HLTENN005 Contribute To Nursing Care Of A Person Assessment

Subject Code :- HLTENN005
Title :- Contribute To Nursing Care Of A Person With Complex Needs
Assessment Type :- Case Study 4
Instructions to the student
This assessment comprises of two (2) parts.
 Part A – Short answer knowledge-based questions based on the case study attached.
 Part B – Practical skills relating to caring for the patient in the case study.
During this assessment you will be assessed on your ability to analyse the information you have been provided on your patient and use it to plan care and perform nursing interventions specific to the care of the person with complex needs.
HLTENN005 Contribute To Nursing Care Of A Person Assessment

HLTENN005 Contribute To Nursing Care Of A Person Assessment

Part A – Short answer knowledge-based case study questions
You are required to read the case study background information on Mrs xxx and use this information to answer the eleven (11) questions relating to her care. The answers you provide should be related to the patient information provided and all rationales of care should relate to patients’ specific needs.

You are to:
 Answer the questions from the perspective of a qualified Enrolled Nurse.
 Use correct anatomical and medical terminology in your answers.
 Reference your answers using the APA 6 th Edition referencing standard.

This part of the assessment must be completed prior to undertaking Part B – Practical Skills.

Part B – Practical skills
The practical skills component of this assessment will take place on campus in the clinical skills lab at a time outlined in your course timetable. You will be required to print this assessment prior to attending campus.

HLTENN005 Contribute To Nursing Care Of A Person With Complex Needs Assessment 4 

The five (5) skills to be demonstrated as part of this assessment are as follows:
Skill 35.1 Performing a neurological assessment
Skill 20.4 Measure oxygen saturation
Skill 31.6 Insertion of a female urinary catheter
Skill 31.7 Emptying collection bags
Skill 31.8 Removal of indwelling urinary catheter

The practical skills you will be assessed on will be conducted against the competency checklists provided in the textbook (unless indicated otherwise):

HLTENN005 Contribute To Nursing Care Of A Person Assessment

The non-invasive skills will be simulated with one of your classmates representing the patient. The invasive skills will be simulated with a mannequin representing the patient.

During this part of the assessment your educator will ask and discuss your rationales for your nursing actions and will ask you clarifying questions as this will encourage you to think critically problem-solve and identify the evidence that underpins your knowledge.

Deliverables for this assessment :-
To gain a satisfactory result for this assessment you will need to upload all the following documents into OpenSpace in one submission. Your OpenSpace assessment submission is to include:

 This assessment including your completed assessment cover sheet. This is to be submitted in a word doc format
 Part A – Your completed responses to your short answer case study questions on Mrs xxx. This is to be submitted in a word doc format
 Part B – Copies of your five (5) clinical skills checklists which are to be demonstrated as part of this assessment.

Once uploaded your educator will assess your assessment submission and provide feedback to you on the Assessment Evidence Checklist attached to this assessment.

You will be given either a Satisfactory or Not Yet Satisfactory result. If your result is Not Yet Satisfactory you will be given a due date for resubmission and feedback indicating what areas need addressing to gain a satisfactory result.

Case study background information – Mrs xxx

xxx is a 72-year-old English lady who lives with her partner Malcolm in their own 2- bed room house. xxx has two daughters who visit regularly and she cares for one of her grandsons on Tuesdays and Thursdays while his parents are working.

xxx presented to her GP following a 12hr history of droopy eye’ which is diagnosed as ptosis.

On neurological examination the GP noted that her L) pupil was sluggish to respond to light and she was hypertensive 172 / 98mmHg on assessment. Neither of these symptoms were present in xxx’s past medical history so suspecting a neurological event.

HLTENN005 Contribute To Nursing Care Of A Person Assessment

The GP sent xxx to the local hospital for an MRI and further investigation by the neurological team. Now in the hospital xxx complains of a sudden intense headache with visual disturbance neck stiffness and nausea.

Past medical history 
 Hypertension, diagnose 20 years ago
 Hypercholesterolaemia diagnosed 20 years ago 
 L) TKR, 10 years ago 
 Osteoarthritis 
 Psoriasis diagnosed 55 years ago 
 L) Leg DVT, post TKR

Vital signs 
 Pulse: 115 beats per minute 
 BP:172/98 mmHg
 Respirations: 26 breaths per minute
 Temperature: 38.4oC

Current medications include:
 PO Ibuprofen 400mg QID 
 PO Panadol Osteo 650mg TDS 
 PO Simvastatin 40mg nocte 
 PO Trandolapril 4mg Daily 
 Celestone Ointment applied to Psoriatic patches TDS PRN

Part A – Short answer knowledge-based case study questions

Q1 Regular Neurological observations will be necessary for this patient discuss the rationale for under taking these observations.

Q2 Discuss the likely changes you would expect to see in Betty’s neurological and vital signs when her condition deteriorates?  Explain the pathophysiology.

Q3 List three (3) priorities of your immediate care for a rise in intracranial pressure.

HLTENN005 Contribute To Nursing Care Of A Person Assessment

HLTENN005 Contribute To Nursing Care Of A Person Assessment

Case study scenario update

xxx deteriorates and is found unconscious 2 hours following the commencement of her headache.  The MRI scan confirmed she has had a ruptured cerebral aneurysm leading to a large subarachnoid haemorrhage on the R) side of her brain.The plan is for surgery to evacuate the haematoma and repair the aneurysm. An indwelling urinary catheter will be inserted during surgery.

Malcolm, xxx partner becomes very distressed about sudden deterioration.He is anxious and starts to request additional information in a loud manner.


Q5 When answering Malcolm’s questions explain how you would demonstrate the concepts of mediation negotiation or conflict resolution.

Q6 Outline the procedure for the application of anti-embolic stockings and the rationale for their use for this patient.

Q7 Discuss your scope of practice in relation to the care of the deteriorating patient within the inter disciplinary health care team.

Q8 Using the care plan below outline the nursing care and rationale for the management of an unconscious patient and include preoperative care. Provide three (3) actual or potential problems with at least one (1) nursing intervention rationale and evaluation of the goal for each problem you identify.

Scenario update Day 2 Post-op
2 days postoperative xxx is recovering well and has some residual L) leg weakness. She has been mobilising short distances with x1 assistance and a 4-wheel walking frame. She is tolerating a ward diet with free fluids and the doctor has requested her Indwelling Urinary Catheter to be removed.

Q9 Discuss how you can encourage Betty to maintain her own independence taking in to account her physical emotional and psychosocial needs.

Q1 Discharge planning commences on admission.Research three (3) support services Betty might need on discharge and discuss how three (3) members of the interdisciplinary health care team may assist in her recovery at home.

Q1 While preparing Betty for discharge home her partner Malcolm states to you that he is scared about Betty coming home and does not believe he will be able to cope with her increased dependence.  How could you address these concerns with the Registered Nurse?

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