HLTEN504C – Implement and evaluate a plan of nursing care
Assessment Task 2 (Short Answer Questions)
Case study – Ms Singh
Ms Singh (Sangeeta) is a 69 year old retired secretary who lives ‘down the road’ from her daughter and grandchild. Her husband passed
away 6 months ago and since then she has become socially withdrawn; choosing to spend most of her time at home in the garden, or
reading books. She wears bilateral hearing aids and reading glasses. Other than a permanent colostomy (resulting from a large bowel
infarction in 2005) she has had nil significant medical history to report. Ms Singh immigrated to Australia 20 years ago from India.
English is her second language and she practices the Hinduism religion.
Last night Ms Singh was brought in by ambulance (BIBA) to the emergency department after her daughter found her on her bathroom floor.
Ambulance staff report that she was found naked and unable to call for assistance for almost 18 hours. She was diagnosed as having had
a cerebrovascular accident (CVA) with residual right (R) sided hemiplegia, dysphagia and dysphasia.
She is soon transferred to the acute medical ward where you work and is accompanied by her daughter (Nita) who is obviously quite
distressed. Ms Singh appears quiet and drowsy. She is currently Nil by Mouth (NBM) whilst awaiting a speech therapist review.
Her vital signs on arrival are: T 36.9 degrees C; P 115; R 26; SpO2 94% and BP 170/95.
Answer the following:
1. A deficit refers to ‘a lack or impairment in mental or physical functioning’. Using the information from the case study,
identify and define four (4) deficits that Ms Singh presented with (200 words).
2. After review by the speech pathologist, Ms Singh is no longer Nil by Mouth (NBM) and has been placed on a special (modified)
diet.
A) Identify and give an example of each of the 3 (three) levels of modified foods and fluids that are recommended to clients with
dysphagia (100 words).
B) Identify five (5) strategies used to assist the feeding of patients with hemiplegia and dysphagia (100 words – bullet points
acceptable).
3. Assessing Mobilisation:
A) Identify six (6) factors that the nurse needs to consider before mobilising Ms Singh (100 words – bullet points acceptable).
B) What is the most suitable risk assessment tool used in this situation (and why)? (50 words)
4. As a result of the (R) sided hemiplegia, Ms Singh requires assistance to empty and change her colostomy bag. Outline the steps
involved (for the nurse) to change her colostomy bag (100 words – bullet points acceptable).
After 5 weeks on your ward Ms Singh’s condition has shown no improvement. She requires full assistance with all aspects of her ADLs
and still has dysphagia and dysphasia. Her daughter approaches you in tears stating “What’s going to happen to mum now? I work full-
time and cannot look after her. Surely she can’t go home?”
Answer the following:
5. What is the nurse’s role in the discharge planning of Ms Singh? In your answer include when the discharge planning process
should commence and the members of the multidisciplinary team involved (150 words)
6. The Australian Nursing and Midwifery Council (ANMC) have a guide of standards that all nurses must uphold in order to ensure
the ‘good standing’ of the nursing profession – it is known as the ‘Code of Professional Conduct for Nurses in Australia’.
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx . From this document, identify the most
applicable conduct statement(s) relating to cultural awareness that apply to the case study (50 words).
Ms Singh is soon transferred to ‘Serenity Nursing Home’. Over the next several months her condition continues to decline. She has
now developed aspiration pneumonia and her condition has deteriorated rapidly. She has been transferred back to your ward for
intravenous antibiotics. Upon arrival to the ward you notice Ms Singh has a reddened area on her left hip that has not gone away with
relief of pressure. Her daughter Nita explains that her mother has not been sleeping lately and is concerned for her level of rest and
comfort. She also mentions that her mother has an Advanced Health Directive and she has expressed her wish that no active
interventions are to be taken in the event of cardiac or respiratory arrest (Not For Resuscitation – NFR). Supportive measures for
comfort only, will be implemented.
Answer the following:
7. Pressure Area and Decubitus Ulcers:
A) What are the extrinsic and intrinsic factors that cause (or contribute) to the formation of pressure areas/decubitus ulcers?
(50 words)
B) Define what a decubitus ulcer is and identify six (6) of the most common sites where these can occur? (50 words)
C) Identify five (5) strategies you could implement to prevent Ms Singh’s pressure area from worsening and to promote healing?
(100 words – bullet points acceptable).
D) What is the most suitable risk assessment tool used in this situation (and why)? (50 words)
8. Comfort, Sleep & Rest:
A) Identify four (4) factors that you can discuss with the daughter that would help her understand what may be contributing to her
mother’s poor sleep? (100 words – bullet points acceptable).
B) Identify four (4) factors that the nurse can implement to promote sleep? (100 words – bullet points acceptable).
9. What is an Advanced Health Directive? (50 words)
10. Identify three (3) ways you could demonstrate respect for Ms Singh’s decision to not actively be resuscitated? (50 words).
Specific requirements to be included in assessment
Word Count Guideline • Word limits are identified within each question as a guide only; however the total assessment should
not exceed 1500 words (the word limit does not include references, the original question or a title page.
Format & Structure • Read the scenario and then answer the ten (10) questions in a new Word doc and upload to Assessment
Task 2 on completion.
• Please ensure you have your name and student number on the assessment – either as a title page or a header/footer.
Referencing requirements • Each answer must contain APA style intext referencing. Your assessment should also contain a
correctly formatted reference list. The APA referencing guidelines are available in your student support material.
Plagiarism/Academic Misconduct
You must use your own words to answer these questions (not a cut and paste from a textbook or website) and APA style referencing should
be used, both in-text and in the form of a Reference List at the end of the paper. Please note that assessments that contain plagiarism
will be allocated an unsatisfactory grade. Please refer to the student rules for more information.
http://training.qld.gov.au/resources/about/pdf/tafe-qld-student-rules.pdf
File Name SURNAME_HLTEN504C_MS SINGH_CASESTUDY
An example is SMITH_HLTEN504C_MS SINGH_CASESTUDY
Submission Via Connect – HLTEN503b_504C Assessment & Care Planning – Assessment tab 2
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