Using current, reliable journal articles to support your thoughts and ideas (Textbooks are not appropriate sources in this section)  Describe what you might expect to see, hear and/or feel when you do your initial assessment of Brian AND  Explain why you might expect to see, hear or feel these findings  (150 words)

Brian is 65 years old and lives with his dog ‘Spider’ in a town flat on the first floor of a block of units

in a government housing estate.

 

About a year ago Brian had to move to town from his home community because his increasing

health needs could not be readily met in his community. He misses his community, the close bonds

with family and friends back home and is worried about his family’s welfare in his absence.

 

Brian has been a smoker for 30 years. He smokes 20 cigarettes per day and has a history of

recurrent chest infections, hypertension, sleep apnoea and gout. He has a persistent cough that he

calls a ‘smoker’s cough’. Recently he has noticed his cough is getting worse and producing greenish

colored sputum.

 

Over the last few days he has been finding it increasingly difficult to walk up stairs and to look after

himself. He now has to stop every few minutes to catch his breath and decided it was time to come

to the Emergency Department at the hospital where you are practicing.

 

On your shift today, the Emergency Nurse gives you the following handover as part of

Brian’s admission to the setting where you are practicing today as a registered nurse:

Brian presented to the Emergency Department because his respiratory function has been

deteriorating over the last few days. After medical review, his provisional medical diagnosis is an

acute chest infection exacerbating suspected chronic obstructive pulmonary disease. He is being

admitted for treatment and further investigation of his respiratory function.

 

Brian’s current medications include allopurinol, cilazipril and metoprolol and in the emergency

department he has had first doses of ampicillin and a combination bronchodilator by metered dose

inhaler which are to continue until review. The doctor also ordered low flow oxygen via nasal

prongs, chest physio after the bronchodilator therapy and a high energy, high protein diet.

 

The Emergency nurse also tells you that Brian has reported he hasn’t had a shower for two days

because he gets “too puffed out’ and that he is very worried about his dog ‘Spider’ who has been left

locked up alone in his flat. He also is concerned that his family back in the community doesn’t know

that he’s not well and had come to hospital.

 

Your task in Assessment 1 is to critically discuss some of the key nursing issues related to

Brian’s care on your shift. Details of the specific nursing issues to address are identified on

the following pages.

Tasks

Based on Brian’s case and the information you have available, address the following seven

(7) items.

 

Do not make up or assume information in relation to Brian’s case. Only use what you

know from the case study information on the previous page.

 

Note: In most items Assessment 1, textbooks are not appropriate resources.

 

Item 1: Clinical presentation No Textbooks are to be used in this section

Brian is part of your patient allocation for your shift today. You haven’t met or seen him 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 Brian.

 

Using current, reliable journal articles to support your thoughts and ideas (Textbooks are not

appropriate sources in this section)

 Describe what you might expect to see, hear and/or feel when you do your initial assessment of

Brian AND

 Explain why you might expect to see, hear or feel these findings

 (150 words)

Item 3: 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 to monitor the patient to

ensure they are responding to prescribed medications as they should.