While Mr Thomas is in Rehabilitation accompanied by his wife It is decided that home support is needed. The Enrolled Nurse is working as part of the interdisciplinary team as the community Nurse; the Rehabilitation centre has commenced an assessment of Mr Thomas and the environment he is living in, while he is still in rehabilitation.

A time and date is agreed upon for the EN to visit Mrs Thomas at home to continue the assessment and commence care planning.

 

You are visiting Mr Thomas and his wife in their home to provide primary health care:                                                                   

Briefly explain to the Thomas's one (1) benefit of receiving care in their home for Mr Thomas

 

We are used to discussing multidisciplinary care and health professionals who make up this team.

A)   Explain how Interdisciplinary care is different.

B)   List four (4) members of the interdisciplinary team and explain their role related to Mr Thomas's care

 

When planning care for Mr Thomas, you have identified various members of the interdisciplinary team within the primary Health Care setting and the roles they have, who else would we need to include in our initial assessment that are not members of the interdisciplinary team? List two (2) people.

Refer to Mr Thomas's history to see who he lives with and other family members he has.       

 

Prior to visiting, the EN asks questions to assess Mr Thomas's home to determine if it is appropriate to deliver wound care. Mr Thomas states they have a dog at their home. Refer to Mr Thomas's history to look at where he lives and what support services are in place already, if any.

List two (2) further questions the EN might ask Mr Thomas to help her decide if this will be a safe work environment?

 

      Following Mr Thomas's discharge from Rehabilitation you are about to undertake a home visit for Mr Thomas.

What are two (2) activities you should undertake prior to this visit and why you should undertake them?         

 

               Infection control is important for all nurses and individuals in any health care environment.

You are at the home, preparing to commence wound dressings at Mr Thomas's home on his chronic ulcer. You have been informed that he has a dog but also a cat. You assume that there is dog and cat hair throughout the house.  

Problem solve this situation and discuss actions that you can use to:

A)   Identify Mr Thomas correctly in this community environment?

B)   Maintain your safety

C)   Maintain Infection Control principles

 

When Nursing in the Primary Health Care Environment, both clients and nurses have rights and responsibilities.

A)   What is one (1) responsibility of Mr Thomas?

B)   What is one (1) responsibility of the Nurse

 

A)   Discuss why the nurse's initial assessment of the individual is so important? Please give 3 reasons.

B)   When aiming to provide holistic care and other than performing a physical assessment, list two (2) other assessments with an explanation (not physical assessments) you as the EN should make.

Again, consider Mr Thomas in your answer.

 

Briefly explain two (2) reasons why monitoring, evaluating and documenting is so important working in a primary health care environment, such as in in Mr Thomas's case. 

 

Identify and discuss one (1) actual and one (1) potential risk/problem for this client considering his confusion in the evenings

For each problem/risk discuss the impact for the client.

 

Considering Mr Thomas and the environment in which he lives, list two (2) changes in:

a.    Mr Thomas OR

b.    His family OR

c.    His environment,

you believe should be reported and what should be discussed with the care team.

(NOT physical changes related to COPD)

 

Explain two (2) professional aspects of your nursing practice to consider when delivering care in Mr Thomas's home environment?

 

Why is health promotion and health education so important in the primary health care environment? Give two (2) reasons.

 

When visiting Mr Thomas at home you were concerned, he was having an exacerbation of his Chronic Obstructive Pulmonary Disease (COPD).

A)   What is an exacerbation of COPD?

B)   What are two (2) physical observations could you make of Mr Thomas, that would cause you concern and may indicate that he is experiencing an exacerbation of his COPD? Explain why?  

 

A.    Briefly explain what health literacy means?                 

B.    How would the EN identify the Thomas's level of health literacy to ensure they understand the important education provided? Explain one (1) way you could do this.   

A.    How could we improve the Thomas' health literacy? List one (1) idea you have and explain.                   

B.    What education could you provide to Mr and Mrs Thomas about possible signs of deterioration that may indicate another exacerbation of his COPD?

C.   Other than Verbal communication to explain, what other method could you use to communicate this important information?

D.   What is a tool you could use to assist Mr and Mrs Thomas in monitoring and responding to his COPD?

E.    What would you advise them to do when considering his day to day health to prevent another hospitalisation?

 

 

Mrs Thomas felt she was finding it more difficult to cope with her husband's early Dementia because at the end of the day he was becoming confused and agitated and wanted to go for walks alone. She was worried he might fall.

What is one piece of advice you could offer to manage his confusion in the late afternoons?

 

One (1) piece of advice given and clearly explained      

 

 

Mr Thomas is taking Warfarin and therefore needs regular monitoring.

A)   From his history can you state why he is taking Warfarin?

B)   What home visiting health service could you request Mr Thomas's GP refer him to, for regular monitoring of his INR?   

 

While visiting Mr Thomas and showering him to assess his care needs, he has a fall and sustains a small laceration to the left side of his forehead.

He almost fell on you and you broke his fall but are not hurt.

He did not lose consciousness. No one else is at home and he is asking you to help him up.

A)   Would you help him up, why/why not?

B)   What would you do?

C)   Who would you notify? Why?

D)   What other first aid do you need to provide?

List two (2) procedures

 

Mr Thomas has a current diagnosis of Osteoporosis. What risk factors are important for Mr Thomas to consider to prevent complications and promote wellness?

Outline two pieces of advice for Mr and Mrs Thomas with an explanation for each.

 

 

Living in the community there are many primary health care services available to support independent living in their communities.

Considering Mr Thomas's history, list one (1) service you could recommend to do the following for one (1) of Mr Thomas' many health problems (it may be a different health problem for each service) and what assistance can this provide for Mr Thomas's health:

a.    Preventative

b.    Curative and

c.    Rehabilitative

1 mark for an appropriate service for a, b and c with brief but appropriate explanation                                  

 

Working in primary health care, list two (2) Nursing and/or Midwifery organisations that would support you working as a nurse providing primary health care.    

 

 We have learnt that there are age specific health issues throughout the life span. The Thomas's have their daughter and grandchildren visit regularly.

List one specific health issue and one health promotion or prevention activity for the following age groups:

A)   Infants

B)   Children

C)   Adolescents

D)   Adults

E)   Older adults over 65 years                       

 

 

         One of the roles of a primary health care nurse is to immunise people across the life cycle to prevent communicable diseases.

A)   Where can a nurse find information on immunisation specific to Victoria

B)   For two (2) of the above groups name one (1) disease that a nurse providing primary health care may vaccinate these groups against 

 

 

           List one (1) Australian Government Health assessment tool that is performed as part of providing primary health care to the community.

Briefly explain the aim of the tools and what primary health setting they would be useful.    

 

Considering Health-Illness Continuums briefly discuss what they are and include why you as an Enrolled Nurse may use one to assist Mr Thomas in understaining his wellbeing.

A brief discussion as to what a Health-Illness Continuums is

                                                                                               1 mark                                                

Why you as an Enrolled Nurse may use a Health-Illness Continuums to support patient wellbeing.

 

Briefly explain to the Thomas's one (1) benefit of receiving care in their home for Mr Thomas

• Home care is a trusted solution for keeping loved ones safe, happy and comfortable especially in Mr. Thomas case. Also there is a Rehabilitation Center available and an Enrolled Nurse who is part of the team to help Mr. Thomas in continuing rehabilitation.

 

We are used to discussing multidisciplinary care and health professionals who make up this team.

A)   Explain how Interdisciplinary care is different.

•  Interdisciplinary care is different because it is created by representatives from several medical disciplines or specialties, each focused on a specific patient's condition, treatment goals, and methods for improving outcomes.

 

B)   List four (4) members of the interdisciplinary team and explain their role related to Mr Thomas's care

• Enrolled Nurse is a community nurse who assigned to continue the assessment and commence care planning.
• Physician who prescribes medication, who give orders
• Physical Therapist help Mr. Thomas in rehabilitation to improve their ability to move, reduce or manage pain, restore function
• Occupational Therapist  they help Mr. Thomas in promoting independence and self-care.

 

When planning care for Mr Thomas, you have identified various members of the interdisciplinary team within the primary Health Care setting and the roles they have, who else would we need to include in our initial assessment that are not members of the interdisciplinary team? List two (2) people.

• Social workers it will help Mr. Thomas if he needs help in regards to mental, behavioral, and emotional issues.
• Chaplain it will help Mr. Thomas to see the value of his life and positive impact he had on the world. Since he is an elderly. It will also give him a chance to talk to about his concerns or fears. Chaplain will help him to comfort up until the very end of his lives.

 

Prior to visiting, the EN asks questions to assess Mr Thomas's home to determine if it is appropriate to deliver wound care. Mr Thomas states they have a dog at their home. Refer to Mr Thomas's history to look at where he lives and what support services are in place already, if any. List two (2) further questions the EN might ask Mr Thomas to help her decide if this will be a safe work environment?

• Do you have on going house renovation or construction? (Because it will cause infection to the wound if it is exposed to the dirty environment like cements, sands, rust, etc.)
• Do you have efficient electricity or power supply? (Because it will cause eye disturbance if their is no good power supply, you cannot perform wound care well)

 

 

Following Mr Thomas's discharge from Rehabilitation you are about to undertake a home visit for Mr Thomas.

What are two (2) activities you should undertake prior to this visit and why you should undertake them?    

• Make a home care plan for Mr. Thomas so that you can be able to perform and do your activities well
•  Check all the papers, equipment, materials needed in the visit it will help you to save time and energy. If your materials are complete, you can record your assessment and do your job well.

 

 Infection control is important for all nurses and individuals in any health care environment.

You are at the home, preparing to commence wound dressings at Mr Thomas's home on his chronic ulcer. You have been informed that he has a dog but also a cat. You assume that there is dog and cat hair throughout the house.  

Problem solve this situation and discuss actions that you can use to:

A)   Identify Mr Thomas correctly in this community environment?

• Explain the source of infection, the importance of infection control,

B)   Maintain your safety

• Place the cat and dog outside

C)   Maintain Infection Control principles

• Always wash your hands
• Do not touch the pet if necessary
• Proper disposal of waste

 

When Nursing in the Primary Health Care Environment, both clients and nurses have rights and responsibilities.

A)   What is one (1) responsibility of Mr Thomas?

• Responsibility to cooperate during a house visit, responsibility to take medications, and doctors prescription well.

B)   What is one (1) responsibility of the Nurse

• Responsibility to give appropriate care to Mr. Thomas

 

A)   Discuss why the nurse's initial assessment of the individual is so important? Please give 3 reasons.

• To know what initial action that needs to do
• To know the priority intervention
• To know what is the cause of the problem

 

B)   When aiming to provide holistic care and other than performing a physical assessment, list two (2) other assessments with an explanation (not physical assessments) you as the EN should make.

Again, consider Mr Thomas in your answer.

• Emotional/Mental assessment is necessary for identifying and nurturing the feelings, conscious inner state, and intellect of Mr. Thomas
• Social Health Assessment it will help Mr. Thomas to determine his ability to interact and form meaningful relationships with others. And also to know how he adapt in social situations. 

 

Briefly explain two (2) reasons why monitoring, evaluating and documenting is so important working in a primary health care environment, such as in in Mr Thomas's case. 

• It will help to protect the health care provider and Mr. Thomas. Good documentation promotes patient safety and quality of care. Complete and accurate medical recordkeeping can help ensure that your patients get the right care at the right time.

 

Identify and discuss one (1) actual and one (1) potential risk/problem for this client considering his confusion in the evenings

For each problem/risk discuss the impact for the client.

• Actual Problem: Imbalanced nutrition less than body requirements it will affect his physical health, poor nutritional status.
• Potential/Risk Problem: Risk for Injury it will give additional problem to the patient like falls and injuries since he has confusion

 

Considering Mr Thomas and the environment in which he lives, list two (2) changes in:

a.    Mr Thomas

• able to cope up easily
• able to obey and participates in all activities that will help him to gain healthy life

 

Explain two (2) professional aspects of your nursing practice to consider when delivering care in Mr Thomas's home environment?

• Respectful
• Passionate

 

Why is health promotion and health education so important in the primary health care environment? Give two (2) reasons.

• It helps empower individuals and communities to live healthier lives by improving their physical, mental, emotional and social health
• Helps to increased their knowledge and influencing their attitudes about caring for their well-being.

 

When visiting Mr Thomas at home you were concerned, he was having an exacerbation of his Chronic Obstructive Pulmonary Disease (COPD).

A)   What is an exacerbation of COPD?

•  is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.

B)   What are two (2) physical observations could you make of Mr Thomas, that would cause you concern and may indicate that he is experiencing an exacerbation of his COPD? Explain why?  

• Breathless all the time and it severely limits everyday activities, such as dressing and undressing because it means their is not enough oxygen supply to the body.
• Mucus (sputum) that is yellow or greenish because it means he has a severe chronic cough

 

A.    Briefly explain what health literacy means?

• degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.        

       

B.    How would the EN identify the Thomas's level of health literacy to ensure they understand the important education provided? Explain one (1) way you could do this.   

• By answering open ended questions, make a return demonstration in a simple things

 

A.    How could we improve the Thomas' health literacy? List one (1) idea you have and explain.        

• Always remind the patient everyday, and explain the activities that you are doing to him.           

 

B.    What education could you provide to Mr and Mrs Thomas about possible signs of deterioration that may indicate another exacerbation of his COPD?

• Explain the signs and instruct to call the health care provider immediately if he experience:

- Increased Shortness of Breath

- Wheezing

- Worsening Cough

- Edema

 

C.   Other than Verbal communication to explain, what other method could you use to communicate this important information?

• using actions or return demonstrations, by watching tv, by giving flyers and tarpaulins

 

D.   What is a tool you could use to assist Mr and Mrs Thomas in monitoring and responding to his COPD?

• by the used of pulse oximeter, it helps to monitor oxygen saturation level.

 

E.    What would you advise them to do when considering his day to day health to prevent another hospitalization?

• conserve energy
• avoid polluted environment
• eat a well balanced meal
• take medications as prescribed
• avoid used of cigarettes and tobacco

 

Mrs Thomas felt she was finding it more difficult to cope with her husband's early Dementia because at the end of the day he was becoming confused and agitated and wanted to go for walks alone. She was worried he might fall.

What is one piece of advice you could offer to manage his confusion in the late afternoons?

One (1) piece of advice given and clearly explained

      

• Stick to the same schedule every day to help your loved one feel more calm and collected. Try to avoid making changes to routines that work for you both. If you need to make changes, try to adjust their routine gradually and as little as possible. Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar. In the evening, try to reduce background noise and stimulating activities, including TV viewing, which can sometimes be upsetting.

 

Mr Thomas is taking Warfarin and therefore needs regular monitoring.

A)   From his history can you state why he is taking Warfarin?

• Prophylaxis and treatment for arising pulmonary embolisms because he has COPD

 

B)   What home visiting health service could you request Mr Thomas's GP refer him to, for regular monitoring of his INR?   

 

While visiting Mr Thomas and showering him to assess his care needs, he has a fall and sustains a small laceration to the left side of his forehead. He almost fell on you and you broke his fall but are not hurt. He did not lose consciousness. No one else is at home and he is asking you to help him up.

A)   Would you help him up, why/why not? Yes because you are the EN in charge, you have the right for the patient

B)   What would you do? Assess level of consciousness, placed in a safe area

C)   Who would you notify? Why? Health care provider, because he has small laceration

D)   What other first aid do you need to provide? Provide a pressure to the left side of the forehead to reduced bleeding, provide an ice pack to provide comfort and reduced swelling.

 

Mr Thomas has a current diagnosis of Osteoporosis.

What risk factors are important for Mr Thomas to consider to prevent complications and promote wellness?

Outline two pieces of advice for Mr and Mrs Thomas with an explanation for each.

• Exercise daily as tolerated
• Keep safe always
• Do not carry heavy objects
• Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains.
• limit alcohol consumption.
• limit caffeine.