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Nursing care of a patient with altered urinary and renal function

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Topic: Nursing care of a patient with altered urinary and renal function

Length: 2000 words

Assessment purpose: Are developing appropriate critical thinking, clinical reasoning and sound clinical decision making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings

  • Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings
  • Are able to explain and justify or defend their nursing care decisions
  • Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context
  • Are progressing towards the level of professional written communication required for nursing practice in Australia


Assessment is to be submitted and presented:

  • As a computer generated document in Word format.
  • 1.5 spaced using Arial or Calibri font in size 11 or 12
  • In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia
  • Using appropriate professional terminology
  • Contents page, title page, introduction and conclusion are NOT required
  • With no acronyms, abbreviations and/or nursing jargon
  • Unless otherwise indicated, grammatically correct sentences and topic paragraphs are required
  • No more than 20% over or under the stated word count o Note: Headings, any task information copied in and in-text citations are included in the word count
  • Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice

Referencing Students are reminded of their academic responsibilities and professional nursing practice requirements when using the work of others in assignments. Reminder marks are allocated for academic integrity.

  • All information is to be interpreted and restated in your own original words demonstrating your ability to interpret, understand and paraphrase material from your sources
  • APA 6th referencing style is to be used for both in-text citations and end of assessment references. · Use current, reliable evidence for practice
  • All resources for this assignment should be from quality, reliable and reputable journals relevant to nursing practice and the Australian healthcare industry or reputable, reliable, professional websites. · All resources must be dated between 2008 and 2016
  • There must be at least 12 peer-reviewed journal articles cited in your assignment.

Assessment: Case scenario

Sonya, a 45year old female, is being admitted to your ward from the emergency department during your afternoon shift for observations, treatment and further investigations of her urinary and renal symptoms. Sonya was referred to the local hospital by her GP after returning 5 days ago from her honeymoon overseas with a urinary tract infection (UTI). Her primary concern was dysuria and frequent scant urination. Sonya was prescribed an oral antibiotic for 5 days and rest. On assessment Sonya stated 3-4 days of fevers with rigors, lower back and flank pain which is not responding to regular paracetamol, nausea with intermittent vomiting and lethargy. She has been unable to tolerate oral intake for over 24 hours and her urine remains dark and offensive. In the emergency department the preliminary diagnosis of pyelonephritis was made by the medical team but confirmation is pending pathology results and renal ultrasound. Sonya has a past medical history of hypertension, hyperlipidaemia and renal calculi but has been unable to tolerate her regular medications. She has a documented allergy to penicillin. Prior to transfer her observations have been charted and remain stable:

Vital signs                                                                                           Urinalysis

Glasgow Coma Scale 15 alert & orientated
Blood Pressure 110/60mmHg
Heart Rate 117bpm regular
Oxygen saturation 99% on nasal prongs@2L
Respiratory rate 18bpm
Pain score 5/10
Temperature 38.6oC
Output 30mL/hr cloudy & dark
LEU Positive
NIT Positive
 URO Negative
PRO Positive
pH 6.0
BLO Positive
SG 1.005
KET Negative
BIL Negative
GLU Negative

Medical orders

  • Regular observations
  • Monitor fluid input and output
  • Nil by mouth until ultrasound completed
  • Urine to be strained for renal calculi

Medications orders

  • Hartmann’s 1000mls over 12 hours
  • intramuscular Ondansetron 4mg prn 12 hourly
  • oral Paracetamol 1g 4hourly, oral ibuprofen 400mg 8hourly and S/C morphine 5mg prn
  • Intravenous Vancomycin 1g 12hourly

Assessment Tasks: Using the template provided and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following tasks. Do not make up or assume information in relation to or about Sonya. Only use what you know from the information you received today.

Task 1:

Based on the handover information and in grammatically correct sentences identify

  • The charts and documentation that will accompany her from the emergency department or that you need to commence for Sonya’s care on admission. AND For each chart/document you have identified explain:
  • Why it is necessary for Sonya’s diagnosis and nursing care?
  • What consequences can occur if this documentation is not in place or completed accurately?

(200 words, 5 marks)

Task 2:

Based solely on the handover you have received and using the template provided, develop a full nursing care plan for Sonya. Your plan must address the physical, functional and psychosocial aspects of care.

Note: Students are expected to demonstrate they have read beyond the set texts to prepare their nursing care plan. Reliance on text books alone is no guarantee that your information is current and reliable evidence for practice. However, set texts are a good place to start to identify key points and to develop search strategies to locate appropriate journal articles.

For each nursing problem on your plan you need to identify what it is in relation to and your:

  • Goal of care
  • Interventions
  • Rationales for interventions
  • Evaluation

Notes for Task 2 only

  • The nursing problem of pain has been provided for you as an example. This will not be included in marking allocation.
  • Dot points may be used in the care plan template
  • Appropriate professional language must be used, no abbreviations or nursing jargon
  • Rationales must be appropriately referenced. It is strongly recommended only current, reliable journal articles be used as references when providing rationales

(750-1000 words, 30 marks)

Task 3:

Two important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications, how to monitor the patient to ensure they are responding to the prescribed medications as they should and identify any contraindications with medication type or administration choice.

  • In grammatically correct sentences briefly explain why Sonya has been prescribed;
  • Analgesics orally
  • Vancomycin intravenously
  • Hartman’s 1000mls over 12 hours AND
  • Identify and explain
  • The nursing responsibilities associated with administering the three (3) medications/fluid above
  • How you will assess or monitor Sonya to ensure she is responding appropriately to these three (3) medications/fluid you are administering today?

(350 words, 10 marks)

Information needed for Tasks 4 and 5

You will need to use the following information to complete tasks 4 and 5 (this information is for these tasks only). During your shift the following occurs:

Vital Signs

Glasgow Coma Scale 14 confused and disorientated
Blood Pressure 95/50mmHg
Heart Rate 135bpm thready & irregular
Oxygen saturation 96% on Hudson mask@6L
Respiratory rate 26bpm
Pain score Unable to assess score– verbal groans only
Temperature 39.9oC
Output <25mL/hr dark, cloudy, purulent, offensive
Capillary refill >3sec, pale, poor skin turgor
  • Indwelling catheter in place with hourly collection bag
  • MC&S collect and sent to pathology
  • Blood cultures taken by attending doctor and sent to pathology
  • Ultrasound completed still waiting for the report
  • No arterial blood gas done
  • Cannula in right arm has signs of inflammation yet still flushing well
  • Offensive vaginal discharge noted during personal cares
  • Fluid challenge of 300mls given with no change
  • Medical team have reviewed Sonja and requested urgent transfer to ICU

Task 4:

Based on what has occurred during your shift (see previous page) address the following:

  • What conclusion would you make from the signs and symptoms


  • Explain why you have come to this conclusion about Sonya’s current condition

(200 words, 2.5marks)

Task 5: Clinical communication – handover ward transfer

Using ISBAR and incorporating the additional information from the previous page prepare a written handover for the nurse taking over Sonya’s care in ICU. Handover must address the physical, functional and psychosocial aspects of care and reflect any changes required to your nursing care plan above. You must use appropriate professional language with no jargon or abbreviations.

(250 words, 5 marks)

Task 6:

An important part of the clinical reasoning process is to reflect on what you have done and learnt as well as to help you understand the concepts of holistic nursing practice.

  • Reflecting on the care plan you have prepared for Sonya, tell me about your experience developing the care plan. Things you might consider to include: what was easy for you and what was challenging?
  • Reflect on how applying the nursing care plan framework you used in Task 2 will help you to provide holistic nursing care for people in the clinical setting.

(200 words, 2.5 marks)

Notes for Task 6 only

Reflective writing is the opportunity for you to document your thoughts and feelings. This requires a different writing style to the rest of the assignment.

As you are expressing your thoughts and feelings, you write in the first person. It is expected to see words like “I” and “my“ and phrases like “I have learnt…”, “I now understand or realise that…”

It is not appropriate to reference your own personal thoughts and feeling. However, if you refer to professional nursing standards and codes, information from specific sources (eg a text book or journal) or draw on your understanding of the role and scope of practice of the registered nurse, you must provide a reference to support your statements.


  • Task 2: Nursing care plan: Ability to interpret & address task Demonstrated ability to develop an individualised evidence based nursing care plan for case scenario addressing physical, functional and psychosocial needs. Identifies appropriate nursing problems, what each is related to, goals of care, interventions, and rationales for planned care and evaluates outcomes for each stated nursing problem. At least 9 nursing problems identified. All are appropriately stated and relevant to case. All rationales demonstrate high level ability to explain or justify identified nursing actions. High level ability to evaluate appropriate expected outcomes for planned care.
  • Ability to interpret & address other tasks Demonstrated ability to (1) identify nursing priorities & actions, to provide rationales for nursing care & to reflect on assignment learning. (2) Develop a succinct, comprehensive handover that incorporates physical, functional and psychosocial aspects of care [Task 1, Task 3, Task 4, Task 5, and Task 6] Excellent interpretation of the items. Demonstrates high level ability to (1) identify nursing priorities & actions, discuss medication management responsibilities, to provide rationales for nursing care and to reflect on assignment learning (2) develop a succinct, comprehensive handover that incorporates physical, functional and psychosocial aspects of care
  • Critical thinking & clinical reasoning Demonstrates the ability to critically interpret, integrate and apply evidence to practice and to make sound clinical decisions. Clear paraphrasing which demonstrates level of understanding. Demonstrates a high level ability to interpret, integrate and apply evidence to practice and to make sound clinical decisions. Demonstrates high level of understanding and ability to paraphrase information.
  • Academic Integrity 1: Evidence for practice Demonstrated engagement with current, reliable evidence for practice. Has 12 or more relevant journal articles that meet stated criteria. One nursing and one medication textbook only used as a reference. Demonstrates high level engagement with current, reliable evidence for practice. At least twelve (12) highly relevant journal articles that meet stated criteria. Only one (1) nursing and one (1) medication textbook cited as a reference.
  • Referencing Demonstrated ability to adhere to academic and professional policies and standards when using the work of others. Thoughts and ideas well supported by correct and accurate in-text citations and complete and accurate reference list in APA format. Direct quotes appropriately acknowledged but minimal.
  • Academic Literacy Demonstrates appropriate level of written communication for nursing practice. Content flows logically and demonstrates appropriate professional language with no spelling or grammatical errors and no acronyms, abbreviations, nursing jargon, lists, or diagrams. Uses grammatically correct sentences and paragraphs. Dot points and table format only used where directed.
  • Presentation/submission Assignment is submitted on required template and is no more than 20% over and 10% under stated word count including in-text citations, identified headings, any task information copied in. Identifying information and reference list excluded from word count.

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