NURS 2003 AV2 Assessment 2: Case Study
Brian Fuller is a 78 year old man who lives with his wife Esme in suburban Adelaide. Both Brian and Esme are fully independent. They have 3 children who all live overseas, so they only see them once or twice a year. Brian & Esme are very social and like getting together with their friends. Brian plays bowls three times a week and then joins his friends at the local club for lunch.
Brian was shaving this morning when he noted that the left side of his face was drooping. His left arm also felt very weak. Brian tried to call out to Esme, but he could not speak properly. He then fell to the floor. Esme heard the fall, ran to Brian & then immediately called an ambulance.
Brian was taken to ED where on arrival he had a BP of 190/91, HR 115, RR 24, SaO2 95% on room air and a temperature of 37.2. He was immediately sent for a CT head and Brian was diagnosed with a CVA.
PMHx:
Hypertension
Hypercholesterolaemia
T2DM
AF
GORD
Cholecystectomy 5 years ago
Brian is transferred to the neurological ward. On assessment he has a GCS of 13, left sided hemiplaegia, expressive dysphasia, dysphagia & blurred vision in his left eye. He is scheduled to see the speech pathologist and the physiotherapist later today.
After a week of therapy Brian is ready to be discharged to rehab. He still has some residual dysphasia, but the dysphagia and blurred vision have largely resolved. He still has significant weakness on his left side.
The doctors have ordered the following medications for discharge:
Apixaban 5 mg PO daily
Digoxin 125 mcg PO daily
Simvastatin 40 mg PO daily
Ezetimibe 10 mg PO daily
Perindopril 2 mg PO daily
Amlodipine 10 mg PO daily
Assignment Instructions
2000 words (+/- 10%)
35%
1. Identify the most likely type and cause (what you think is the main risk factor) of Brian’s CVA
• Your answer must include a rationale for this selection and explain how and why this cause can lead to a CVA from a pathophysiological perspective.
• Include in your answer the pathophysiology of Brian’s CVA.
• In other words, discuss the pathogenesis of the most likely cause and how it can lead to CVA. Consider his past medical history.
20%
2. Identify two (2) other risk factors that Brian has for CVA
• For each of these risk factors explain how & why they can increase the risk of & lead to CVA.
3. Select two (2) signs and/or symptoms that Brian had as a result of his CVA
• For each sign/symptom explain how & why it can occur after a CVA, again from a pathophysiological perspective.
35%
4. Select three (3) of Brian’s medications and explain why each of the three (3) medications was ordered for Brian
• Your discussion should include the pharmacodynamics and pharmacokinetics of each medication, including relevant adverse effects and contraindications.
5. Each of Brian’s discharge medications is to be administered orally. This means they will all undergo the first pass effect. Explain what first pass is and the implications this has for a drug’s bioavailability.
This is a case study, not a general discussion of CVA. It is important that only information relevant to the specific case be discussed in this assignment. Information that is not directly relevant to the case study should not be included.
The assignment is not an essay, i.e. it does not require an introduction or conclusion. However, it must be written in accordance with academic conventions, i.e. full sentences, not dot points. Headings can be used to organise your assignment and please ensure appropriate use of paragraphs.
All claims or assertions must be supported with evidence form the literature, using APA6 referencing guidelines.
Help with Academic Writing
For assistance with assignment writing, you are encouraged to make a time for an appointment with the Student Learning You can also submit a request for assistance through Studiosity. Benefits of this are the ability to:
1. Upload up to two assignment drafts per semester to Studiosity, and an English specialist will provide you with constructive feedback in less than 24 hours – including comments, suggestions and encouragement for how you can improve your own work
2. Studiosity live chat offers one-to-one, personal help in real-time. Subject specialists are available from 2.30pm until 11.30pm, Sunday to Friday, to help you with your study questions. Students can utilise up to two live chats (appx 20 min each) per semester.
https://blogs.flinders.edu.au/student-health-and-well-being/2018/02/19/studiosity-study-help-anywhere/
Assignment Submission
Please submit your assignment to FLO, to the link called ‘Assessment 2: Case Study’. Assignments need to be submitted via turnitin first, and all submissions are subject to Flinders University academic integrity requirements.
Academic Integrity
All work must be in your own words (i.e. paraphrased), with references included. All claims or assertions must be supported with evidence form the literature, using APA6 referencing guidelines. This means that everything that is not an original idea needs to be referenced. Copying sentences/paragraphs directly from resources will is not acceptable. Should you not know how to paraphrase, or need guidance with this, please refer to the above resources, and to the academic integrity informational videos under the Assessment 2 tab on FLO. Please check your Turnitin report prior to submitting your assignment (appropriate time management to allow this is your responsibility). Please also refer to the Flinders University Academic Integrity policy and resources:
https://students.flinders.edu.au/my-course/academic-integrity
Appropriate Resources and Referencing
Referencing must be in line with the School’s referencing guidelines (APA referencing guide). Reference lists do not count towards the word total – but ‘in-text’ citations are included in the word count. References from consumer-based websites & Wikipedia WILL NOT be accepted, this includes but not limited to MyDR, Better Health Channel, Health Direct and WebMD. Please use journal articles, appropriate nursing textbooks etc. References must be no older than 10 years. P lease seek clarification from your tutor if you are uncertain as to whether a referencing source is reliable. Minimum twelve (12) credible references are EXPECTED to be used
Performance Standard:
Assessment Criteria: % Excellent Good Satisfactory Unsatisfactory
Pathophysiology:
Discuss the pathophysiology of Brian’s CVA showing clear understanding of altered physiology.
Identify the most likely cause of Brian’s CVA. Include a rationale for this cause and explain how and why it can lead to a CVA from a pathophysiological perspective. In other words, discuss the pathogenesis of the most likely cause and how it can lead to a CVA.
35%
?Comprehensive understanding of pathophysiology in case study
?Comprehensive discussion/ excellent understanding of cause/ rationale presented
?Comprehensively supported with relevant evidence.
?Good understanding of pathophysiology in case study
?Sound discussion/ good understanding of cause/ rationale presented
?Sound support of discussion with relevant evidence ?General understanding of pathophysiology in case study
?General discussion/ limited understanding of cause/ rationale presented
?Discussion supported with minimal relevant evidence ?No or unsatisfactory understanding presented of pathophysiology.
?Not linked to case study
?Cause/ rationale not presented / incorrect
?No or inappropriate evidence utilised to support discussion.
Risk Factors/ Signs & Symptoms:
Identify 2 other risk factors that Brian has for a CVA. For each of these risk factors explain how & why they increase the risk of & lead to a CVA.
On transfer to the neurological ward, select 2 signs or symptoms from Brian’s assessment data and explain for each, how & why they occur after a CVA, again from a pathophysiological perspective.
20% ?Comprehensive understanding / rationale of risk factors and signs and symptoms presented (2 risk factors & 2 signs/symptoms addressed)
?Linked to case study
?Comprehensively supported with relevant evidence. ?Good understanding / rationale of risk factors and signs and symptoms presented (2 risk factors & 2 signs/symptoms addressed)
?Linked to case study
?Sound support of discussion with relevant evidence ?General understanding / rationale of risk factors and signs and symptoms presented (2 risk factors & 2 signs/symptoms addressed)
?Linked to case study
?Discussion supported with minimal relevant evidence ?No or unsatisfactory understanding / rationale of risk factors and signs and symptoms (2 risk factors & 2 signs/symptoms not addressed)
?Not linked to case study
?No or inappropriate evidence utilised to support discussion.
Pharmacology:
Discuss the rationale for why Brian has been ordered three of his discharge medications. Also, include the pharmacokinetics and pharmacodynamics of each medication, including relevant adverse effects and contraindications.
Each of Brian’s discharge medications is to be administered orally, which means they all undergo the first pass effect. Explain what first pass effect is and the implications this has for a drug’s bioavailability.
35% ?Comprehensive understanding of indications, pharmacokinetics, pharmacodynamics of each medication, including relevant adverse effects and contraindications.
?Comprehensive understanding presented of first pass effect and bioavailability.
?Linked to case study, no irrelevant information included
?Comprehensively supported with relevant evidence. ?Good understanding of indications, pharmacokinetics, pharmacodynamics of each medication, including relevant adverse effects and contraindications.
?Good understanding presented of first pass effect and bioavailability.
?Linked to case study, no irrelevant information included
?Sound support of discussion with relevant evidence ?General understanding of indications, pharmacokinetics, pharmacodynamics of each medication, including relevant adverse effects and contraindications.
?General understanding presented of first pass effect and bioavailability.
?Linked to case study, no irrelevant information included
?Discussion supported with minimal relevant evidence ?No or unsatisfactory understanding of indications, pharmacokinetics, pharmacodynamics of each medication, including relevant adverse effects and contraindications.
?No or unsatisfactory understanding presented of first pass effect and bioavailability.
?Not linked to case study / irrelevant information included
?No or inappropriate evidence utilised to support discussion.
Academic requirements:
Meets all style and academic requirements.
Accurate referencing (APA6)
Word limit met
Clear, concise flow
Spelling, grammar and punctuation correct.
10% ?All CNHS academic requirements met. No errors.
?Word limit met, clear, concise flow with correct spelling, grammar and punctuation. ?All CNHS academic requirements met.
?Word limit met +/- 10%
Logical flow and clarity.
All spelling, grammar and punctuation correct. ?All CNHS academic requirements met with minor errors / omissions.
?Word limit met +/- 10%
Mostly clear, concise flow with
minimal spelling, grammar and punctuation issues. ?Limited or omission of CNHS academic requirements. References presented incorrectly/ inconsistently.
?Word limit below or exceeds+/- 10%
Unclear, poor flow Many spelling, grammar and punctuation issues.
Marker’s Name: Grade:
Overall Comment:
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