HNN 751 : Advanced Physiology and Patient Assessment AT1 Case Study - Medical Science Assignment Help

Assignment Task:

Task:

Purpose of assessment task
Nurses play a key role in patient assessment and nurses’ approach to patient assessment, documentation of assessment findings, interpretation of data and escalation of care are major influences on patient care. As registered nurses who are transitioning into specialty practice, this assessment task will assist you to develop required clinical assessment and reasoning skills necessary for safe practice. In this task, you will be asked to show the depth of your pathophysiological knowledge, justify cue acquisition strategies based on hypothesised problems, and interpret complex patient data to inform your patient care decisions. Additional skills developed during this assessment task include database searching and screening to select best evidence for clinical practice and academic writing skills to communicate clear and succinct answers.

Task Description:
In this assessment, you will:
1) provide short answer responses to a series of questions based on a case study, and;
2) write a short extended response to a question about nurses’ roles in assessment, informed by research evidence.
Details are provided under the section ‘Instructions for this assessment task’ in addition to the marking criteria and mark allocation at the end of this document. There is 70 marks in total for this assessment task (40% weighting).

Case Study 

Presentation
Mrs Goodman, aged 76 years, has been unwell with a viral illness for 2 days. She is nauseated and has had multiple loose bowel actions over the last two days, as well as 2 vomits. She has been unable to tolerate any food since becoming unwell, and has only been able to drink some small, infrequent sips of water. Her skin is pale and cool to touch, and she is agitated and drowsy.

History
Mrs Goodman has a past history of an anterior myocardial infarction, hypertension, and a recent echocardiogram confirmed a left ventricular ejection fraction of 26%. Her usual medications are: metoprolol 25 mg bd, ramipril 5mg mane, atorvastatin 40 mg nocte, and aspirin 100 mg mane. It is unclear whether Mrs Goodman consistently takes all of her medications.

You are the critical care nursing student responsible Mrs Goodman’s care. Your initial assessment findings are:
• respiratory rate: 29 breaths per minute
• blood pressure: 92/58 mmHg
• pulse: 109 bpm (regular)
• SpO2: 93% on room air
• temperature: 37.4 degrees Celsius

Question 1.
Mrs Goodman is likely hypovolaemic, as evidenced by her hypotension, tachycardia and tachypnoea. With specific reference to Mrs Goodman’s history and presentation, explain the physiological causes of her hypotension, tachycardia and tachypnoea. Focus your response on the physiological and pathophysiological causes and emergence of these findings specifically drawing on determinants of cardiac output and compensatory mechanisms. Your answer does not need to include potential diagnoses.

(14 marks)

Question 2.
Mrs Goodman has a central venous catheter (CVC) inserted to facilitate a fluid infusion to restore her circulating blood volume. Four replacement options are discussed;
• Hartmann’s solution
• 0.9% Normal saline
• 5% Dextrose
• Packed Red Blood Cells
Explain the physiological action of each fluid and, drawing on research evidence, explain why each of these options should or should not be infused.

(8 marks)

Question 3.
Identify four (4) priority nursing and collaborative assessments the registered nurse should perform and monitor to evaluate the re-establishment of normal fluid and electrolyte homeostasis for this patient. For each assessment, explain;
• the physiological rationale for performing the assessment (why it is a priority)
• the expected/target assessment findings or parameters that would indicate a return to homeostasis

(4 marks)

Question 4.
Provide an overall interpretation of Mrs Goodman’s arterial blood gas results and provide a physiological explanation for each parameter that is deviated from normal.

(6 marks)

• pH 7.32
• PaCO2 30 mmHg
• PaO2 83 mmHg
• SaO2 94%
• HCO3 19 mmol/L
• Lactate 3.1 mmol/L

Question 5.
On assessment of Mrs Goodman’s heart rate, an irregular rhythm is noted.

List four possible reasons for this rhythm in Mrs Goodman. Provide a physiological rationale for each.

(4 marks)

Question 6.
Mrs Goodman undergoes a portable chest X-ray. Describe and rationalise four (4) factors or issues that should be evaluated by the nurse to assess the quality of a chest x-ray prior to performing an analysis of a chest x-ray.

(4 marks)

Question 7: Extended response
“The notion that adverse events are sudden, unexpected and occur without warning has now been challenged and there is evidence that, for the majority of patients who suffer an in-hospital adverse event, the event is preceded by a period of physiological abnormality, whereby the patient exhibits clearly abnormal physiological signs.”

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