A suggested structure of Assessment One CLINICAL SCENARIO – We use NRSG259 Tutorial scenario… 

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. 
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 Consider 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 87 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 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 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. 
• deep breathing exercise to increase the lung expansion and 
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 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. 
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.

edical Surgical Nursing 2 S2 2016 Before you begin NUR251 Assessment 1 It is strongly… 

NUR251 Medical Surgical Nursing 2 
S2 2016 
Before you begin NUR251 Assessment 1 
It is strongly recommended that students revisit and ensure they understand the University and 
Unit policies and guidelines related to academic integrity, plagiarism, submission, extension, late submission and resubmission. 
The Unit Coordinator cannot be held responsible for information about Assessment 1 that students’ access outside of the NUR251 Learnline site. 
This includes information students may access from other students, whether enrolled in the unit or not, using social media tools such as Facebook and/or friends and/or colleagues they may discuss their assignment with. 
The Unit Coordinator is the person to contact if you have any questions or queries about Assessment 1 
NUR251 Assessment 1 
Topic: 
Nursing care of a patient with altered urinary and renal function 
Due date: 
Week 8 Monday 12th September 2016 1500 (3pm) CST 
Length: 2000 words 
Contribution to overall grade: 40% 
Assessment purpose Learning objectives 
Assessment 1 is the only written academic assignment in NUR251 for students to demonstrate they: 
• Are developing the ability to locate, interpret, integrate, synthesize and apply nursing knowledge from NUR251 to a relevant nursing practice scenario in medical surgical settings 
• 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 
• Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy This assessment addresses the unit learning outcomes; 
1, 2, 3, 4 and 5 
Medical Surgical Nursing 2: Assessment 1 Topic and Tasks 

Preparation 
• Timely completion of study materials including modules 1 ,2 and 3 with participation or review of online collaborate sessions, pre-recorded lectures or internal classes. 
Presentation 
Assessment 1 is to be submitted and presented: 
• On the Assessment 1 template located in the Assessment 1 folder on NUR251 Learnline • 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. See the marking criteria for Assessment 1 for full details. Breaches of academic integrity will be lodged on the University system and may have serious consequences for students. 
• 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 
• CDU APA 6th referencing style is to be used for both in-text citations and end of assessment references. 
• Use current, reliable evidence for practice 
• Markers must be able to access ALL your resources therefore ensure they can be accessed via CDU databases or freely available by internet search. 
• All resources for NUR251 assignments 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. 
Please complete the assessment task on the next page. 
Assessment 1: Case scenario 
This is Sonya 
You will be caring for her today. 
Photo used with permission from Flicker – https://www.flickr.com/photos/58847482@N03/5581044438 
Shift handover: 
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 1 Tasks: 
Using the template provided in the Assessment 1 folder 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; 
o Analgesics orally o Vancomycin intravenously o Hartman’s 1000mls over 12 hours AND 
• Identify and explain o The nursing responsibilities associated with administering the three (3) medications/fluid above 
o 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 
AND 
• 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 NUR251 Learnline) 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.

As the country focuses on
the restructure of the U.S. health care delivery system, nurses will continue
to play an important role. It is expected that more and more nursing jobs will
become available out in the community, and less will be available in acute care
hospitals.

1. Write
   an informal presentation (500-700 words) to educate nurses about how the
   practice of nursing is expected to grow and changes. Include the concepts
   of continuity or continuum of care, accountable care organizations (ACO),
   medical homes, and nurse-managed health clinics.
2. Share
   your presentation with nurse colleagues on your unit or department and ask
   them to offer their impressions of the anticipated changes to health care
   delivery and the new role of nurses in hospital settings, communities,
   clinics and medical homes.
3. In
   800-1,000 words summarize the responses shared by three nurse colleagues
   and discuss whether their impressions are consistent with what you have
   researched about health reform.
4. A
   minimum of three scholarly references are required for this assignment.

While APA format is not
required for the body of this assignment, solid academic writing is expected
and in-text citations and references should be presented using APA
documentation guidelines

Auditing Theory and Practice – Auditing Assignment Question – Chan and Partners Chartered 

ACCT6006 : Auditing Theory and Practice – Auditing Assignment

Question –

Chan and Partners Chartered Accountants is a successful mid-tier accounting firm with a large range of clients across Australia. During the 2017-year Chan and Partners gained a new client, Medical Services Holdings Group (MSHG), which owns 100 percent of the following entities:

Shady Oaks Hospital, a private hospital group

Gardens Nursing Home Pty Ltd, a private nursing home

Total Cancer Specialists Limited (TCSL), a private oncology clinic that specialises in the treatment of cancer.Year-end for all MSHG entities is 30 June. 
On 1 April 2017, Gardens Nursing Home Pty Ltd switched from its ‘home grown’ patient revenue system to the MSHG equivalent system. MSHG is confident that its ‘off the shelf’ enterprise system would perform all of the functions that Gardens Nursing Home’s home grown system performed. 
Gardens Nursing Home’s home grown patient revenue system comprised the following. 
1. Billing system — produces the invoice to charge the patient for services provided such as accommodation, medications and medical services. This software includes a complex formula to calculate the patient bill allowing for
government subsidies, pensioner benefits and private medical insurance company benefits plans. 
2. Patient database — a master file containing personal details about the patient as well as the period of stay, services provided and patient’s medical insurance details. 
3. Rates database — a master file that shows all accommodation billing rates, rebate discounts and government assistance benefits. 
At the request of the board, the group’s internal audit unit was involved throughout the entire switchover process. The objective of its engagement, as the board stated, is to ‘make sure the switch-over worked without any problems’. 
As part of the planning arrangement for the 2017 financial report audit, the audit partner Tania Fellowes asked her team to speak with a number of Gardens Nursing Home staff about the impact of the switching to the MSHG patient revenue system. 
Set out below is an extract of the staff feedback comments:

There were some occasions where we invoiced people that were past patients. This seems to have happened when they shared the same surname as a current patient.’

‘We seem to have some patient fee invoices where for no reason we have billed patients at a lower room rate than what we hold on the rates database.’

‘Lately we’ve had an unusually high number of complaints from recently discharged patients that the fee invoice we sent them does not line up with the agreed medical fund and pensioner subsidy rates.

We then found out that halfway during last month someone from the IT team made a software change to fix a bug in the billing calculation formula.’

‘There was some sort of power surge last Friday and we had to re-enter every patient invoice that we processed in the last two weeks’.

(A) Identify the audit risks associated with the installation of the new IT system for patient revenue. 
(B) Comment on the audit strategy likely to be adopted for the audit of patient revenue for Gardens Nursing Home.