Description

Short Answer Assessment 1

Subject Name: Health Variations 3 – Acute Exacerbations of Chronic Conditions

Weight: 30%

Type of Collaboration: Individual

Due: Week 7- Monday 2nd of September 2024 at 23:59 hours

Submission: Refer to instructions below

Format: Short Answer

Length: 1000 words

Use of Artificial Intelligence:

In this assessment task, you will not be able to meet the learning outcomes related to analysing the causes, pathogenesis, clinical manifestations and appropriate selection and prioritisation of nursing interventions as appropriate to NURS2016 by using generative artificial intelligence (AI) tools. Working with another person or technology in order to gain an unfair advantage in assessment or improperly obtaining answers from a third party including generative AI to questions in an examination or other form of assessment may lead to sanctions under the Student Misconduct Rule. Use of generative AI tools may be detected. More information is available on the Library web page.

Instructions:

Word Count- There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% the marker will stop marking at 1100 words.

Aim of Assessment– The aim of this assessment is to enable students to:

1. Demonstrate knowledge by analysing the information provided in the case study
2. Explain the underlying pathophysiology related to the clinical manifestations of a patient with exacerbation of COPD
3. Demonstrate understanding of nursing strategies and evidence-based rationales to manage a patient with exacerbation of COPD

Details -You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past 10 years with at least two references from the resources provided in the vUWS site. Resources must include peer-reviewed journal articles, textbook material or other appropriate evidence-based published resources.

Case Study ISBAR Handover: Chronic Obstructive Pulmonary Disease

Introduction-David Nazzal a 62-year-old male with no known allergies (NKA)

Situation– David presented to the Emergency Department at 2200 hrs. Upon assessment he was sitting in a tripod position and found to have a barrel chest. David presents with fever, sore throat, productive cough, yellow phlegm and dyspnoea.

Background– David tested positive for COVID-19 three days ago through a rapid antigen test. Wife Linda indicated symptoms had progressively worsened with no relieving factors noted. David had similar episode a year ago with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring hospitalisation. David has an increasing amount of purulent mucus which appears as yellow phlegm. He self-medicated with a Ventolin inhaler prior to admission but this had not resolved his symptoms.

Past Medical History– COPD, hypertension, hyperlipidaemia. He was a previous smoker for 30 years however he quit when he was diagnosed with COPD 10 years ago.

Current Regular Medications taken:

– Ipratropium (Atrovent) via nebulizer once a day

– Salbutamol (Ventolin) puffer PRN

– Lipitor 40mg daily

– Not up to date on his annual pneumococcal and influenza vaccinations.

A to G Assessment.

Airway– Patent, own

Breathing– RR-30 b/min, SPO2 78% on room air, Increased Shortness Of Breath (SOB).

Auscultation: Diminished breath sounds bilaterally, with wheezing and crackles in the lung bases. Using accessory muscles of respiration ++.

Circulation– Heart Rate (HR) Regular- 128 b/min-Sinus tachycardia. BP- 168/85 mmHg.

Capillary Refill Time 3 sec, peripherally cool, heart sounds dual no murmur.

Disability– GCS-14/15 E4V4M6, confused and distressed +

Exposure– Febrile, skin intact, IV cannula right cubital fossa

Abdo: bowel sounds present in all four quadrants with a soft, nontender abdomen

Fluid– IVF fluids in progress TKVO, Nil by mouth

Glucose– BSL- 5.8 mmol/L

Imaging: Chest X-ray showing hyperinflated lungs with increased interstitial markings consistent with COPD exacerbation.

Lab tests

• CBC

Result                                   Reference Range

Haemoglobin                                     153 g/L                                  120-140 g/L

White blood cells                             15.0×10^9/L                        4.0-11.0×10^9/L

Neutrophils                                        11.0×10^9/L                       2.0-7.5×10^9/L

Platelets                                              200×10^9/L                         150-400×10^9/L

C Reactive Protein (CRP)               25 mg/L                                3mg/L

 

• 2- COVID-19 PCR Test: Positive
• ABG on room air (at 2200hrs)

Result                                   Reference Range

pH                                          7.30                                                        7.35-7.45

PaO2                                     55 mmHg                                             80-100 mmHg

PaCO2                                   60 mmHg                                             35-45 mmHg

HCO3-                                   28 mmol/L                                           22-26 mmol/L

SpO2                                     78%                                                        (88-92% COPD)

BE                                           -4 mmol/L                                           -2 to +2 mmol/L

Clinical Impression: Infective Exacerbation of COPD COVID 19 +ve

Recommendations

• Continuous monitoring of vital signs- Transfer to High Dependency Unit
• COVID-19 Management: Isolate the patient in a negative pressure room, implement infection control precautions, and monitor for progression of COVID-19 symptoms
• Controlled oxygen therapy -Continuous pulse oximetry, to keep O2 between 88% to 92%
• Sit patient in high fowlers position
• 4/24 ABGs
• Salbutamol (Ventolin) nebuliser 2/24
• Ipratroprium (Atrovent) via nebuliser 6/24
• Prednisolone (40–50 mg daily)
• 12- lead ECG 6th hourly
• Blood troponin
• Sputum culture
• IV Azithromycin (Zithromax) 500 mg on day 1 , followed by 250 mg once daily for the next four days.
• 300 mg nirmatrelvir with ritonavir 100 mg taken together orally every 12 hours for 5 days.
• Pulmonary function tests Spirometry when patient is stable

Question 1 (600 words- worth 50 marks)

Explain the pathophysiology leading to all the clinical manifestations with which David Nazzal presents. Use the information from the deranged vital signs shown in the A to G assessment and the ISBAR handover.

You must critically analyse the available evidence-based literature to support your response and provide intext in-text references.

Question 2 (400 words- worth 30 marks)

1. Select 1 (one) intervention, from 2 (two) of three categories listed in the table below.
2. Provide rationales for each of the interventions listed for Mr Nazzal in the categories that you have selected.

You must critically analyse the available evidence-based literature to support your response and provide intext in-text references

 

Category 1 Non-pharmacological interventions	Category 2 Pharmacological interventions	Category 3 Diagnostic interventions
1.       Administer controlled oxygen therapy to maintain O2 saturation between 88% and 92%. 2.       Position the patient in a high Fowler’s position. 3.       Perform continuous monitoring of vital signs.	1. Salbutamol, Ipratropium, and Prednisolone 2. Azithromycin 3. Nirmatrelvir and Ritonavir	1. 4th hrly ABGs 2. Sputum culture 3. Pulmonary function test- Spirometry 4. Blood Troponin level

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