart rate is 120bpm. Her respiratory rate is within normal limits but she has nasal flaring, tracheal tug and some intercostal recession. Pulse oximetry is borderline with nasal prong oxygen and a random capillary venous blood gas overnight indicated a mixed metabolic and respiratory acidosis with the PaO2 at the lower end of normal range. She hasn’t reported any chest pain since admission. Peripheral oedema is still present and, this morning, her weight is unchanged from her admission weight.
Current medications include an ACE inhibitor, diuretic, a cardiac glycoside, a beta-adrenergic blocker, glycerine trinitrate and prn analgesia. She also has an IV cannula in situ requiring 6/24 saline flushes. Sylvie has been living independently with good family and community support for the last year or so. She is really worried that this current episode might put that in jeopardy. Sylvie’s parents came in last night and are quite worried about Sylvie’s condition. They would like to speak with the Cardiac Consultant when they come in this morning. They were going to check Sylvie’s place on their way home last night and pick up some clothes, care items and other things Sylvie wanted to have with her.
NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2015 7
Assessment 1 Tasks:
An important part of your nursing care of Sylvie today is to support and maintain adequate cardiac function and to begin the discharge planning process. This involves
   
Assessment and monitoring of cardiac function A nursing care plan that reduces cardiac workload and myocardial oxygen demand Medication management Patient teaching and preparation for discharge
Your task in Assessment 1 is to critically discuss key nursing issues related to the care of Sylvie during your shift.
Based on the handover you received at the beginning of your shift today (on the previous page), address the following 7 items.
Do not make up or assume information in relation to or about Sylvie. Only use what you know from the handover information you received today.
Note: Unless otherwise stated, textbooks are not appropriate references for the items below. Students are expected to locate, critically evaluate and use current, reliable and relevant evidence
from reliable nursing journals.
It is recommended, however, that students refer to the set texts to help identify key points to include in their responses and to identify relevant search terms.
Item 1: Clinical presentation No Textbooks are to be used as references in this section
Sylvie is in your patient allocation today.
You haven’t met or seen her as yet. An important first step in the clinical reasoning process is to anticipate what you might see, hear and feel when you first meet Sylvie.
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Based only on the handover information you are given and using current, reliable journal articles to support your thoughts and ideas (Textbooks are not appropriate references in this section)
 Describe what you might expect to see, hear and/or feel when you do your initial assessment of Sylvie
AND
 Explain why you might expect to see, hear or feel these findings
NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2015 8
(250 words, 5 marks)
Item 2: Nursing priorities No Textbooks are to be used as references in this section
Before meeting Sylvie, it is useful to identify what needs your immediate attention, ie your nursing priorities, when you do get to her beside after handover.
Based only on the handover you have received and using current, reliable journal articles to support your thoughts and ideas
 Identify your first 3 nursing priorities when you meet Sylvie for the first time today AND
 Explain why they are your first 3 priorities.
(200 words, 5 marks)
Item 3: Nursing Management: Assessment and monitoring of cardiac function
An important part of caring for a person with altered cardiovascular function is to monitor their cardiac function to ensure early detection of changes in their condition.
 Identify how you will assess and monitor Sylvie’s cardiac function during your shift today. AND
 Explain o How these strategies will help you to identify any changes in Sylvie’s condition o Changes that indicate improvement or deterioration in her condition
(400 words, 10 marks)
Item 4: Nursing Management: Reducing cardiac workload
An important goal in the nursing care of a person with altered cardiovascular function is to reduce cardiac workload and myocardial oxygen demand to promote recovery.
 Identify strategies you would implement in your nursing care today to reduce Sylvie’s cardiac workload and myocardial oxygen demand
AND  Explain how or why they will help you meet this nursing goal
NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2015 9
(300 words, 10 marks)
Item 5: Nursing management – Medication management
Two important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications and how to monitor the patient to ensure they are responding to prescribed medications as they should.
 Briefly explain why Sylvie has been prescribed a cardiac glycoside, an ACE inhibitor and a diuretic
AND
 Explain o The nursing responsibilities associated with administering these medications and
monitoring Sylvie’s response o How you will monitor Sylvie to ensure she is responding appropriately to these
medications you are administering
Item 6: Preparation for discharge
(400 words, 10 marks)
Sylvie is hoping to return to supported independent living when she is discharged.
Part of any discharge plan for a person with altered cardiovascular function is to ensure they are provided with, and understand, what they need to do to remain at their optimum level of wellness and to minimise further cardiac problems.
 Identify two (2) patient teaching topics you will address with Sylvie during your shift today to help prepare her for discharge
AND
 Explain why these 2 topics are appropriate for Sylvie as part of a her discharge plan (200 words, 5 marks)
Item 7: Legal and ethical practice
During your shift you attend an arranged meeting with the Cardiac Specialist, the Medical Team Registrar, Sylvie and her parents.
During the meeting you note that the medical staff appear to be talking directly to Sylvie’s parents, rather than her. When everyone has gone, Sylvie also comments that she felt this was the case.
 Briefly explain what Sylvie’s rights are in relation to making decisions about her care  Briefly outline how you as a registered nurse could ensure that Sylvie is more involved in the
information sharing and decision-making related to her care.
(300 words, 10 marks)
A reminder to prepare and submit your assignment as directed above.
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