Learning outcomes: Demonstrate an understanding of the planning and delivery of care within a contemporary healthcare setting / Demonstrate knowledge and understanding of a range of health issues encountered when caring for people / Demonstrate an understanding of the student nurses role in safeguarding service users, their families and the wider public.

Script: Slide 1.

Hello, today I am going to show my understanding of my role as a student nurse in planning, implementing and evaluating care for a patient with co-morbidities. One Acute, One Chronic.

Slide 2

Learning Outcomes

To fulfil the initial learning objective, I will conduct research to understand the unique care requirements of the patient. This includes gaining insight into potential complications, risks, and appropriate interventions and treatments related to their conditions. Additionally, I will emphasise the significance of safeguarding patients with chronic health issues,  by prioritizing their safety and well-being. This will involve effective communication, vigilant observation, and timely reporting of any issues to the appropriate senior healthcare professionals

Slide 3.

As we go through this presentation, I want to emphasise my commitment to professional standards. In line with the Nursing and Midwifery Council (2018a) and the Data Protection Act (2018), I will uphold confidentiality, respect for privacy, dignity, and my patient's autonomy at all times. So, with that, I will refer to my patient as ‘Mandy’. Furthermore, I aim to demonstrate the standards of care outlined in the Nursing and Midwifery Council (2018b) Future Nurse Proficiencies, focusing on sections 3 and 4.  

I chose Mandy for this presentation as I built a good rapport with this patient, which helped me enhance my learning experience and build upon effective communication skills. She was on the ward regularly, and I dealt with her care often under the supervision of my assessor which provided a valuable environment for my learning and development.  She was a patient who had both an acute and chronic illness, which helped me to explore (and I will express,) how nursing interventions can address these health concerns simultaneously.

Slide 4:                                                                                                                                                            

This is Mandy, a single 58-year-old lady. She was admitted to hospital with pneumonia and transferred to the renal ward as Mandy was previously diagnosed with CKD stage 5 and attends as an outpatient 3 times a week for haemodialysis. Mandy has a mortgage on her own home and lives with her son, Peter and his 3 young children, Mandy’s grandchildren. Mandy always considered herself quite active and healthy prior to her CKD diagnosis; she enjoyed long walks with her friends and her shihtzu ‘Mitzy’. She had an active job working for a cleaning company and regularly worked long shifts. She prides herself on her garden, enjoyed tending to her flower beds and baskets, and getting her grandchildren involved to help. She described it to me as her little sanctuary where she used to sit and listen to the birds and wildlife in a morning with a cup of tea. Despite being poorly Mandy has such a positive perspective on life and was always friendly and chatty.

To uphold confidentiality and respect Mandy’s privacy, I will adhere to the Nursing and Midwifery Council Code (2018a), particularly section 5. I discussed with Mandy about sharing her experiences in a manner that would also respect her privacy and dignity in this presentation, which she consented to.

Slide 5: Chronic Kidney Disease (CKD)

What? Well put simply CKD is when the kidneys aren’t working the way they should (Same ref as below) Damage to the kidney filter system allows blood and protein to leak into the urine.

Chronic Kidney Disease (CKD) is graded from 1 to 5, with a test called estimated glomerular filtration rate)  eGFR used to assess kidney function. eGFR measures how efficiently the kidneys remove waste from the blood, known as excretory kidney function. This rate is measured in milliliters per minute (ml/min), indicating the amount of waste filtered per minute.

Excretory kidney function is determined by the concentration of creatinine in the blood. High creatinine levels may suggest poor kidney function, but this can vary based on factors like age, race, and gender. These factors are considered in the eGFR calculation to ensure accurate assessment

CKD is present when the estimated glomerular filtration rate has fallen to around 20% of normal. My patient had less than 15mls per min of eGFR and was graded with established kidney failure – CKD5

CKD is diagnosed through blood tests and urine samples

A urine sample is tested for proteins, as protein leakage into the urine increases the risk of Kidney disease. (causes of proteinuria = weight gain and poorly controlled diabetes or high blood pressure) Mandy had high blood pressure.  

CKD has an estimated global prevalence of 9.1% in the adult population. (Cai, X.Y et al. (2023) ‘Development of a new prognostic prediction of CKD patients with pneumonia at hospital admission’, Frontiers in Medicine, 10, pp. 1135586-1135586.)

Slide 6

Pneumonia

What is Pneumonia? – Is an umbrella term for a variety of syndromes with different etiologies and refers to infection of the lung parenchyma (Pur-reng-kuh-muh) Rezaei, N (2022) Pneumonia. London, England: IntechOpen.

Pneumonia is typically caused by a virus or bacteria a patient has been exposed to in the environment or is passed to a patient from another person. Jones, B. et al. (2016) ‘Patient education information series. What is Pneumonia?’ American Journal of Respiratory and Critical Care Medicine, 193(1), pp. 1-2.

It affects the alveoli in the lungs, which swell and fill with fluid making it harder for the patient to breathe

Symptoms often reported include a fever, chills, fatigue, a cough, shortness of breath (Dyspnea) chest pain and a fast heartbeat

Some people get pneumonia when they are already in the hospital for another condition this is called Hospital-acquired pneumonia (HAP), people in intensive care on breathing machines are at the most risk of developing this. However Mandy had Pneumonia that was acquired outside of the hospital which is known as community-acquired pneumonia (CAP)  

Pneumonia can be diagnosed through different tests: Firstly a doctor will listen to your lungs with a stethoscope – they will check for abnormal bubbling or crackling sounds; Blood Cultures – to check the presence of infection and to identify the causative organism; Urine Tests – As bacterial infections can be identified through urine, Sputum Test – Confims the cause of infection, a chest X-ray – to check for the presence of infection, CT Scan – is performed to detect the severity of the infection.  

According to asthma and lung UK,

Each year in the UK, 5 to10 in every 1000 adults get community-acquired pneumonia. Asthma and Lung UK (2022) What is pneumonia?. Available at: https://www.asthmaandlung.org.uk/conditions/pneumonia/what-is-it (Accessed: 30^th April 2024)

Pneumonia is three times more common in CKD patients than in those with normal renal function (Same ref as above).

A decreased glomerular filtration rate is associated with an increased risk of pneumonia-related hospitalization James, MT et al. (2009) ‘CKD and risk of hospitalization and death with pneumonia’. American Journal of Kidney Diseases. 54(1), pp. 24-32.

Patients with chronic health problems are also more at risk of pneumonia

Slide 7

Impact on the patient

Living with her three grandchildren and her son, Mandy is the primary breadwinner in her household, shouldering the responsibility of a mortgage on her home

Gave Mandy leaflet off the ward for KidneyCare Uk for help with one off financial payments due to her having to give up work.

Accessed online financial local and national website links for mandy to look at and apply for grants etc due to her illness.

Reduced mobility – mental health

Getting out in the garden because of dizziness and not being able to manage the big step to the backyard? OT referral for handrails or a ramp to her backyard due to Mandy's poor mobility. The electronic Remittance advice team (ERA) was informed to deal with the necessary home equipment and adjustments to safe-guard the patient from falls at home when trying to access her garden.

Slide 8

Nursing Process and Care Planning –

Discuss and critically analyse how the care was planned, considering different outcomes and why it was planned in that way.

Question the planning what were the benefits to the patient. +

According to the Nursing and Midwifery Council (2018b) platform 3 (assessing needs and planning care), nurses must prioritise patients' needs when performing assessments and work in partnership with the patient to develop person-centred care plans, which identify patients' needs, their priorities and their preferences. The NMC code (2018a) highlights the importance of working with patients to ensure the delivery of effective high-quality care which involves the patient in the planning of that care, empowering them to make their own decisions. The patient should always be viewed holistically!.

ADPIE

What is in their nurse care plan?  Fluid restricted, maybe? Daily bloods?

Slide 8 – pt struggling mobility etc?