RECENT ASSIGNMENT

ASSESSMENT 2 BRIEF
Subject Code and Title TUM202 Therapeutic use of Medicines
Assessment Case Study- Polypharmacy
Individual/Group Individual
Length 1500 words (+/- 10%)
Learning Outcomes The Subject Learning Outcomes demonstrated by successful completion of the task below include:
a) Identify and discuss the general principles of pharmacology including pharmacokinetic concepts and pharmacodynamics and their application to pathophysiological states. (Criteria 1.1, 1.4, 3.2)
b) Explain and apply quality & safety frameworks to the use of therapeutic medicines in clinical practice (Criteria 1.1, 2.7, 2.9, 4.3,
6.1, 6.5)
c) Compare and contrast the mechanisms of action, therapeutic uses, adverse effects, interactions, contraindications and routes of administration of different drug groups. (Criteria 1.1, 4.2)
d) Deduce the factors contributing to individual variability and determine dosage individualisation strategies to control variability in drug response including lifespan aspects of drug therapy and population groups with specific needs. (Criteria 1.1, 4.1, 4.2, 5.1, 6.1,
7.1)
e) Identify and justify utilisation of evidence-based reference resources relating to integrative pharmacology to identify, prevent and clinically manage polypharmacy, potential adverse drug
reactions, interactions and toxicity to ensure safe practices. (Criteria
1.1, 4.1, 4.2, 5.1, 6.1, 7.1)
g) Explore and apply professional, legal and ethical issues surrounding the safe prescription and administration of medications. (Criteria 1.1, 1.4, 1.5, 3.4, 5.1,6.2, 6.5, 6.6)
Submission Due by 11:55pm AEST/AEDT Sunday end of Module 4.2 (week 8)
Weighting 35%
Total Marks 100 marks
Assessment Task
In this assessment, you will review the case of a patient who is on multiple medications and answer a series of short answer questions related to polypharmacy (1500 words).
Please refer to the Task Instructions for details on how to complete this task.
Context
Polypharmacy is a significant problem in the community, particularly for people living with multiple comorbidities or multiple chronic diseases. Knowledge of medications and their actions and interactions with each other is an important skill of nursing practice. Drug-drug interactions can have significant consequences for the patient. This task is designed to assess the theoretical knowledge that you have acquired whilst undertaking TUM202 Therapeutic Use of Medicines.
Instructions
To complete this assessment task, you must:
1. Read the case study document found in Assessment 2 resources folder on Blackboard.
2. Using credible evidence based literature, write a response to the case study that addresses the following points:
• Briefly introduce the case study scenario, and intention of the case study response.
• Define polypharmacy.
o Explain who is at risk of polypharmacy and why.
o Identify and describe the impacts of polypharmacy on 1) the older person, and 2) the healthcare system.
• Identify the drug- drug interaction(s) and explain which of the drug -drug interaction(s) are linked to the signs and symptoms that the case study patient is experiencing.
• Explain what is causing the symptoms the patient is experiencing (consider if this is due to pathology or a result of the drug interactions and/or human error)
• Propose strategies that can be implemented to identify and prevent polypharmacy.
• Identify evidence-based resources that can assist the Registered Nurse (RN) to identify possible drug – drug interactions.
• Consider and explain how the RN can incorporate a person centred approach when advocating for the case study patient, with relevant members of the multi-disciplinary team.
Assessment format
• A cover page must be included which includes; subject name and code, assessment number, student name, student number and word count
• Assessments must be submitted in a Microsoft Word document (unprotected) and not PDF
• Headings and Sub-headings should be used for different sections
• Size 11 font
• Times New Roman or Calibri Body writing style
• Double line spacing is required
Referencing
It is essential that you use appropriate APA style for citing and referencing research. Please see more information on referencing in the Academic Skills webpage.
Submission Instructions
Please submit your word document into the Assessment 2 submission link in the Assessment section found in the main navigation menu of the subject TUM202 Blackboard site. A rubric will be attached to the assessment. The Learning Facilitator will provide feedback via the Grade Centre in the LMS portal. Feedback can be viewed in My Grades. Assessments must be submitted in a Microsoft Word document (unprotected) and not PDF
Academic Integrity
All students are responsible for ensuring that all work submitted is their own and is appropriately referenced and academically written according to the Academic Writing Guide. Students also need to have read and be aware of Torrens University Australia Academic Integrity Policy and Procedure and subsequent penalties for academic misconduct. These are viewable online.
Students also must keep a copy of all submitted material and any assessment drafts.
Assessment Rubric
Assessment Attributes Fail
(Yet to achieve minimum standard) 0-49% Pass
(Functional)
50-64% Credit
(Proficient) 65-74% Distinction
(Advanced)
75-84% High Distinction
(Exceptional)
85-100%
Knowledge and understanding of polypharmacy and its implications for the patient and healthcare system
15%
Incomplete knowledge and understanding of polypharmacy.
Omitted or inaccurate
definition of polypharmacy.
Does not accurately explain the impacts of polypharmacy on the patient or healthcare system. Demonstrates basic knowledge and understanding of polypharmacy.
Limited definition of polypharmacy, no-minimal key elements of polypharmacy identified.
Basic attempt to explain the impacts of polypharmacy on the patient or healthcare system, with key elements missing.
Demonstrates proficient
knowledge and understanding of polypharmacy.
Provides a satisfactory definition of polypharmacy but missing multiple key elements.
Satisfactorily explains the impacts of polypharmacy on the patient or healthcare system, with one-two key elements omitted.
Demonstrates strong knowledge and understanding of polypharmacy.
Provides a thorough definition of polypharmacy but missing one or two key elements.
Demonstrates advanced explanation of the impacts of polypharmacy on the patient or healthcare system. Demonstrates exceptional knowledge and understanding of polypharmacy.
Provides an exceptional and accurate definition of polypharmacy.
Provides an excellent description on the impacts of polypharmacy on a patient and healthcare system.
Identification of drug-drug interaction(s) and
their link to signs and symptoms experienced by the case study patient
20%
Failure to identify any drug-drug interaction(s).
Unable to identify which drug – drug interactions are causing the patients symptoms.
No-limited use of evidence based resources Partial identification of the drug – drug interaction(s).
Attempts to link drug interactions to signs and symptoms in the case study.
Limited use of evidence based resources to identify drug interactions. Identifies drug – drug interaction(s), with key detail missing.
Satisfactory linking of the signs and symptoms to the drug interactions.
Good use of evidence based resources to identify drug interactions. Identifies drug- drug interaction(s) with minor omission of relevant details.
Well-developed explanation of the link to signs and symptoms and the drugdrug interactions.
Clearly identifies the drug – drug interaction(s). Clearly links the signs and symptoms to the drug interaction.
Exceptional use of evidence based resources to identify drug interactions.
to identify drug interactions.
Very good use of evidence based resources to identify drug interactions.
Proposal of strategies to identify
and prevent polypharmacy, including evidencebased resources
15% Limited identification of strategies and resources to identify and prevent polypharmacy
No- very limited identification of evidence based resources to identify and prevent polypharma.cy Limited identification of strategies and resources to identify and prevent polypharmacy
No- very limited identification of evidence based resources to identify and prevent polypharmacy. Limited identification of strategies and resources to identify and prevent polypharmacy
Good attempt to identify evidence based resources to identify and prevent polypharmacy, with several key resources missing. Limited identification of strategies and resources to identify and prevent polypharmacy
Very Good identification of multiple evidence based resources to identify and prevent polypharmacy, with one-two key resources missing. Limited identification of strategies and resources to identify and prevent polypharmacy
Highly developed, thorough identification of multiple evidence based resources to identify and prevent polypharmacy.
Consideration and explanation of incorporation of a person centred approach to care, demonstrating advocacy for the case study patient, with relevant members of
the multi-disciplinary
team
10%
Limited- no explanation of how to incorporate person centred
approaches to care for the case study patient.
Limited ability to identify strategies to prevent poly pharmacy and how the nurse may advocate for patients. Basic explanation of how to incorporate person centred approaches to care for the case study patient, missing key details and rigor.
Some ability to identify strategies to prevent poly pharmacy by advocating for the patient with members of the multi-disciplinary team, but key members and details missing
Good explanation of how to incorporate person centred approaches to care for the case study patient, with some key details missing.
Identifies several strategies to prevent polypharmacy by advocating for the patient with the multidisciplinary team, with some key strategies and members missing.
Very good explanation of how to incorporate person centred approaches to care for the case study patient, with one- two key details missing.
Identification of multiple strategies to prevent polypharmacy, by advocating for the patient with the multi-disciplinary team, with one-two key strategies missing
Excellent explanation of how to incorporate person centred approaches to care for the case study patient.
Excellent identification of strategies to prevent polypharmacy by advocating for the patient with the multi-disciplinary team.
Analysis and application with synthesis of new Limited synthesis and analysis of topic.
Confuses logic and emotion. Information Functional synthesis and analysis of topic.
Often conflates/confuses assertion of personal opinion Well-developed analysis and synthesis of the topic.
Thoroughly developed and creative analysis and synthesis of the topic. Highly developed and critical analysis, of the information pertaining to the topic.
knowledge and links to case scenario
10%
taken from reliable sources but without a coherent analysis or synthesis.
Viewpoints of experts are taken as fact with little questioning, or linking to case study.
Limited understanding of key concepts required to support the case study.
with information substantiated by evidence from the research/course materials.
Analysis and evaluation do not reflect expert judgement, intellectual independence, rigor and adaptability.
Resembles a recall or summary of key ideas, with some links to the case study.
Demonstrates a capacity to explain and apply relevant concepts.
Identifies logical flaws.
Questions viewpoints of experts, and makes several links to the case study.
Supports personal opinion and information substantiated by evidence from the research/course materials. Well demonstrated capacity to explain and apply relevant concepts, linking literature to the case study.
Viewpoint of experts are subject to questioning.
Analysis and evaluation reflect growing judgement, intellectual independence, rigor and adaptability.
Discriminates between assertion of personal opinion and information substantiated by robust evidence from the research/course materials and extended reading.
Information is taken from sources with a high level of interpretation/evaluation to develop a comprehensive critical analysis or synthesis.
Strong links made between literature and the case study.
Identifies gaps in knowledge.
Exhibits intellectual independence, rigor, good judgement and adaptability.
Systematically and critically discriminates between assertion of personal opinion and information substantiated by robust evidence from the research/course materials
and extended reading
Breadth and depth of research and the use of resources
10% Demonstrates inconsistent use of good quality, credible and relevant resources to Demonstrates use of some credible and relevant resources to support and develop ideas.
Demonstrates use of several credible resources to support and develop ideas.
Demonstrates use of multiple good quality, credible and relevant resources to support and Demonstrates use of multiple high quality, credible and relevant resources to support and develop ideas.
support and develop ideas.
Minimal evidence of wide scope within the organisation for sourcing evidence
Shows some evidence of wide scope within the organisation for sourcing evidence. develop arguments and statements.
Show evidence of wide scope within the organisation for sourcing evidence.
Show strong evidence of wide scope within the organisation for sourcing evidence
Effective
Communication
(written)
10%
Poor presentation of information that does not adhere to the given format.
Omission of specialised language and terminology with accuracy
Meaning is repeatedly obscured by errors in the
communication and
articulation of ideas, including errors in structure, sequence, spelling, grammar and punctuation.
Under/over word count by more than 10%. Communicates in a readable manner that largely adheres to the given format.
Generally employs specialised language and terminology with accuracy.
Meaning is sometimes difficult to follow.
Information, arguments and evidence are structured and sequenced in a way that is not always clear and logical, including minimal use of subheadings.
Some errors are evident in spelling, grammar and/or punctuation.
Under/over word count by more than 10%. Communicates in a coherent and readable manner that adheres to the given format.
Accurately employs specialised language and terminology.
Meaning is easy to follow. Information, arguments and evidence are structured and sequenced in a way that is clear and logical.
Occasional minor errors
present in spelling, grammar and/or punctuation.
Within word limit. Communicates coherently and concisely in a manner that adheres to the given format.
Accurately employs a wide range of specialised language and terminology.
Engages audience interest. Information, arguments and evidence are structured and sequenced in a way that is, clear and persuasive.
Spelling, grammar and punctuation contain onetwo minor errors.
Within word limit. Communicates eloquently. Expresses meaning coherently, concisely and creatively within the given format.
Discerningly selects and precisely employs a wide range of specialised language and terminology.
Engages and sustains audience’s interest. Information, arguments and evidence are insightful, persuasive and expertly presented.
Spelling, grammar and punctuation are free from errors.
Within word limit.
Correct citation of
resources
Referencing is omitted or does not resemble required APA format. Referencing resembles required APA format, with frequent or repeated errors. Referencing resembles required APA format, with occasional errors. APA referencing follows required format, containing only a few minor errors. APA referencing follows required format, and is free from errors.
10%
The following Subject Learning Outcomes are addressed in this assessment
SLO a) Identify and discuss the general principles of pharmacology including pharmacokinetic concepts and pharmacodynamics and their application to pathophysiological states.
SLO b) Explain and apply quality & safety frameworks to the use of therapeutic medicines in clinical practice
SLO c) Compare and contrast the mechanisms of action, therapeutic uses, adverse effects, interactions, contraindications and routes of administration of different drug groups.
SLO d) Deduce the factors contributing to individual variability and determine dosage individualisation strategies to control variability in drug response including lifespan aspects of drug therapy and population groups with specific needs.
SLO e) Identify and justify utilisation of evidence-based reference resources relating to integrative pharmacology to identify, prevent and clinically manage polypharmacy, potential adverse drug reactions, interactions and toxicity to ensure safe practices.
SLO g) Explore and apply professional, legal and ethical issues surrounding the safe prescription and administration of medications.
Therapeutic Use of Medicines (TUM202) T3 2021
Assessment 2 - Polypharmacy case study
Background information
Judy is a well-known patient of the medical practice, as a result of having multiple chronic conditions which require regular visits to the medical practice.
Due to a decrease in available appointments as a result of the covid-19 vaccination rollout, Judy has not visited the clinic in 5/52, following the second dose of the Pfizer vaccine, and a check up to monitor her response to newly prescribed sertraline (Zoloft), which has had an initial positive effect on her mood.
Prior to seeing the GP, the Practice Nurse conducts a physical assessment and conducts an interview with the patients, so that when the GP is ready, they will have recent assessment data to expedite and facilitate the consultation.
Judy is known to sometimes self-adjust her medication doses to manage the clinical manifestations of heart failure, asthma and diabetes, without consulting her GP.
Judy’s chief complaints for booking the appointment today are:
• Request to review her asthma management plan
• Increased shortness of breath (SOB), increased chest tightness and heart palpitations
• Increased lower leg oedema, and newly recent bilateral hand oedema
• Feeling general aches and pains all over her body
Patient Details
Name: Judy Harris Age: 61
Allergies: None
Language: English speaking
Religion: Catholic
Diet: Type 2 diabetic diet
N.O.K: Husband (Douglass)
Medical Past History
• Chronic Heart Failure (CHF)
• Hypertension
• Hyperlipidaemia (diet controlled)
• Type 2 diabetes mellitus (T2DM)
• Depression • Obesity
• Asthma
• Atrial fibrillation
• Eczema
Social History
• Lives with husband
• Owns a small business (currently closed due to covid-19)
• Supportive daughters x2
• Consumes 1-2 standard alcohol drinks per week • Ceased smoking 16 years ago (smoked 5 packs a week for 21 years)
• Volunteers occasionally with the Country Women’s Association (CWA)
Current Medications
• Perindopril 5mg oral Daily
• Digoxin 250mcg oral Daily
• Sertraline 50mg orally Daily
• Humalog 75/25, 33 units before breakfast and 23 units before dinner.
• Amiloride 10mg oral daily • Albuterol MDI PRN
• Glyceryl trinitrate ½ tablet SL (when symptomatic)
• Salmeterol MDI PRN (not currently taking)
• Fluticasone MDI PRN (not currently taking)
• Prednisolone 5mg-30mg Oral (tapered)
Nursing Assessment:
Judy was able to walk into the assessment room unaided from the waiting room, and greets you with a smile.
Vital Signs
Manual BP: 144/88 HR: HR: 72 bpm; feels strong but irregular
RR: 21 per minute Sp02: 97% on Room air
GCS: 15, PEARL 3mm Temperature: 36.7c
• Pain 3/10 at rest, 4/10 on movement, cramping in nature, widespread all over the body.
• Weight: 91kg; height 5`4?
• Whilst conducting a pupillary assessment, Judy mentions she recently started noticing halo’s in her visual field, and her vision is mildly blurred despite previously never needing to wear glasses
• Lungs: Clear on auscultation
• Electrocardiogram (ECG) shows Atrial Fibrillation, peaked T waves, and a shortened QT segment
• Lower extremities: +1 pitting oedema bilaterally; pedal pulses present but difficult to palpate as a consequence of oedema
• Bilateral hand oedema (mild) – unable to fit wedding rings on her fingers.
Whilst interviewing Judy, she reveals the following information:
Judy has been self-adjusting her medication regime, to try to find the right balance for her symptoms of heart failure, asthma and diabetes, but she feels like she has gotten worse over the last 5-6 days.
Judy reports the increasing frequency of exacerbations of asthma require ongoing prednisolone tapers, which she finds a lot of effort to stay on top of, and reports she has been taking prednisolone almost every day for the last month.
During her last round of prednisolone therapy, her BGLs increased to 15-25mmol/L, despite decreasing her carbohydrate intake.
To self-manage this, Judy “takes a little more” insulin when she notes high blood glucose readings, but she has not been instructed on the use of an insulin sliding scale.
Judy reveals she typically increases the frequency of her fluticasone, salmeterol, and albuterol to 4-5 times/day during an asthma flare-up however, she can no longer afford the fluticasone or salmeterol and so has only been taking prednisolone and albuterol.
Judy and her husband have been out of work for 18 months as a result of the global pandemic, and their only source of income is their Job Keeper payments, as their small business has closed.
The ongoing costs of regular medications has placed additional stress on Judy’s finances, making her feel anxious and more aware of her chest tightness, and heart palpitations. When Judy experiences chest discomfort, she takes glyceryl trinitrate as prescribed however, this has had no effect on the discomfort or palpitations.
Judy reports that on the days her lower legs and hands swell the most, she is active and in an upright position throughout the day. Swelling increases throughout the day, to the point she cannot wear her wedding ring, or fit into close fitting shoes comfortably. Judy makes the decision to take an extra amiloride tablet, sometimes half a tablet, if her swelling is excessive and painful around lunch time; as taking the amiloride later in the day prevents her from sleeping because of nocturnal urination.
Disclaimer:
This clinical scenario has been developed for educational purposes only, for students undertaking TUM202 in T3, 2021 at Torrens University Australia (TUA).
All characters are fictitious, and the clinical scenario does not depict any real person, or event.