Title: Foundations of Clinical Practice: Case Study 2023-2

Student name: Dhyani Sakhiya

Student number: 21314708

Unit: NURS1000

Unit Coordinator: Joy Sears

Date Due: 21st September 2023

I declare that this assignment is my own work and has not been submitted in any form for another
unit, degree or diploma at any university or other institute of tertiary education. Information derived
from the published or unpublished work of others has been acknowledged in the text and a list of
references is given. I warrant that any disks and/or computer files submitted as part of this
assignment have been checked for viruses and reported clean.

Student electronic signature: ___Signature_______________________________

Date: _______________21s September 2023___________________

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Read the following information and then answer the questions below within this template.

Antonio Rodrigues was born in Queensland in 1972 (DOB: 06/12/72) Patient Number
A12345678. He was an only child and was found to be profoundly deaf. In 1982, his family moved to
Perth as they thought he would be better educated at a special school for deaf children.
In 1992 he found that he loved to work with theatre set designs and subsequently went to a
tertiary college to learn to be a carpenter. After completing his trade diploma, he set himself up in a
small business doing carpentry jobs.
He married Maria in 1997 when they discovered she was pregnant with their daughter
Isabella. In 2013 Maria and Antonio divorced, and Isabella went to live with her mother as Antonio
entered a relationship with Raymond. Antonio and Raymond are very fond of Isabella and regularly
invite her and her two children to their home at 5 Short Street, Doubleview.
At Maria’s insistence, Antonio gave up cigarette smoking in 2009 after he developed “hay
fever” with no known allergen determined. In 2017 he was diagnosed with Type 2 Diabetes. He was
not very compliant with his diet and blood glucose regulation and rapidly developed poor sight and
hypertension. In 2019 he discovered that he had almost no feeling in his feet (neuropathy) after he
was found to have a needle embedded in his right foot. This resulted in the amputation of his second
toe. In 2019, he also had a cataract removed from his right eye, and the left cataract was removed in
2020.
On Monday 31st of July 2023, he presented to his doctor with an infected right foot. He
thought he had a minor infection of a crack in his heel. The doctor discovered that he had a stone
embedded in his heel and removed it before sending him to the hospital for admission.

On admission to Curtin Hospital, Ward 3 Room 14 it was decided that Antonio needed surgery
to remove all the dead tissue in the wound and antibiotics to combat the infection. He felt “hot” to
the touch (Temperature 38.5°C) and quite unwell. His heart rate was 105 beats per minute, his
respiratory rate was 22 breaths per minute, and his blood pressure was 160/90 mmHg.
After the surgery, Antonio was confined to bed for five days. He had to have his leg elevated
to reduce the swelling. His vital signs returned to normal levels after he commenced the antibiotics
(T 368, HR 86, RR 18, BP 140/86). Antonio was very unhappy as he disliked attending to his meals,
hygiene and elimination needs in the bed, and he felt that the staff were never available to assist
him when he needed them. He told Raymond that most of them did not recognise his hearing
disability. He was feeling very tired because the nurses kept waking him to check his vital signs.
On the 6th August, he was allowed to move around using crutches, and he began his transition
to go home on Monday 7th August. Antonio will not be able to weight bear for four weeks. When he
gets home, he will have a visit from a Community Nurse every day to have the wound dressed.

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Answer the questions below on this template and put your word count after each of your answers.
The word count does not include the question but does include your in-text references.
The total word count is 600 ± 10%. You must put a reference list at the end of the document.

A Registered Nurse asks a Student Nurse to complete a Gordon’s Functional Health Assessment on
Antonio to prepare for his person centred care planning.
1. After considering the information presented in the case study, identify four relevant
Functional Health Patterns (General assessments) requiring further investigation
(Focused assessments) for Antonio? Include evidence-based rationale to support this
answer. (Approximately 200 words)
Marjorie Gordon highlighted four major health assessment patterns. These patterns
give guidelines to prepare for Antonio’s person centred care planning. (Functional
Health Patterns - M. Gorden, 2020). Firstly, Health Perception and management
which makes it important to understand the history about Antonio’s type 2 diabetes
and non-compliance with the diet. It also comprehend Antonio’s regulations of blood
glucose levels that has raised concerns about health perception and management.
There is need to understand his perception of his health, diabetic awareness and
management and factors that leads to non-compliance helps in guiding person
centred planning. Secondly, Antonio’s foot infection indicates some limitations in his
activity and exercise patterns. To develop tailored intervention, there is need to
investigate his current physical activities and mobility issues. Thirdly, because of
diabetes related issues that has led to cataract surgery for both eyes suggest a lot
about cognitive perceptual patterns. There is need to investigate his visual challenge
and copying mechanism to suggest strategies that for enhancing a safe environment
and communicating effectively. Lastly, there were changes of relationships where
Antonio’s change his marital status from marrying Maria to entering into relationship
with Raymond. There is need to investigate his social support and the dynamics
about his relationship and the mechanisms to copy with his life transitions. It helps to
describe about his psychological understanding and help in personal care planning.
(Reihchelle Bayad, 2013)

Word count: 219

2. Discuss two basic nursing care skills that a nurse would offer to Antonio during his
hospitalisation. Using critical thinking processes, state clearly the rationale for selecting
these two skills. Check essential textbooks for a reference. (Approximately 150 words)

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Firstly there is need to provide wound care management for Antonio as he is already having a
foot infection. In this nursing skill, Antonio need to undergo treatment of his wound, undertake
minor surgeries to remove stone that was in his infected foot (Rn) et al., 2021). Antonio will
also require proper dressing to avoid further infection and enhance fast healing of the wound
as well as monitoring any complications further. Secondly, Antonio needs to be health
education and management of diabetes. (Livingston et al., 2020). As a nurse, there is need to
provide tailored information about the management of diabetes since Antonio was diagnosed
with type 2 diabetes and poor compliance with diet. Antonio, need emphasis of adhering to
diet restrictions and monitor blood glucose levels as well as knowing the effects of non-
compliance diet. The needs for Antonio requires critical thinking to understand preferred
learning methods and the potential barriers. It helps to achieve effective delivery of his
education.

Word Count: 153

3. Name one risk management tool a nurse could implement to assist in managing
Antonio’s care while in hospital. Include evidence-based rationale to support this
answer. (Approximately 150 words)

The most effective and reliable risk management tool is the Braden scale. (Kennerly
et al., 2022). A nurse can employ this tool to help in managing Antonio’s health state
while he is in the hospital. It is suitable for Antonio’s state because recently Antonio
undergone surgery and movement restrictions which may lead to high-pressure
ulcers. Braden scale is based on six common risk factors. They include moisture,
activity, sensory function, mobility, nutrition, friction and shearing force. Braden
scale tool is valuable tool for patients like Antonio who are developing pressure
ulcers because of some movement restrictions and surgeries. When Braden scale is
regularly used, it helps nurses to identify potential risk, develop preventive
mechanisms and monitor changes in Antonio’s condition overtime leading to
outcome and quality care. Braden scale reduces the risk of Antonio developing
pressure ulcers because the tool heighten surveillance and bed alarms.

Word count: 142

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After a final assessment by Doctor Elizabeth Stevens, Antonio is to be sent home for ongoing
wound care.
Consider the communication strategies that should be implemented in the community to ensure
that Antonio can communicate with the Community Nursing Organisation.
4. Provide one example of an important communication strategy and link this to
recognised strategies for assisting deaf people in health care. (Approximately 100
words)
A good communication strategy for Antonio’s care plan is visual communication. This
is generally by use of whiteboards or written formats. This method of communication
will enhance effective communication with Antonio. (Sign Health, 2020).The reason
for this is that it is in line with recognized methods of communication to assist deaf
persons in hospitals. It promotes visual communications and written instructions to
improve understanding. When we use visual aids, there is clarity and Antonio will
participate in the discussion fully about is personal care plan, wound care
management, and treatment and medications. (National Association of the Deaf -
NAD, 2023). Health care promoters must as well be in a position to understand some
basics of sign language, which gives further support to effective communication.
Antonio will actively engage himself in his healthcare decisions. (Organization, 2021)

Word count: 123

Total word count for answers 1 - 4 ( 600)

5. Complete the following ISOBAR handover tool using the information available in the
case study to enable the Discharge Nurse to give a handover to the Community Nurse.
(Not included in word count)

Identify Discharge nurse: Dhyani Sakhiya

Referring organisation/ward: Curtin Hospital, Ward 3 Room 14
Actual discharge date: Monday 7th August
First Community Nursing visit due: Monday 7th August

Patient ID number: A12345678

Name: Antonio Rodrigues
Date of birth: 06/12/72
Address: 5 Short Street, Doubleview

Situation Current diagnosis at discharge: Wound infection in right foot heel

Reason for referral: Post-Surgery care and Wound dressing

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Observations
-Recent vital signs and
clinical assessment
Background
-Relevant new information
related to the patient
Assessment & Plan
-Problems identified and
what needs to be done
Ready for discharge
-what needs to be achieved
for discharge and by whom?
-estimated discharge date
-communicate this plan with
patient & the community
nurse team
Recent vital signs: T_368__HR 86___R_18__BP__140/86_
Description of wound:
 Location of wound: Right foot heel
 Frequency of visits: Daily
Presenting complaint at hospital: Infected wound of right foot
History of presenting complaint: Embedded stone in heel
Medical history: Hypertension, Type 2 Diabetes, Neuropathy
Surgical history: Cataract surgery, Amputation of the second toe, and Foot
surgery for wound debridement
Allergies: None
Roles and relationships: Formerly married to Maria, in a relationship with
Raymond, and daughter Isabella
Sensory or cognitive deficit: Had profound deafness
Work status: Carpentry
Primary problem identified: Infected right food wound
 Action plan: Daily wound dressing by Community Nurse, taking
antibiotics as prescribed
Risk assessments:
 Action plan: Monitor for signs of infection, especially given
history of poor blood glucose regulation
Activity of daily living assistance:
 Action plan: Assistance required with meals, hygiene and needs
for the elimination for next four weeks due to inability to
weight bear.
Planned discharge date: Monday 7th August
Requirements for discharge:
 Medical: Monitor blood glucose levels, continue wound care
and antibiotics
 Nursing: Daily dressing of wound and assisting with daily
activities
 Allied Health: None
Discharge discussed with patient: Yes / No: Yes
Discharge plan sent: Yes / No: Yes
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 References

References

Functional Health Patterns - M. Gorden. (2020). Currentnursing.com.

https://currentnursing.com/theory/functional_health_patterns.html

Kennerly, S. M., Sharkey, P. D., Horn, S. D., Alderden, J., & Yap, T. L. (2022). Nursing Assessment

of Pressure Injury Risk with the Braden Scale Validated against Sensor-Based Measurement

of Movement. Healthcare, 10(11), 2330. https://doi.org/10.3390/healthcare10112330

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns,

A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N.,

Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., & Orgeta, V. (2020).

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The

Lancet, 396(10248), 413–446. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392084/

National Association of the Deaf - NAD. (2023). Www.nad.org.

https://www.nad.org/resources/technology/video-remote-interpreting/

Organization, W. H. (2021). World report on hearing. In Google Books. World Health Organization.

https://books.google.co.in/books?

hl=en&lr=&id=zMRqEAAAQBAJ&oi=fnd&pg=PR5&dq=addressing+hearing+impairment+

of+patients+by+using+appropriate+communication+strategies+during+patient+education+is

+essential+to+ensure+comprehends+and+retains+the+information+provided

Reihchelle Bayad. (2013, January 4). Gordons 11-functional-health-patterns. Slideshare.

https://www.slideshare.net/ReihchelleBayad/gordons-11functionalhealthpatterns

Rn), O. R. for N. (Open, Ernstmeyer, K., & Christman, E. (2021). Chapter 20 Wound Care.

Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College.

https://www.ncbi.nlm.nih.gov/books/NBK593201/

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Sign Health. (2020). 12 tips for communicating with Deaf patients - SignHealth. SignHealth.

https://signhealth.org.uk/resources/learn-about-deafness/tips-for-communicating-with-deaf-

patients/