Course Objectives assessed:CO2, CO3, CO4, CO5CO2Demonstrate the ability to synthesise and interpret assessment data from a variety of sources to inf

Course Objectives assessed:CO2, CO3, CO4, CO5CO2Demonstrate the ability to synthesise and interpret assessment data from a variety of sources to inform clinical decisions and care planning in the provision of comprehensive person-centred care in a simulated environment.CO3Critically analyse the nursing application of diagnostic, therapeutic and preventative techniques in the recognition and management of the deteriorating client.CO4Apply pharmacological knowledge to recognise and describe indicators and contraindications for appropriate medication management in the provision of person-centred care.CO5Apply principles of diagnostic reasoning and pharmacotherapeutic management to the provision of person-centred nursing care of clients with common health conditions. Word count:2500 wordsComponent of assessment scheme:This assessment task comprises 30% of the total course grade.Use of generative artificial intelligence

Artificial intelligence mustnotbe used at any point when completing this assessment. In line with the University of South Australia's university policy (AB - 69 Academic Integrity Policy, p.2) presenting and/or submitting academic work for assessment or review produced through generative artificial intelligence tools will be considered a form of academic misconduct.

Essay

Background

In order to provide safe and comprehensive nursing care, Registered nurses need to be able to interpret clinical information and draw upon their knowledge of pharmacology and evidence-based clinical practice. Therefore, this assessment is to support the development of knowledge and skills needed to evaluate the evidence and to develop reflection and clinical reasoning skills.

Assessment description

In this essay, you will apply your knowledge of clinical assessments, clinical reasoning, and pharmacotherapeutics to critique a scenario involving a person living with heart failure (Mrs Gina Goddard). The scenario presents a series of events leading up to an exacerbation of heart failure and re-admission to hospital. Your task is to analyse the situation, identify the criticalerrors of omissionmade in assessment, clinical decision-making, and medication management and provide recommendations for improving patient care and safety. This essay will allow you to demonstrate your understanding of the importance of these nursing skills and their impact on patient outcomes.

Note:Make sure to refer to the specific clinical information from the case scenario (Mrs Gina Goddard), Australian clinical guidelines, and evidence-based literature throughout your essay to support your arguments and recommendations.

How to approach this assignment

1.Read the clinical scenario (below) and identify the main issues that arise from the clinical scenario that you will focus on in the essay.

2.Read for current Australian clinical guidelines and evidence-based literature and plan your essay. The readings provided in NURS 2040 Topics 1-4 will provide a good starting point.( I have attached the readings as well)

3.Reflect on your learning outcomes from NURS 2040 Topics 1-4.

4.Write and present your essay using the following headings:

Introduction(250 words)

Introduce the essay purpose and structure. Briefly summarise the clinical scenario (Mrs Gina Goddard) and identify the main issues arising from the scenario that you will focus on in the essay.

Heart Failure with Reduced Ejection Fraction (HFrEF)(500 words)

Explain the pathophysiology and clinical manifestations of heart failure with reduced ejection fraction (HFrEF) as experienced by Mrs Goddard. Support your explanation with specific clinical information from the clinical scenario, Australian clinical guidelines, and evidenced-based literature.

Medication Management for Heart Failure with Reduced Ejection Fraction (HFrEF)(500 words)

Describe the medication management for heart failure with reduced ejection fraction (HFrEF), as prescribed for Mrs Goddard. Review the clinical scenario and identify the probabledrug-to-diseaseinteractionand/ordrug-to-drug interactionthat has contributed to the exacerbation of heart failure and hospital re-admission for Mrs Goddard. Support your discussion with specific clinical information from the clinical scenario, Australian clinical guidelines, and evidence-based literature.

Person-centred nursing care(500 words)

Describe the nurses role in patient education and discharge planning to ensure safe person-centred nursing of the person living with HFrEF. Discuss the factors that may have contributed to the exacerbation of heart failure and hospital re-admission for Mrs Goddard.

Support your discussion with specific clinical information from the clinical scenario, Australian clinical guidelines, and evidence-based literature.

Reflection on learning(500 words)

Use areflective frameworkto critically reflect on what you have learned from completing this essay. Reflect on the importance of nursing assessments, clinical reasoning, and medication management in ensuring safe and effective discharge planning for patients. Provide a personal reflective statement of how you will apply what you have learned from this case scenario to your own clinical practice as a nursing student and/or as a Registered nurse.

Conclusion(250 words)

Summarise and conclude the main points presented in the essay.

Referencing

The content of the essay must be supported by referencing of current, scholarly literature and Australian clinical guidelines and must include a reference list and in-text citations. You will be assessed on referencing so make sure to follow the APA 7 referencing style closely.

Please refer to theAPA7referencing resourcesto accurately reference your work.

Overall writing and presentation

Your essay must be structured using the headings provided and presented using academic writing. The use of dot points will result in a reduction of marks. You will be assessed on the overall writing and presentation, so make sure that you follow the academic writing guidelines closely to avoid losing marks. Please refer to theCHS Nursing and Midwifery Academic Writing Guidelinesto format your essay.

Youmustsubmit your assignment inWord format(do NOT use pdf, Open Office, or any other document type). Failure to submit your assignment using Word will result in a reduction of marks.

Clinical Scenario: Mrs Gina Goddard

The following scenario describes the case of Mrs Gina Goddard who had an unplanned medication-related hospital readmission within 72 hours of discharge post-surgical repair of a fractured Left femur.

Mrs Goddard is a 78-year-old woman who is returning home following an open reduction and internal fixation (ORIF) for a left hip fracture sustained after a fall at home. Mrs Goddard has heart failure with reduced ejection fraction (HRrEF), diagnosed 12 months ago, post experiencing a silent anterior myocardial infarction. She has a history of hypertension and hypercholesterolemia. Prior to this latest hospital admission, Mrs Goddard was living in her own home independently, managing her own activities of daily living including medications. She is mobilising with a frame and has required regular pain relief post operatively. Mrs Goddards discharge medications were dispensed in blister pack and did not include any analgesia. She was advised by the discharge nurse to visit the community pharmacy for over the counter (OTC) medications (e.g., nonsteroidal anti-inflammatory drugs) and to take Ibuprofen 400mg TDS. Her blister pack contained the following morning medications:

Enalapril 20mg daily

Bisoprolol 10mg daily

Spironolactone 25mg daily

Furosemide 40mg daily

Atorvastatin 40mg daily

Two days post discharge Mrs Goddard phoned her daughter because she was feeling breathless and was having difficulty using the walking frame because her ankles were very swollen. On further questioning from her daughter, Mrs Goddard denied pain and said she had been managing this well with the new pain killers that the nurse recommended for her on discharge. She did admit to feeling increasingly breathless over the weekend and needed to sleep in the recliner chair at night. She had not felt safe standing on the scale, so she had not weighed herself since discharge from the hospital. Mrs Goddard did have an appointment with her General Practitioner for Wednesday the following week, and an outpatient appointment in two weeks with the orthopaedic surgeon. Being a Sunday, Mrs Goddards daughter decided to take her into the emergency department for review.

On admission to the emergency department, her clinical observations were documented as:

BP 190/110

HR 120

RR 28

SpO2 96% with 6L oxygen via Hudson mask

AE: diverse crackles auscultated bilateral lung fields

Pitting oedema bilateral legs

A peripheral intravenous cannula was inserted, and bloods were taken. She was prescribed intravenous Furosemide 80mg which was administered with good effect. Mrs Goddard was admitted with exacerbation of heart failure for investigation.

******Readings from the topic are below:

Durham, B. (2015). The nurses role in medication safety.Nursing,45(4), 14. https://doi.org/10.1097/01.NURSE.0000461850.24153.8b

ISSN: 0360-4039

Khalil, V. (2020). Evaluating the impact of various medication safety risk reduction strategies on medication errors in an Australian health service.International Journal of Clinical Pharmacy,42(6), 15151520. https://doi.org/10.1007/s11096-020-01142-w

ISSN: 2210-7703

Roughead, L., Semple, S., & Rosenfeld, E. (2013).Literature Review: Medication Safety in Australia(pp. 1126). Australian Commission on Safety and Quality in Health Care. https://ourpillstalk.com.au/wp-content/docs/Literature-Review-Medication-Safety-in-Australia-2013.pdfBurton, C. R., & Smith, C. (2012). Understanding stroke. I. Bullock, J. McCleod Clark, & J. Rycroft-Malone (Eds.),Adult nursing practice: using evidence in care(pp. 206222). Oxford University Press. https://ebookcentral.proquest.com/lib/unisa/reader.action?docID=5831054&ppg=231

ISBN: 9780199697410

Allcock, N., & Day, R. (2012). Managing pain. I. Bullock, J. McCleod Clark, & J. Rycroft-Malone (Eds.),Adult nursing practice: using evidence in care(pp. 430445). Oxford University Press. https://ebookcentral.proquest.com/lib/unisa/reader.action?docID=5831054&ppg=455

ISBN: 9780199697410

Prigmore, S., & Scullion, J. (2020). Understanding chronic obstructive pulmonary disease. I. Bullock, J. Macleod Clark, & J. Rycroft-Malone (Eds.),Adult Nursing Practice: Using Evidence in Care(pp. 7592). OXford. https://ebookcentral.proquest.com/lib/unisa/reader.action?docID=5831054&ppg=100

ISBN: 9780199697410

Sartelli, M. (2021). Hospital-acquired pneumonia and ventilator-associated pneumonia. M. Sartelli, R. Coimbra, L. Pagani, & K. Rasa (Eds.),Infections in surgery: prevention and management(1st ed., pp. 6772). Springer International Publishing. https://doi.org/10.1007/978-3-030-62116-2_7

ISBN: 978-3-030-62115-5

Coggon, J. M. (2008). Arterial blood gas analysis 1: understanding ABG reports.Nursing Times,104(18), 2829.

ISSN: 0954-7762

Coggon, J. M. (2008). Arterial blood gas analysis 2: compensatory mechanisms.Nursing Times,104(19), 2425.

ISSN: 0954-7762

Prigmore, S., Knowles, V., & Callaghan, J. (2012). Managing breathlessness. I. Bullock, J. McCleod Clark, & J. Rycroft-Malone (Eds.),Adult nursing practice: using evidence in care(pp. 238255). Oxford University Press. https://ebookcentral.proquest.com/lib/unisa/reader.action?docID=5831054&ppg=263

ISBN: 9780199697410

Spathis, A., Booth, S., Moffat, C. (2017). The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.Npj Primary Care Respiratory Medicine,27, 16. https://www.nature.com/articles/s41533-017-0024-zJorge, A. J. L. . M., & T., E. (2021). Pathophysiology, diagnosis, and management of heart failure. C. T. Mesquita & M. F. Rezende (Eds.),Nuclear cardiology: basic and advanced concepts in clinical practice(1st ed., pp. 383397). Springer International Publishing. https://doi.org/10.1007/978-3-030-62195-7_15

Atherton, J. J., Audehm, R., & Connell, C. (2019). Heart failure guidelines: A concise summary for the GP.Medicine Today,20(6), 1424.

ISSN: 2203-0794

Vuckovic, K., Ryan, C., Yorman, G., & Bierle, R. (2023). Heart Failure: An update for Nurses.Nursing 2023,53(6), 1827. https://doi.org/10.1097/01.NURSE.0000927504.24034.9dAtherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., Hopper, I., Briffa, T., Abhayartna, W., Audehm, R., & Branagan, M. (2018).National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the prevention, detection, and management of heart failure in Australia 2018.Heart, Lung & Circulation,27(10), 11231208. https://doi.org/10.1016/j.hlc.2018.06.1042Brieger, D., Amerena, J., Attia, J., Bajorek, B., Chan, K. H., Connell, C., Freedman, B., Ferguson, C., Hall, T., Haqqani, H., Hendriks, J., Hespe, C., Hung, J., Kalman, J. M., Sanders, P., Worthington, J., Yan, T. D., & Zwar, N. (2018).National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.Heart, Lung and Circulation,27(10), 12111266. https://doi.org/10.1016/j.hlc.2018.06.1043

ISSN: 1443-9506

Sukumar, S., Orkaby, A. R., Schwartz, J. B., Marcum, Z., Januzzi, J. L., Vadaganathan, M., & Warraich, H. J. (2022). Polypharmacy in older heart failure patients: a multidisciplinary approach.Current Heart Failure Reports,19(5), 290302. https://doi.org/10.1007/s11897-022-00559-w

ISSN: 1546-9549

Kim, J., & Parish, A. L. (2021). Nursing: polypharmacy and medication management in older adults.Clinics in Integrated Care,8. https://doi.org/10.1016/j.intcar.2021.100070Australian Government Department of Health and Aged Care. (2022).Guiding Principles for Medication Management in the Community(pp. 1102). https://www.health.gov.au/resources/collections/guiding-principles-for-medication-management-in-the-community-collectionOzasa, N., Kato, T., Morimoto, T., & Yaku, H. (2023). Polypharmacy and clinical outcomes in hospitalized patients with acute decompensated heart failure.The Journal of Cardiovascular Nursing,38(1), 3343. https://doi.org/10.1097/JCN.0000000000000885Wright, D. J., Scott, S., Buck, J., & Bhattacharya, D. (2019). Role of nurses in supporting deprescribing.Nursing Standard,34(3), 4450. https://doi.org/10.7748/ns.2019.e11249