Subject Code & Title :- NURBN3030 Nursing Management of Deteriorating Patient
Weighting :- 50%
Word Count :- 2000 words (+/- 10%)
Presentation :- 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.
NURBN3030 Nursing Management of Deteriorating Patient Assignment
Description of the task :-
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 hand over high lights:
1. 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.
2. 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) how ever because no time of on set can be identified he is not a candidate for thrombolytic management.
3. Background: Previous ST- elevation Myocardial Infarction (STEMI) 5 yrs ago with associated Left Ventricular Failure (LVF), hypertension and hyper cholesterolaemia. Managed with medications: Aspirin Furosemide Enalapril and Bisoprolol. He has nil known allergies.
4. 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.
5.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:
i. Altered conscious state, GCS 10
ii. Temperature: 35.1 and cool on palpation
iii. Pulse: 65 bpm and irregular
iv. Blood Pressure: 196 / 120 mmHg
v. Respiration: 14 bpm
vi. SpO2: 96% on room air
vii. 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 under taking 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.
NURBN3030 Nursing Management of Deteriorating Patient Assignment
Nursing interventions would include nursing activities or actions that the nurse could initiate in response to nursing assessment findings. Note: please be aware of the difference between an assessment and an intervention.
…The resuscitation team arrives and provides supportive care and after 5 minutes a stat order of Lorazepam 8mg Intravenously is prescribed.
Question 4: Describe the mode of action indications nursing administration adverse effects and con train dications of Lorazepam with in 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
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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