NURBN 2012: Nursing Practice 3 - Pathophysiology and Pharmacology Applied to Nursing Assessment Task 2 – Clinical Scenario Assignment
Due Date: Friday the 30th of April, at 23:55
Word Count: 2000 words +/- 10%
Format: Report style, with introduction and conclusion. A cover sheet is not required. You will be required to submit this assignment through Turnitin.
Directions
For this assessment task, you are required to write a 2000 word report answering the questions from the scenario. You will need to explore the pathophysiology, pharmacology and psychosocial aspects of the scenario and demonstrate your understanding in the answers you provide. Your answers should be informed by your reading of current research and literature.
A report format includes an introduction and conclusion, but headings are used in the body of the text. Use the question you are answering as your heading. Do not use dot points for your answers. Do not write in the first person. Appropriately referenced and labelled tables, diagrams or images may be used in the body of the paper. You may reproduce the tables used in the questions in your answers.
Use APA 7 referencing throughout your assignment. References must be current, preferably from the past five years. You are required to cite no less than 10 references, and the majority of these should be current journal articles. We are looking at information informing current clinical practice, and your choice of references must reflect this.
Consider the quality of the references you use. Wikipedia, Web MD, the Better Health Channel and blogging websites are not acceptable references. References must be written in English. References will not be accepted written in another language, as this leads to potential issues regarding both academic integrity, best practice and the reliability of the source. Any non-reliable sources in your reference list will not count toward the number of required references, and this will result in a loss of marks. At this point in your BN you are expected to be able to source and engage with best practice literature.
Criteria for grading
Marking of this assessment task will be undertaken by academic and teaching staff. Pre and post moderation will be undertaken for this assessment task to ensure consistency with marking, both between markers and campuses
The marking rubric for the assignment is provided on Moodle. Marks will be allocated for each section of the rubric. Use the rubric and word allocation as a guide when writing your assignment to identify the depth of the answer expected.
Scenario
Deependra Sidhu (preferred name of “Deep”) is a 68 year old male of Indian descent. He immigrated to Melbourne at the age of 18. He became an Australian citizen at the age of 28.
Past medical history
Myocardial infarction (MI) 2017
Stable Angina
Hypertension
Hypercholesteremia
Type 2 Diabetes Mellitus (currently diet controlled, diagnosed 2016)
Current Medications
Aspirin 100mg mane
Atenolol 25mg mane
Furosemide 40 mg mane
Pravastatin 40mg oral nocte (bedtime)
GTN spray 1 – 2 sprays S/L PRN
Sildenafil (Viagra) 50mg prn
Social history
Deep tells you that he is trying to lose a bit of weight by having soup for lunch, he is particularly fond of hot and sour soup. His wife has bought him lunch and dinner every day he has been admitted. Deep has a very supportive family but they are currently studying. Deep works 3 days a week and would like to retire soon but “needs to support my family first”. He confides in you that he doesn’t like the side effects (“makes me go to the toilet too much”) of the Lasix tablet and sometimes doesn’t take it.
History of presenting complaint
Deep has called for help after waking up at 2am feeling breathless with pain in his chest (8/10 pain score). You sit him up in the bed and perform a set of observations while asking for assistance.
Your buddy nurse comes to assist and asks you to perform and ECG and prepare to take a troponin T and MKMB blood test. You prepare to give Deep GTN S/L as per the wards chest pain management. Your buddy nurse says to double check his PRN and OTC medication. You ask Deep if he has taken any medication in the last day, apart from his prescribed medication (Aspirin, Atenolol, Furosemide, Pravastatin). Deep says he has not and you administer the medication at 02:40 after performing your first set of observations.
Observations at 02:35
HR 90, regular
BP 145/85
Skin – sweaty and pale, RR 26, regular
SpO2 94% RA
Temp. 36.7oC
Oedematous legs, moderate pitting oedema (2+)
History of presenting complaint continued
Deeps chest pain has reduced to 3/10, You perform another set of observations. Deep asks you if it would be important if he had taken viagra the night that he was admitted to hospital (around 6 hrs ago). The ward chest pain guide allows for GTN every 5 minutes but your Buddy nurse says to wait for the medical team review.
Observations at 02:45
HR 110 regular, regular
BP 85/50
Skin – sweaty and pale RR 26, regular
SpO2 94% RA
Temp. 36.7oC
Oedematous legs, moderate pitting oedema (2+)
Outcome
The medical team comes to review Mr Sidhu. They consider that Mr Sidhu likely has heart failure and schedule and ECHO for the next day to confirm. They ask for Mr Sidhu to be placed on 2L fluid restriction, give a stat dose of IV furosemide and ask for his urine output to be measured.
Question 1 (10 marks) 200 words
Your buddy nurse asks for an ECG. Explain the rationale for the ECG request (5 marks). Why would the nurse also ask you to prepare for a blood test? (2 marks) Why do both ECG and a blood test? (3 marks)
Question 2 (20 marks) 600 words
The medical team confirm the diagnosis of heart failure.
Describe the pathophysiology of heart failure with reference to causes, progression and outcomes (15 marks). Include links to how heart failure has progressed for Deep (5 marks).
Question 3 (6 marks) 100 words
Appendix 1 is an ECG that was taken while Deep was experiencing shortness of breath. Systematically analyse the ECG, commenting on the:
- Rhythm
- Rate
- Presence and regularity of p waves
- ST segment
What is your interpretation of this ECG?
Question 4 (10 marks) 200 words
Deep became short of breath overnight during admission. Discuss the physiology as to why this occurred (5). What two things has Deep been doing that would exacerbate his heart failure, with explanation? (5)
Question 5 (8 marks) 200 words
Deep asked if it would be important if he had taken ‘Viagra’ 6hrs ago. Provide an example of how you would respond to Deep. (2 marks – one mark for ‘response’ and one mark for ‘rationale’)
Include an explanation of the pharmacodynamics of both Glyceryl Trinitrate and its potential interaction to Viagra. Relate this back to Deep – has this potentially occurred? (4 marks)
While holistically caring for Deep, discuss 2 factors that may influence a patient to potentially with-hold sensitive information such as this? (2 marks)
Question 6 (16 marks) equivalent of 250 words
Use the table below (or something similar) to discuss the following drugs: Atenolol and Furosemide oral. Do not list gastrointestinal upsets (such as nausea and vomiting) as complications/side effects or nursing considerations. Only include information that can be directly applied to Deep.
Generic name Atenolol Furosemide oral
Drug group (1 mark)
Mechanism of action (3 marks)
Complications/side effects (2 major) (1 mark each)
Nursing considerations (2 major) (1 mark each)
Question 7 (10 marks) 250 words
Deep discussed not taking a medication (furosemide) due to the side effects. Using at least 3 peer reviewed sources, discuss the reasons for medication non-adherence. Consider if they apply to Deeps’ situation and how you would assist Deep to take his medication.
10 marks referencing and quality of sources
10 marks for presentation, introduction and conclusion (200 words total)
Page 6 of 6
Appendix 1 – ECG
Troponin level 10ng/l (normal range 0-14)
CK – MB level 4mcg/l (normal range 0-7mcg/l)