case study scenerio - final.pdf
NURBN 2012: Nursing Practice 3 - Pathophysiology and Pharmacology Applied to Nursing
Assessment Task 2 – Clinical Scenario Assignment
Due Date: Friday 8th May at 5pm
Word Count: 2000 words +/- 10%
Format: Report style, with introduction and conclusion. A cover sheet is not required. You will be
equired 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 cu
ent 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 referencing (6th) throughout your assignment. References must be cu
ent, preferably from
the past five years. You are required to cite no less than 10 references, and the majority of these
should be cu
ent journal articles. We are looking at information informing cu
ent 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
logging websites are not acceptable references. 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 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.
The marking ru
ic for the assignment is provided on Moodle. Marks will be allocated for each
section according to the ru
ic. Use the ru
ic as a guide when writing your assignment to identify
the depth of the answer expected.
Case Scenario
Russell is a truck driver aged 68 years whos admitted to Monash Health with
eathlessness.
History of presenting complaints
He describes progressive dyspnoea that he has had for the past three months and is now
eathless
when showering and dressing. For the past week, he has felt more comfortable overnight sleeping
on three pillows. He denies any chest pain.
You have taken Russell’s history and vitals and made a Med call to review Russell.
Past medical history
Russell says he had a heart attack 15 years ago, which was treated with a stent, and has had no chest
pain since then.
Russell has Chronic Obstructive Pulmonary Disease (COPD) for the past 30 years.
He also has had problems with high blood pressure, diabetes and cholesterol.
Medication history
His medications are as following -
Aspirin 100mg oral daily,
Salbutamol 2 – 4 puffs PRN
Budesonide/Efomoterol fumarate dehydrate 2 puffs daily
Perindopril 5 mg in the morning daily
Atenolol 50 mg daily in the morning
Metformin 500mg oral BD
Atorvastatin 40 mg daily.
Russell is ma
ied and has two children. He used to smoke 20 cigarettes per day since he was 18
years old, but stopped smoking when he had his heart attack. He drinks a small amount of alcohol.
Observation/On Examination
On examination his
Heart rate (HR) is 90 bpm and regular
Blood pressure (BP) is 150/90 mmHg
Jugular venous pressure (JVP) is slightly elevated
He has mild oedema in his both legs
BMI 26 m2/kg
Skin – sweaty and pale
RR 26, regular
SpO2 94% RA
Temp. 37o C
BSL 5.5
Duty doctor examined him and confirmed Russell develop heart failure. He orders some laboratory
investigations, CXR and Echocardiogram, 2L oxygen, Tab Frusemide 40 mg in the morning and Tab
Spironolactone 25 mg orally once a day.
Biochemistry results are:
Na 135 mmol/L [134 to 145 mmol/L]
K 4.2 mmol/L [3.5 to 5.0 mmol/L]
Urea 8.9 mmol/L; [2.5 to 7.1 mmol/L]
Creatinine 98 μmol/L [53 to 106 μmol/L]
Total cholesterol (TC) 6.8 mmol/l, [<5.5 mmol/L]
Low density lipoprotein (LDL) 5.0 mmol/L [2.0 mmol/L]
High density lipoprotein (HDL) 1.0 mmol/L [> 1.0mmol/L]
Triglycerides (TG) 2.1 mmol/L [< 2.0 mmol/L]
Full blood count is normal
Chest X-ray
A chest X-ray shows an increased cardiothoracic ratio (dilated heart) and obliteration (not visible) of
cardiophrenic and costophrenic angles in the lung fields suggestive of pulmonary oedema and heart
failure
Echocardiogram shows a dilated left ventricle with severe systolic dysfunction (left ventricular
ejection fraction (LVEF) 25%.
Russell’s dyspnoea improves with Frusemide and Spironolactone
Case scenario questions
Q1. Discuss risk factors that contributed to Russell developing heart failure (10 marks)
Q2. Describe pathophysiology of right and left sided heart failure using clinical presentation and
examination findings of Russell (20 marks)
Russell has long history of COPD.
Q3. Explain the term ‘acute exace
ation of COPD’ [8 marks]
What factors put patients like Russell at high risk for exace
ations of COPD? [8 marks]
Q4. Use the table below (or something similar) to discuss the following drugs:
Perindopril, Spironolactone, Budesonide/Fomoterol fumarate dehydrate puffs. 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 Russell (24 marks for
medications)
Generic name
Perindopril Spironolactone Budesonide/Fomoterol
fumarate dehydrate
puffs
Drug group (1 mark)
Mechanism of action
(3 marks)
Complications/side
effects (2 major) (1
mark each)
Nursing
considerations (2
major) (1 mark each)
Q5. What non-pharmacological recommendations, if any, do you make for Russell? (20 marks – 5
marks for each)
a. For heart failure
. To prevent exace
ation of COPD
c. To prevent pneumonia
d. To reduce his high cholesterol level
Presentation, readability and ref – [10 marks]
NURBN 2012 Clinical Scenario Assignment Marking Ru
ic.pdf
NURBN 2012 Clinical Scenario Assignment Marking Ru
ic /2020
Criteria High Distinction 80 –100% Distinction 70 – 79% Credit 60 – 69% Pass 50 – 59% Fail 0 – 49%
Discussion of risk factors that
contributed to Russell
developing heart failure [10
marks]
Co
ect identification of all
isk factors and explained
them with evidence.
Risk factors not mostly
co
ectly identified and
some evidence provided
Risk factors partially identified
and explained partially with
evidence
Risk factors inco
ect and
cursory use of evidence
Risk factors inco
ect OR
question not attempted
Describe pathophysiology of
ight and left sided heart failure
using clinical presentation and
examination findings of Russell
[20 marks]
Excellent explanation of
pathophysiology of right
and left sided heart failure.
Excellent linking of
Russell’s presentation to
his underlying pathology
Very good explanation
pathophysiology right and
left sided heart failure.
Excellent linking of Russell’s
presentation to his
underlying pathology
Good explanation
pathophysiology right and left
sided heart failure.
Good linking of Russell’s
presentation to his underlying
pathology
Inadequate explanation
pathophysiology right and left
sided heart failure.
Inadequate excellent linking
of Russell’s presentation to
his underlying pathology
Pathophysiology question
not attempted or
explanation mostly
inco
ect
Explain the term ‘acute
exace
ation of COPD’ [8
marks]
Explain factors that can likely to
put Russell at high risk for
exace
ations of COPD [8
marks]
Excellent explanation of
“acute exace
ation of
COPD”
Excellent discussion of risk
factors that can likely to
put Russell at high risk for
exace
ations of COPD.
Very good explanation of
“acute exace
ation of
COPD”
Very good discussion of risk
factors that can likely to put
Russell at high risk for
exace
ations of COPD.
Good explanation of “acute
exace
ation of COPD”
Good discussion of risk factors
that can likely to put Russell at
high risk for exace
ations of
COPD.
Inadequate explanation of
“acute exace
ation of COPD”
Inadequate explanation of risk
factors that can likely to put
Russell at high risk for
exace
ations of COPD.
No attempt to answer the
clinical scenario
Identification of
pharmacological issues relevant
to clinical scenario – three
drugs worth 8 marks each [24
marks]
All relevant
pharmacological concepts
and mechanisms of action
are included and co
ect.
All relevant
contraindications, adverse
eactions, nursing
considerations and patient
education points included
All relevant pharmacological
concepts and mechanisms
of action are included and
co
ect. Most relevant
contraindications, adverse
eactions, nursing
considerations and patient
education points included
Most relevant pharmacological
concepts and mechanisms of
action are included and
co
ect. Some relevant
contraindications, adverse
eactions, nursing
considerations and patient
education points included
Few relevant pharmacological
concepts and mechanisms of
action are included or co
ect.