NRSG259-Part A – identifying three nursing care priorities

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CLINICAL SCENARIO – We use NRSG259 Tutorial scenario Giuseppe’s situation as
an example to help you understand and structure of Assessment One.
INTRODUCTION: (175 words approx.)
 Introduce the topic and any important and relevant concepts to the
 Indicate the purpose of the paper
 Describe the overall plan or structure of the paper
BODY: (1400 words approx.)
Please note that the table below is to guide you to structure the body of the essay.
You will need to use paragraphs to present the discussion in your assignment. The
body of the essay includes Part A and Part B:
Part A – identifying three nursing care priorities
Identify the three nursing care priorities
using the first four steps of the Clinical
Reasoning Cycle
Consideree Functional
Consequences Theory –
(embedded in discussion):
1. Consider the patient – describe facts
and contents. This is the first stage of
the clinical reasoning cycle, the nurse
begins to gain an initial impression of
the client’ situation.
For example:
This is an 89 old client – Giuseppe
Guinta. He feels breathless on
exertion, with wheezing and chest
tightness. A 5 x 6x 0.2 cm ulcer is
found at his right ankle, with a fair
amount of exudate and an offensive
2. Collect cues/information – review the
information, gather new information and
recall knowledge;
Giuseppe had a history of smoking for
20 years, COPD for 10 years,
hypertension and cardiac failure for 6
Giuseppe feels tired easily and has
difficulty climbing stairs and managing
garden recently. His leg ulcer shows no
sign of improvement. He also feels
embarrassed about the smell and
exudate from his leg ulcer…
performing ADLs; a risk of being
socially isolated and depression.
3. Process information – to interpret,
discriminate, relate, infer, match the
data and predict an outcome.
 COPD – related to smoking
 Shortness of breath – related to
COPD and cardiac failure…
 Leg ulcer – related to immobility,
smoking, cardiac failure and
(You should expand each point with support
of the literature evidence.)
4. Identify problems/issues – synthesise
all the information that has been
collected and processed in order to
identify the most significant patient
problems or issues. You only need to
identify three (3) issues for this
You can conduct a literature search on your
client’s issues and find relevant nursing
diagnoses for each of the identified
problems. Here is a useful link for some
nursing diagnoses for COPD as an
We have chosen the “Ineffective breathing
pattern” as the top priority of care.
Part B: Having identified all of the nursing care priorities, choose the top
priority of care and then discuss using the remaining 4 steps in the Clinical
Reasoning Cycle
5. Establish goals – setting up the goal
with the patient (demonstrating
dignity) for the particular nursing issue.
The goal should be specific,
measurable, achievable, realistic and
timely (SMART).
The goals for managing ineffective
breathing pattern could be:
 Giuseppe’s frequency and severity of
the shortness of breath will be
reduced to the level that John can
tolerate within a week.
 Giuseppe will be able to climb the
stairs with decreased breathlessness
in one month.
You can write more goals according
to the nursing issues identified.
Considering Giuseppe’s age, his
pathological conditions,
psychological stressors, living
environment, life style, and social
network, etc. throughout the clinical
reasoning cycle wherever it is
6. Take action – showing your nursing
interventions/strategies with the
relevant rationale(s) for each
 deep breathing exercise to
increase the lung expansion and
prevent pneumonia
 refer Giuseppe to GP for
consideration of provision of
home oxygen, bronchodilators
and antibiotics;
 ADLs assessment and
organising a carer to assist
Giuseppe with ADLs if needed.
 Falls’ risk assessment
(You should expand each point with
support of the literature evidence. The
rationale for each action should be
7. Evaluate outcomes showing the expected
outcomes and how you would evaluate
them (objectively and subjectively). These
should relate to your Goals. Think about
using both objective and subjective data
to evaluate the effectiveness of the
nursing actions.
 Giuseppe is able to wash and dress
himself within minimal
 Giuseppe is able to take the stairs
with minimal breathlessness after
using bronchodilators.
(You should expand each point with support
of the literature evidence.)
8. Reflection – what you have learned
from this process and what you could
have done differently. E.g.
Next time, I would…
I should have …
If I had…
I now understand…
Here are a few examples:
 I now understand the effects of
COPD in limiting ability to carry out
 If I had more knowledge of COPD I
would understand the impact on the
patient’s ability to undertake their
 I now understand the effects of long
term smoking on lungs.
(You should expand each point with support
of the literature evidence.)
CONCLUSION: (175 words approx.)
 In several sentences summarise what you have discussed. – THIS IS NOT
A REPEAT of what you have written previously.
 Then provide overarching statements that provide the reader with the most
important take-home messages regarding the care plan for your client.
Useful tips: The introduction and the conclusion need to be written AFTER the content
has been written, not before.
REFERENCES (12-15 references approx.)
Two key references must be included:
Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New
Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs
Forest, NSW: Pearson.

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