Word Limit: 2000 words Assessment purpose Unit objective
The assignment will help you to:
? Understand the rationale for use of the ACAT assessments for discharge planning
? Promote independence and quality end of life care through the engagement of community care supports
? Understand the rational for use of palliative care services and advanced care directives
? Prepare appropriate person centred care plan
? Inclusion of family in care plan development
? Develop and identify key factors for handover of care
This assessment address unit learning objective
1- 6

Assessment 3 task: Using the case study scenario below, map a person centred care plan and handover summary for the elderly patient being discharged from acute care to home to promote independence and quality end stage life.
Harold is a 68year old Indigenous man due for discharge at the end of the week from an acute medical ward following treatment for exacerbation of congestive heart failure (CHF) including oedema, shortness of breath, reduced appetite, increased pain and lethargy .
Harold has a past and current medical history (Mhx) of RHD, CHF, and coronary artery disease with angioplasty, hypertension and type II diabetes.
Medications on admission: Digoxin, Metoprolol, Perindopril, Frusemide, Metformin, Novomix 30 and Oxycontin.
The medical team visit him on the morning ward rounds with you present. The team have identified the congestive heart failure has deteriorated to end stage and surgical intervention is not possible due to Harold’s medical history, comorbidities and continuous moderate use of tobacco and alcohol.
NUR341 Healthy Ageing 2015
Harold, an Elder, lives in a large remote community in the Northern Territory with his wife, Trish, adult children, grandchildren and some nieces and nephews when needed. He has 3 adult children who all work fulltime to help provide food and necessities for the family. Harold and Trish care for the young children whilst the adults are at work all day, but with Harold’s ailing health his wife is caring for both him and the grandchildren.
Harold is becoming increasingly frustrated with his hospital admissions and medication regime. He has stated to you he is sick and tired and just wants to die at home in community with his family.
Now that Harold has been diagnosed with End Stage Congestive Heart Failure you need to prepare for this discharge back to community.
To ensure Harold is provided with the best care for this stage in his life you need to map Harold’s care plan using the template attached. In your mapping you should consider Harold’s physical, mental, social and emotional wellbeing. For each problem or issue you identify on the map you need to include a goal, intervention, rationale and evaluation.
You will need to develop a summary of care for handover to the community for discharge. This will provide key factors and priorities identified in the care plan to promote Harold’s independence and quality end stage life. You will need to provide justification for your priorities and key factors in your handover summary.
Your handover and care plan mapping should include Harold’s cultural identity.
NUR341 Healthy Ageing 2015
Preparation – timely completion of study materials – Module 7. Utilise your learning materials, set text and library resources to research the assessment task topics.
Presentation –
? NO introduction of topic and statement of intent required
? Completed mapping of care plan on the template provided
? Handover summary (between 500 – 1000 words) priority care needs to ensure quality end stage of life and cultural safety
? NO conclusion necessary
? Font 12pt Arial preferred, 1.5 spacing
? Ensure you have footer with page number and your student name and number
? Please provide a title at the beginning of your essay (no title page required)
? Dot points may be used in the mapping template only