Subject Code & Title :- NURBN2027 Case Scenario Essay
Weighting :- 40%
Word Count :- 2000 words (+/- 10%)
Assessment Purpose :-
This assessment task is designed to help you develop the application of your pathophysiology and pharmacology knowledge to assessment and clinical decision making skills so that you may apply these to your professional role. As a registered nurse you will be expected to recognise and identify clinical manifestations risk factors and potential complications of client presentations in a variety of situations to improve care outcomes and within your professional scope of practice. Providing evidence based care and advise to others during various clinical situations and environments, requires a sound under standing of various theoretical and practical approaches of pathophysiology and pharmacology
NURBN2027 Essay Case Scenario Assessment 2
Assessment Description :-
For this assessment task, you are required to write a 2000 word report answering the questions from the scenario. Heading, subheading, in-text references/citations and reference list will not be the part of the total word count. You will need to explore the pathophysiology pharmacology and psychosocial aspects related to the scenario in a specific and prioritised manner to demonstrate your understanding in the answers you provide. Your answers should be informed by your reading of current research and literature.
A report format includes an introduction and conclusion but headings and subheadings are used in the body of the text. Use the question you are answering as your heading. Do not use dot points except medication table 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 but will not be counted towards word count. You may produce a table (question 2.2 – medications) for your answers.
Use APA 7th referencing throughout your assignment References must be current preferably from the past five years. You are required to cite no less than 15 references, and the majority of these should be current journal articles. We are looking at information informing current 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 blogging 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. References that are not written in English are not acceptable to be used as references for this task.
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 as per University guidelines.
The marking rubric for the assignment is provided in Moodle. Marks will be allocated for each section according to the rubric. Use the rubric as a guide when writing your assignment to identify the depth of the answer expected.
When requesting your submission to be remarked and a grade review a self-assessed rubric and script with comments on the areas where you believe marks were allocated unfairly and with out due process, needs to attached to an email within 10 working days of grade release .
Sandra Bullock 39 years of age is seeing a GP, where you work as practice nurse. Over the past 3 weeks Sandra has experienced significant tiredness palpitations and tremor. She has also aware that she is always feeling hot, ‘even when others are feeling cold’. She has lost 5 kg in weight over the past 2 weeks without any change to her lifestyle habits . She has also noticed a swelling over the front of her neck. On interviewing , Sandra has noticed her eyelids are ‘a bit puffy’ and friends have commented that she often looks like she is ‘staring’.
Sandra is a mother of 5 children and lives in suburban Melbourne. Sandra works as a Real Estate Manager. She has been married to Frank, who is an electrician, for 18 years.
Sandra has been suffering from type 2 Diabetes and rheumatoid arthritis for the past two years. She takes metformin (APO-Metformin XR 500 mg tablet daily) and glipizide (Minidiab 5 mg half a tablet daily) to control her diabetes and Ibuprofen (APO-Ibuprofen 400 mg one table dails for joint pain. She does not get enough time to exercise and depends on the nearby cafeteria for her lunch and grabs “takeaway” dinners as she rushes home at the end of the day . She states that she often very busy mixing and matching work and home commitments which leads to her being distracted often enough to take her medication regularly. Sandra also admits to smoking 5-6 cigarettes daily just to calm her in between appointments and unwind after a busy day.
Her mother and older sister were both diagnosed with T2DM in their early 50’s. Her mother also has Hashimoto thyroiditis.
Sandra is quite “stressed” about her ongoing conditions and the recent development of other symptoms.
The examination findings of Sandra are as following –
• BMI: 29 m2
• Blood Pressure: 140/90 mmHg
• Pulse rate: 105 beats/min, irregular
• Respiratory Rate: 22 breaths/minute
• Temperature: 37.7oC tympanic
• SpO2: 97% on RA (Room Air)
• A smooth, mildly enlarged thyroid gland with a bruit (increased blood flow in the thyroid gland mild proptosis
• eyelid retraction bilaterally
• brisk reflexes, and a fine tremor.
Sandra’s blood tests reveal –
• Full blood examination (FBE): haemoglobin: 125 g/L (reference range: 120–150 g/L)
• White cell count: 11.5 X10^9/L (reference range: 4.0–10.0 X 10^9/L)
• neutrophil: 8.0 X 10^9/L (reference range: 2.0–7.0 X 10^9/L)
• lymphocytes: 0.8 X 10^9/L (reference range: 1.0–3.0 X 10^9/L)
• Platelet: 250 X 10^9/L (reference range: 150–400 X 10^9/L)
• Free T3 = 15 pmol/L (reference range 3.5 – 6.0 pmol/L)
• Free T4 = 75 pmol/L (reference range 10 – 20 pmol/L
• TSH = 0.02 (reference range 0.500 – 4.2 IU/L
• TSH-Receptor antibody (TSH-RAB AB) = positive and significantly elevated.
• Antithyroid peroxidase (anti-TPO) and antithyroglobulin = negative or low titre
Part 1 Questions
1.What underlying endocrine condition is indicated by Sandra’s blood test, as well as the signs and symptoms (clinical features) she is experiencing? Describe the pathophysiology of the condition. You need to explain the following aspects in this section and relate them specifically to Sandra:
1.1 Identify the underlying condition
1.2 Interpret Sandra’s blood test results and clinical features, and link back to Sandra
1.3 Include at least 4 risk factors relevant to Sandra
1.4 Explain the pathophysiology of the specific condition Sandra is suffering from, making links to Sandra throughout
1.5 Explain at least 5 complications of this condition that are relevant to Sandra
Part 2 Questions :-
Further blood test results reveal that Sandra’s blood glucose level (BGL) is 12.9 mmol/L
Sandra’s GP referred her to an Endocrinologist. Her conditions, blood test results and medications were reviewed by the specialist. Sandra was advised to stop metformin and prescribed Tab
Sitagliptin (Januvia) 50 mg daily in addition to glipizide 5 mg (Minidiab) half a tablet daily. The Endocrinologist also added Tab Carbimazole 5 mg daily for managing her recently developed signs and symptoms, and the related Endocrinological condition.
2.1. Identify 4 risk factors potentially causing Sandra’s high BGL and HbA1c. Discuss how each risk factor affects BGLs and HbA1c.
2.2 Discuss the three medications Sandra is prescribed by the Endocrinologist. Include in your answer the action, complications, relevant side effects and relevant nursing considerations linked to Sandra’s situation.
2.3 Explain five complications that Sandra could experience if her blood glucose level (BGL) and HbA1c remain high.
2.4 Identify and briefly discuss four preventive measures Sandra could use to reduce her risk of developing complications related to T2DM.
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