Reference no: EM133131470

Assessment Task: Case Study

Application of health assessment, planning, implementation and evaluation of professional nursing care to a clinical deterioration patient scenario

Purpose: This assessment task is designed to develop the student's ability to integrate theory into practical clinical knowledge using a patient case scenario. This task is intended to encourage students to practise writing and presenting researched material in a logical and concise manner that is academically rigorous. Therefore, each student is to demonstrate critical thinking, development of argument, discerning use of resources and the application of the principles of academic writing.

Description:

This assessment task allows students to demonstrate theoretical clinical knowledge around nursing assessment, pathophysiology of factors impacting on clinical deterioration, planning of nursing care, nursing and medical management, and evaluation of care. Students are required to answer the case scenario questions provided.

Students should attempt all questions in the case study:

...You are a Graduate Nurse commencing your afternoon shift in a busy Emergency Department. Your patient has been stepped down from the resuscitation bay to your monitored cubicle. The ISBAR handover highlights:

• Identify: Robert is a 78-year-old male who presented to the Emergency Department 2 hours ago. His wife Agnes is present with him at the bedside.
• Situation: after waking this morning with left upper and lower limb moderate weakness, left side facial droop and aphasia. His wife noted his symptoms and called an ambulance. His CT Brain confirms signs of a cerebrovascular accident (stroke), however because no time of onset can be identified he is not a candidate for thrombolytic management.
• Background: Previous ST- elevation Myocardial Infarction (STEMI) 5 yrs ago with associated Left Ventricular Failure (LVF), hypertension and hypercholesterolaemia. Managed with medications: Aspirin, Furosemide, Enalapril, and Bisoprolol. He has nil known allergies.
• Assessments: Pathology has been sent for initial Urea & Electrolytes, Glucose, Full Blood Examination, coagulation studies, cardiac markers, and C-Reactive Protein (CRP) and results are normal so far. Initial ECG reveals Robert's cardiac rhythm is Atrial Fibrillation, which is new for him. Of interest, his vital signs indicate a moderate hypertension 165/96 and altered conscious state GCS currently 12. He has two intravenous cannulas inserted to his left and right cubital fossa.

• Review: Robert is awaiting a formal medical admission to stabilise his risk factors for further cerebral vascular accident and commence rehabilitation.

Question 1: Using your existing knowledge of Cerebrovascular Accident (CVA), identify and describe the pathophysiology of the most likely type of CVA Robert has presented with. In your response include a definition, causes, clinical manifestations, and typical initial management. Ensure you link this discussion to Robert's presentation and history. (approx. 400 words)

Question 2: Discuss TWO specific nursing assessments that should be PRIORITY for Robert's deterioration (excluding vital signs). For EACH nursing assessment, ensure your discussion includes a description of the undertaking of each assessment in the context of Robert's condition AND clear rationale as to why these assessments would be priority. (approx. 400 words).

Question 3: Discuss THREE specific nursing interventions that YOU as a Graduate Nurse could initiate to initially support Robert's airway and ventilation. For EACH intervention, ensure your discussion includes link to evidence-based practice AND provides rationale as to how it would improve the physiological outcomes of Robert's condition. (approx. 400 words)
*Nursing interventions would include nursing activities or actions that the nurse could initiate in response to nursing assessment findings. N ote: please be aware of the difference between an
assessment and an intervention.

...The resuscitation team arrives and provides supportive care, and after 5 minutes an stat order of Lorazepam 8mg Intravenously is prescribed.

Question 4: Describe the mode of action, indications, nursing administration, adverse effects, and contraindications of Lorazepam within the context of administration in Robert's deterioration episode (approx. 300 words).

Question 5: Discuss THREE nursing evaluations that you would complete following the administration of Lorazepam. For EACH evaluation, provide a brief rationale as to how each evaluation will assist in preventing the further clinical deterioration of Robert considering his management so far. (approx. 300 words).

Question 6: Despite the stress of observing Robert's seizure, Agnes wishes to remain close by. Your department works hard to ensure patient and family centred care is at the centre of care they provide.
Discuss how family centred care can be provided to Agnes during such a stressful event. (approx. 200 words)

Attachment:- Case study outline.rar