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Carefully review the following scenario and answer the related questions. Refer to the marking guide to frame the preparation and setting out of your answers. This task requires you to bring together your nursing knowledge across a range of subjects within this course and then apply these. In brief your paper needs to demonstrate you will be able to appropriately assess, plan, implement and evaluate your care for Mrs & Mr Smith. Scenario Mrs Marjorie Smith, a Teacher aged 58, lives with her husband in their own home at 21 Sunset Strip, Sunshine Bay. The house has 2 steps to the front door and 6 steps to the back door. Four weeks ago Mrs Smith underwent a routine Mammogram where a lump in her right breast was discovered. Her GP referred her to a gynaecologist who specialises in breast tumours and a Tru-cut core biopsy of the breast tumour and a sentinel node biopsy were undertaken in the day ward at her local hospital. One week later at her outpatient’s appointment she and her husband were told that she would require a R Modified Radical Breast Mastectomy due to the presence of cancerous cells present in her R breast and sentinel node. Once the wound had healed she would commence a short course of chemotherapy under the care of an Oncologist to reduce the chance of any further development of malignant growth. Two days later she underwent a R Modified Radical Breast Mastectomy in her local hospital which went well. Today her Gynaecologist is very pleased with her progress post op and is happy for her to go home in two days’ time with her two drain tubes insitu, (one beneath the breast’s superior skin flap and the other in the axilla). She is now mostly self-caring, although requiring some assistance with hygiene and daily chores due to her R breast wound and axillary drain tubes insitu which limits her R arm’s range of movement. Note Mrs Smith is also R handed. During her six day stay in hospital Mrs Smith has seen the breast care specialist re wound care, mobilisation, bra supports and prosthesis choice. The bra support and prosthesis will be introduced once the breast and axilla wound have healed. She has also spent time with the physiotherapist re R arm exercises to reduce muscle atrophy and increase lymph drainage from her R arm. She will require ongoing support at home and has a gynaecologist outpatient appointment in 2 weeks, where her drain tubes will be removed. She will also require a Breast Care Nurse appointment in 2 weeks re breast supports and further care. An urgent referral has been made for the O.T. to do a home visit tomorrow before Mrs Smith is discharged to provide aids for safe mobilisation in and around her home. She will also require home assistance as Mr Smith was injured in a car accident 2 months ago and is still receiving physio for his lower back due to pain. ESSENTIAL PREREADING PREPARATION Before answering the following questions, please read your Smeltzer and Bare’s Textbook of Medical-Surgical Nursing and Tabbner’s Nursing Care Theory and practice (Koutoukidis et al 2013), regarding patients who have breast cancer. This will also provide you with a source of referencing. Question 1. Patient Education Session It is Day 6 and you have been allocated to care for Mrs Smith. Part of your patient care today is to provide Mrs and Mr Smith with a 20 minute patient discharge education session regarding her care at this stage of her recovery, required outpatient’s appointments and home supports she will require post discharge. You will need to prepare a detailed teaching plan, covering the below suggested content for patient education, including a small discussion on normal anatomy and physiology of the breast and axilla lymph glands – see marking guide. You will also be required to fill out the attached discharge planning assessment and RDNS form. You may use diagrams to support your education and the following headings to support a thorough education plan. Suggested Content of Patient Education Session Impact of disease process on daily living post discharge for the first 6 weeks. Signs and symptoms of lymphatic and wound complications post procedure What are the risks associated with poor lymphatic drainage Discuss some strategies to reduce poor lymphatic drainage and wound infection. Who should be contacted and which Allied Health Members should be involved in Mrs Smith’s care if she shows signs of complications Refer: Marking Guide Word length: 800 - 1000 words (+/- 10%) Referencing: Use the APA referencing system where necessary Presentation: Typed. Font: Times New Roman; Font size: 12; Spacing: Double; Sided: Single

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