Scenаriо 1 Surrаnаh is a 72 year оld lady whо has recently been admitted to a respiratory ward with a chest infection and exacerbation of her COPD. She is currently receiving oral antibiotics and steroids and is improving slowly. This is her third admission in six months with the same issue. On admission it is noticed her weight has dropped 6kg since her last admission and her clothes and nightwear is baggy. Her MUST score is 2 and a referral to the dietician is actioned. She is known to be a smoker and although she has tells you she has cut down in the last year she is still smoking daily. Her exercise tolerance has dropped and she now struggles to get washed and dressed without stopping to catch her breath. She has a productive cough in the morning but this eases over the day. She is being planned for discharge and an occupational therapist is going to do a home visit to assess the suitability of the home environment and if there is a need for any support aids to help Surranah stay at home. Surranah lives with her husband Danesh who is 80 and is in poor health. She has two sons who live locally, one of whom is single and the other who is married with a 3 month old baby. A year ago Surranah cooked when the family got together regularly but since she has become unwell these times of contact have dwindled. Provided a summary of the altered physiology of a patient with COPD. Your answer should include the impact on the normal respiratory function as well as an explanation of symptoms a patient might experience and why and the risk factors for developing this condition. (25 marks) From the scenario identify 5 care needs Surranah might have and explain what impact these might have on her considering physical, emotional, psychological where appropriate. (15 marks) Chose one of the care needs you have identified and create a nursing plan of care including SMART goals and provide rationale to support your plan and interventions (20 marks) Discuss the impact of chronic lung disease on the family unit and the NHS in respect of capacity and budget. What current public health initiatives are that aim to tackle this issue? (15 marks) Scenario 2 Carol is a 62 year old woman. She lives alone in a rented bungalow. She is in a relationship with Peter who lives locally. She has experience of severe and enduring mental health needs. She has a diagnosis of schizoaffective disorder. Carol recalls problems with her mental health since her adolescence. She has four adult children from a previous marriage. She only has direct contact with her youngest daughter who lives locally. Carol has recently been diagnosed with breast cancer. She has an appointment in an outpatient clinic to discuss her treatment plan in a few days time. Her parents are both deceased. She describes a chaotic childhood spent between care placements. She worked in a factory for 10 years before leaving work due to recurrent mental health needs, approximately 15 years ago. Carol is prescribed a depot antipsychotic - flupentixol decanoate and lithium carbonate. She has a good relationship with her local GP. Her local practice administers her depot on a fortnightly basis. She is currently hostile and irritable. Her speech is slightly rapid. She says she is subjectively depressed. She is sleeping poorly. Her daughter has called to tell you she thinks Carol has been walking around her local village late at night. Carol dismisses this and tells you “it’s none of her business what I do”. Carol is a smoker. She smokes 30 cigarettes a day. She does not drink alcohol or use drugs. She has a reduced appetite. Her relationship with Peter can be changeable. They are currently happy together and Peter does not express any further concerns. Provide a description of the pathophysiology of a patient with a diagnosis of cancer. Your answer should include symptoms Carol could experience and the investigations she might undergo at her upcoming appointment. (15 marks) Identify maximum of 5 care needs for Carol including what problems these could cause and propose a nursing intervention for each. (25 marks) Describe and consider the ethical and legal implications of the health needs that Carol presents with. Identify and discuss the role of individuals that may be involved in ongoing care. (20 marks) Identify a relevant public health initiative relevant to Carol’s case, considering the impact the target of the campaign has on the wider NHS. (15 marks)
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