27 Apr NUR571 Assessment 2: Interdisciplinary Nursing Case Report and Care Plan
Purpose
This assessment challenges you to apply foundational knowledge of anatomy, physiology, and pathophysiology to a complex clinical scenario. You will use evidence and interdisciplinary insights to plan culturally safe, person‑centred care for an older adult at risk of deterioration. Your report must explicitly integrate the perspectives and contributions of Nursing, Social Work, and Speech Pathology to demonstrate a collaborative care model.
Important: You are expected to attend (or view recordings of) the interdisciplinary lectures in Nursing, Social Work, and Speech Pathology that explore Mr. Niko Costa’s case. Depth of interdisciplinary integration is assessed.
Learning Outcomes Assessed
LO1: Identify and describe the structures of cells and the structures (macroscopic and microscopic) and functions of the circulatory, integumentary, musculoskeletal, and nervous systems.
LO2: Determine the pathophysiological mechanisms and clinical manifestations of diseases related to these systems.
LO3: Explain the concept of homeostasis and its role in maintaining stable internal conditions.
LO4: Apply foundational A&P knowledge to support clinical reasoning and evidence-based, culturally safe, person-centred care.
LO5: Plan safe and effective nursing care for individuals in aged care, extended care, or sub-acute settings.
LO6: Critically reflect on strategies for countering ageism and promoting healthy ageing.
Case Summary (for this Assessment)
Patient: Mr. Niko Costa, 82, widower; lives at home with daily support from his daughter.
Key history: Ischaemic stroke (8 months ago) with mild right-sided weakness; atrial fibrillation (on apixaban), hypertension, type 2 diabetes, CKD3a, GERD, hearing impairment (often without aids), mild cognitive impairment with late-day fluctuation.
Presenting issues: Coughing/choking with thin fluids, wet/gurgly voice, 10% unintentional weight loss (3 months), two bathroom falls in two weeks, fatigue, orthostatic hypotension. RLL crackles; bedside swallow screen positive on thin fluids; functional decline (TUG 19s).
Medications (selected risks): Polypharmacy; anticholinergic burden (oxybutynin, quetiapine PRN); fall/bleed risk on apixaban; possible hypotension with metoprolol/perindopril; variable intake impacts diabetes meds.
Home & psychosocial: Cluttered bathroom, no grab rails, low toilet height, poor night lighting; carer fatigue; social isolation (ceased community garden/church); grief and loneliness; communication impairment (word‑finding, auditory processing).
Assessment Structure
Part A – Clinical Reasoning & Interdisciplinary Synthesis (500 words) = 20%
Use a structured model (e.g., Clinical Reasoning Cycle or ISBAR) to outline Mr. Costa’s presenting problem and risk of deterioration (e.g., aspiration-related respiratory decline, falls/injury—particularly on anticoagulation, hypoglycaemia with poor intake, delirium/cognitive fluctuation, dehydration/malnutrition).
Identify & prioritise problems (signs, symptoms, risks; connect to A&P).
Pathophysiology narrative for one primary diagnosis you prioritise (e.g., post‑stroke oropharyngeal dysphagia with aspiration risk; vascular cognitive impairment/delirium risk; orthostatic hypotension with falls; frailty/sarcopenia trajectory). Explain mechanisms → manifestations, interactions between comorbidities/polypharmacy, and impacts on homeostasis.
Interdisciplinary synthesis: Clearly state how Speech Pathology (dysphagia severity, IDDSI, safe‑swallow, communication supports) and Social Work (psychosocial stressors, carer burden, elder abuse screening, discharge barriers, service navigation) change your nursing priorities and next steps.
LO alignment: LO1, LO2, LO3 with integration of LO4/LO5 via interdisciplinary insights.
Part B – Evidence-Based Nursing Care Plan (1,700 words) = 45%
Identify four (4) priority nursing problems for Mr. Costa. For each problem, provide:
Problem statement: Concise, linked to A&P/pathophysiology and case data. (LO1, LO2)
SMART Goal: One clear, patient-centred goal (Specific, Measurable, Achievable, Relevant, Time-bound).
2–3 interventions: Evidence‑based nursing actions that explicitly incorporate Speech Pathology and Social Work contributions where relevant (e.g., SP: IDDSI/strategies/communication supports; SW: home modifications, respite, meals/transport, ACP, carer coaching). (LO4, LO5)
Justification: Brief rationale with current scholarly sources (2015–2026). (Minimum 5 sources across the whole plan.)
Evaluation criteria: Define how you will measure effectiveness and how you will adjust the plan.
Common priority areas (choose based on your reasoning):
Aspiration risk due to post-stroke dysphagia (wet voice, cough on thin fluids, oral hygiene, IDDSI adherence, FEES/VFSS triggers).
Falls risk while on apixaban (orthostatic hypotension, recent falls, bathroom hazards).
Medication safety/polypharmacy with CKD3a and anticholinergic burden (oxybutynin, quetiapine), health literacy/communication considerations.
Nutrition & unintentional weight loss (risk of sarcopenia/frailty progression).
Cognitive fluctuations/delirium risk affecting self-management/safety.
Diabetes optimisation with reduced intake (avoid hypoglycaemia; realistic older‑adult targets).
SMART Goal Example (illustrative only):
Problem: Aspiration risk related to oropharyngeal dysphagia, evidenced by coughing/wet voice after thin fluids, RLL crackles, and 10% weight loss in 3 months.
Goal: Within 72 hours, Mr. Costa will tolerate IDDSI Level 6 solids and Level 2 fluids with ≤1 cough per meal, using SP strategies (upright 90°, small sips, slow rate, double swallow) and oral care 2–3×/day.
Interventions: Implement SP plan and bedside signage; oral hygiene protocol; coordinate SW for mealtime setup, meals service, and carer coaching.
Evaluation: Nursing meal observation tool; aspiration signs log; intake/weight review; escalation for FEES/VFSS if persistent symptoms.
Part C – Reflection on Interdisciplinary Collaboration & Healthy Ageing (300 words) = 15%
Reflect on how Speech Pathology and Social Work input shaped your nursing approach (priority setting, feasibility of interventions, communication supports/hearing aids, cultural safety). (LO4, LO5)
Identify one barrier to collaboration (e.g., siloed documentation, time constraints, delayed SP assessment, interpreter/hearing aid availability) and propose a practical solution (e.g., shared swallow plan template in chart; twice‑daily huddles; ISBAR that includes IDDSI and SW actions; pre-booked carer coaching). (LO5)
Discuss how nurses counter ageism and promote healthy ageing in this case (strength-based language, autonomy, risk‑enablement with safeguards, meaningful goals like returning to the community garden/church). (LO6)
AI Use Statement – Assessment 2: Interdisciplinary Nursing Case Report and Care Plan
Generative AI tools may be used for this assessment with the following restrictions and conditions:
Students may use AI tools (e.g., ChatGPT, Claude, Microsoft Copilot) only for:
Clarifying task instructions.
Brainstorming potential topics or clinical reasoning steps relevant to Ron’s case.
Exploring general concepts in nursing, pathophysiology, or interdisciplinary practice as a learning aid.
Students must not use AI tools to:
Generate, rewrite, or improve any part of the written assignment (including grammar, structure, or tone).
Draft or assist in writing SMART goals, care plan rationales, or reflective content.
Generate or suggest references or citation content.
Summarise academic articles or evidence.
Submit any content that has not been critically reviewed and written independently by the student.
All academic writing must represent a sincere demonstration of your individual understanding, clinical reasoning, and evidence-based decision-making. Use of AI must be acknowledged in a brief AI statement included at the end of the submission (e.g., under the heading “AI Use Declaration”).
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