NRSG 259 semester one 2016 -Scenario for assignment one Mrs Amalie Jones Mrs. Amalie Jones is an 89-year-old woman who migrated to Australia from Germany 40 years ago after meeting and marrying Mr Henry Jones, an Australian sailor. Amalie’s son Dominik from a previous marriage in Germany lives with his family in Germany but has been visiting regularly since Amalie migrated to Australia. Henry‘s daughter Tracy and Henry’s extended family live in other states in Australia but have kept in regular contact. Tracy and her family in particular, have visited very regularly. Two years ago Henry passed away after a long battle with lung cancer leaving Amalie by herself in their single story home. Amalie retired from primary school teaching twenty four years ago, the same year Henry retired from the Australian Navy. The couple spent their time together traveling around the world and volunteering at the local St Vincent de Paul shop. They participated actively in their local Catholic Church, organising fundraising activities. They were also very active members of the German Association. Amalie is fluent in both written and spoken English and German. She speaks with a strong German accent and sometimes people ask her to repeat herself. Amalie’s health has been slowly deteriorating over the last two years, forcing her to withdraw from the activities she has been involved in for so many years. Last year, when Dominik and his family visited Amalie, they wanted her to return to Germany so that he and his family could be close to her but Amalie refused to go although she was very grateful to her son and family. Henry’s daughter Tracy has kept in touch with Amalie since Henry died and visits every three months with daily phone calls but has not suggested any living arrangements to Amalie. Recently, Amalie has developed dry macular degeneration and has had to give up driving. She has difficulty with mobility due to significant problems with rheumatoid and osteoarthritis, rarely leaves the house and has lost physical contact with most of her friends and members of the German association. Amalie’s house is unusually unkempt and her cupboards are pretty bare except for some tins of soup and baked beans. Amalie feels very connected to her community and wants to stay there, but she has realised that in order to do this, she may need help. Amalie does not want to bother Tracy as she feels she is already too much of a burden on Tracy and her family. Amalie’s doctor is getting concerned that she is not eating properly, losing weight and becoming too isolated. Amalie has a medical history of arthritis, hypothyroidism and macular degeneration. The referral letter from her GP states the following symptoms: · Joint stiffness. · Swollen feet and enlarged joints. · Painful joints particularly, her knee,hip, fingers and back. · Limited joint movement. · Constipation · Occasional dizziness · Vision deficit · Non-significant r.

1. NRSG 259 semester one 2016 -Scenario for assignment one
Mrs Amalie Jones
Mrs. Amalie Jones is an 89-year-old woman who migrated to
Australia from Germany 40 years ago after meeting and
marrying Mr Henry Jones, an Australian sailor. Amalie’s son
Dominik from a previous marriage in Germany lives with his
family in Germany but has been visiting regularly since Amalie
migrated to Australia.
Henry‘s daughter Tracy and Henry’s extended family live in
other states in Australia but have kept in regular contact. Tracy
and her family in particular, have visited very regularly. Two
years ago Henry passed away after a long battle with lung
cancer leaving Amalie by herself in their single story home.
Amalie retired from primary school teaching twenty four years
ago, the same year Henry retired from the Australian Navy. The
couple spent their time together traveling around the world and
volunteering at the local St Vincent de Paul shop. They
participated actively in their local Catholic Church, organising
fundraising activities. They were also very active members of
the German Association. Amalie is fluent in both written and
spoken English and German. She speaks with a strong German
accent and sometimes people ask her to repeat herself.
Amalie’s health has been slowly deteriorating over the last two
years, forcing her to withdraw from the activities she has been
involved in for so many years. Last year, when Dominik and his
family visited Amalie, they wanted her to return to Germany so
that he and his family could be close to her but Amalie refused
to go although she was very grateful to her son and family.
Henry’s daughter Tracy has kept in touch with Amalie since
Henry died and visits every three months with daily phone calls
but has not suggested any living arrangements to Amalie.
Recently, Amalie has developed dry macular degeneration and
has had to give up driving. She has difficulty with mobility due

2. to significant problems with rheumatoid and osteoarthritis,
rarely leaves the house and has lost physical contact with most
of her friends and members of the German association. Amalie’s
house is unusually unkempt and her cupboards are pretty bare
except for some tins of soup and baked beans. Amalie feels very
connected to her community and wants to stay there, but she has
realised that in order to do this, she may need help. Amalie does
not want to bother Tracy as she feels she is already too much of
a burden on Tracy and her family. Amalie’s doctor is getting
concerned that she is not eating properly, losing weight and
becoming too isolated.
Amalie has a medical history of arthritis, hypothyroidism and
macular degeneration.
The referral letter from her GP states the following symptoms:
· Joint stiffness.
· Swollen feet and enlarged joints.
· Painful joints particularly, her knee,hip, fingers and back.
· Limited joint movement.
· Constipation
· Occasional dizziness
· Vision deficit
· Non-significant recent weight loss
· Patient states adherence to medications but suspected she may
forget or skip doses when she is in pain
Medications:
Slow release Paracetamol 665 mg tab ii 3 times a day
Ibuprofen 400 mg three times a day
Thyroxine 150 mcg daily
Hydroxychloroquine 200mg daily
A suggested structure of Assessment One
CLINICAL SCENARIO – We use NRSG259 Tutorial scenario
Giuseppe’s situation as an example to help you understand and
structure of Assessment One.

3. INTRODUCTION: (175 words approx.)
· Introduce the topic and any important and relevant concepts to
the reader.
· 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 smell. Giuseppe lives with his wife, Regina
who experiences an intermittent memory loss, in a two- storey
house…
· Age-related changes (not modifiable) such as the decreased
respiratory muscle tone and efficiency; decreased number of
cilia cells; diminished chemoreceptor sensitivity to hypoxaemia;
increased chest-wall compliance (Hunter, 2012, p. 434).
· Risk factors (modifiable) such as smoking, occupational
exposure to respiratory toxins, living in a 2storey house, with
COPD, etc. (Hunter, 2012, p. 434).
· Negative Functional
Consequences – difficulty
2. Collect cues/information – review the information, gather

4. new information and recall knowledge;
Giuseppe had a history of smoking for
20 years, COPD for 10 years, hypertension and cardiac failure
for 6 years…
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
COPD…
(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 assignment.
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 example.
https://nurseslabs.com/chronicobstructive-pulmonary-disease-
copdnursing-care-plans/
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

5. 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 applicable.
6. Take action - showing your nursing interventions/strategies
with the relevant rationale(s) for each intervention. E.g.
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 included.)
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

6. actions. E.g.
· Giuseppe is able to wash and dress himself within minimal
breathlessness.
· 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 ADL.
· If I had more knowledge of COPD I would understand the
impact on the patient’s ability to undertake their ADL.
· 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.

7. 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.