NURBN 2012: Pathophysiology and Pharmacology Applied to Nursing - Clinical Scenario Assignment Help

Internal Code: C_AI_DCBI_ACG

Nursing Clinical Scenario Assignment Help

Scenario: Betsy Blogger is a 72 year old woman on your surgical ward complaining of nausea and shortness of breath. She had an uncomplicated fixation of a right tibula and fibula fracture 2 days ago. Past medical history Coronary Artery Bypass Graft (CAGs) x 3 (8 years ago) Chronic Obstructive Pulmonary Disease (COPD) Coronary Heart Disease Hypertension Type 2 Diabetes Mellitus Current Medications Aspirin 100mg oral daily Diltiazem SR 240mg oral daily Endone 5mg oral PRN QID Enoxaparin 40mg S/C BD (while immobile in hospital) GTN spray 1 – 2 sprays S/L PRN Metformin 500mg oral BD Paracetamol 1g oral QID Pravastatin 40mg oral nocte (bedtime) Salbutamol 2 puffs PRN Spiriva 2 puffs daily History of presenting complaint Betsy has just returned from the toilet, and buzzed as she sat back down on the bed. She tells you she feels short of breath, and nauseous. She denies any chest pain. Observations HR 90, regular BP 145/85 Skin – sweaty and pale RR 26, regular SpO2 94% RA Temp. 37oC Pain 3/10 to surgical wound BSL 5.5 Your buddy nurses asks you to perform an ECG while she calls the doctor to review Betsy. Task:  Question 1  Your buddy nurse asks for an ECG even though Betsy has no chest pain. Explain the rationale for the ECG request. Question 2  Betsy has stable angina that is responsive to GTN. 2a. Describe the pathophysiology of angina, with reference to causes, progression and outcomes. Include stable angina, unstable angina, nonSTEMI and STEMI in your answer  2b. List two risk factors specific to Betsy (not including age or gender) that increase her risk of Acute Coronary Syndrome  Question 3  Appendix 1 is an ECG that was taken while Betsy was experiencing nausea and shortness of breath. Systematically analyse the ECG, commenting on the: - Rhythm - Rate - Presence and regularity of p waves - ST segment What is your interpretation of this ECG? Question 4  Acute Coronary Syndrome is suspected when specific clinical criteria are met. Discuss three of the central findings that potentially lead to a diagnosis of Acute Coronary Syndrome. Question 5  Use the table below (or something similar) to discuss the following drugs: GTN, diltiazem and pravastatin. 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 Betsy. Generic name GTN Diltiazem Pravastatin Drug group (1 mark) Mechanism of action  Complications/side effects (2 major)  Nursing considerations (2 major)  Question 6  Betsy has been commenced on ticagrelor in addition to her aspirin. Discuss the mechanism of action and use of aspirin and ticagrelor in cardiac patients. Include in your answer how these drugs combined will improve the outcome for Betsy. Question 7 The use of morphine in Acute Coronary Syndrome (ACS) is currently undergoing review. Discuss how morphine is used in ACS, including the benefits and controversies. Make sure to include current research in your answer. Question 8 Betsy has an increased risk of depression due to her coronary heart disease (a chronic illness). Use current research to link the increased risk of depression with chronic illness.

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