Professional Nursing Care & Patient Scenario Case Study - Nursing Assignment Help

Assignment Task

Task 

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. Referencing, spelling and grammar, and overall presentation will also be assessed. 

Format: The layout is a questions and answer style; an introduction or conclusion is NOT necessary. However, should include logically structured discussion sections. May use diagrams in their answers where appropriate. You are strongly encouraged to use headings to assist in the flow of your writing, but they must conform to APA guidelines. The preferred layout of your paper should be double spaced with block paragraphing (no indenting). Do not indent the first line of each paragraph. Page numbers are to be included on the bottom left corner of the page.  
Presentation: All work should be typed in 12-point font, double spaced; and written and presented according to the academic guidelines using APA (7th Edition) referencing.  The length of the essay is 2000 words (+/- 10%). Any task that is under or over the allocated limits by 10% will attract a deduction from the final mark for the task. 

References: A minimum of 15 references must be used for the essay. These should be no more than 
7 years old unless of historical significance and/or of specific relevance to the topic (for example; the Ottawa Charter from 1986). These references must be a mixture of books and journals or Library database sources. Dictionaries or Wikipedia are not considered a primary reference and therefore will not be counted in the reference count. Direct quotes, appendices or the reference list, are not counted in the word limit. Direct quotes must be limited to no more than 50 words and be according to APA 7th Edition style. Please ensure that you adhere to the specific guidelines set out by the APA 7th Edition 

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-Ractive 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.

You check on Robert to undertake routine post CVA assessments and note the following:  
•    Altered conscious state, GCS 10 
•    Temperature: 35.1 and cool on palpation 
•    Pulse: 65 bpm and irregular  
•    Blood Pressure: 196 / 120 mmHg  
•    Respiration: 14 bpm  
•    SpO2: 96% on room air   
•    Pain scale using Baker Wong pain scale indicates no pain.   
 

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. 
  
During your assessment, Robert starts to seize. You grab some gloves and observe no immediate danger, Robert provides no pain response so you press the emergency call bell and lay the bed flat, awaiting the assistance of other staff.  

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. 
 

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.  
 
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.
 
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. 

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