Pathophysiology and Pharmacology Applied to Nursing

NURBN 2012: Nursing Practice 3 – Pathophysiology and Pharmacology Applied to Nursing
Assessment Task 2 – Clinical Scenario Assignment
Due Date: Friday 8th May at 5pm
Word Count: 2000 words +/- 10%
Format: Report style, with introduction and conclusion. A cover sheet is not required. You will be
required to submit this assignment through Turnitin.
Directions
For this assessment task, you are required to write a 2000 word report answering the questions
from the scenario. You will need to explore the pathophysiology, pharmacology and psychosocial
aspects of the scenario and 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 are used in the body of the
text. Use the question you are answering as your heading. Do not use dot points 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. You may reproduce the tables used in the questions in your
answers.
Use APA referencing (6th) throughout your assignment. References must be current, preferably from
the past five years. You are required to cite no less than 10 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.
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.
The marking rubric for the assignment is provided on 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.
Case Scenario
Russell is a truck driver aged 68 years whos admitted to Monash Health with breathlessness.
History of presenting complaints
He describes progressive dyspnoea that he has had for the past three months and is now breathless
when showering and dressing. For the past week, he has felt more comfortable overnight sleeping
on three pillows. He denies any chest pain.
You have taken Russell’s history and vitals and made a Med call to review Russell.
Past medical history
Russell says he had a heart attack 15 years ago, which was treated with a stent, and has had no chest
pain since then.
Russell has Chronic Obstructive Pulmonary Disease (COPD) for the past 30 years.
He also has had problems with high blood pressure, diabetes and cholesterol.
Medication history
His medications are as following –
 Aspirin 100mg oral daily,
 Salbutamol 2 – 4 puffs PRN
 Budesonide/Efomoterol fumarate dehydrate 2 puffs daily
 Perindopril 5 mg in the morning daily
 Atenolol 50 mg daily in the morning
 Metformin 500mg oral BD
 Atorvastatin 40 mg daily.
Russell is married and has two children. He used to smoke 20 cigarettes per day since he was 18
years old, but stopped smoking when he had his heart attack. He drinks a small amount of alcohol.
Observation/On Examination
On examination his
 Heart rate (HR) is 90 bpm and regular
 Blood pressure (BP) is 150/90 mmHg
 Jugular venous pressure (JVP) is slightly elevated
 He has mild oedema in his both legs
 BMI 26 m2/kg
 Skin – sweaty and pale
 RR 26, regular
 SpO2 94% RA
 Temp. 37o C
 BSL 5.5
Duty doctor examined him and confirmed Russell develop heart failure. He orders some laboratory
investigations, CXR and Echocardiogram, 2L oxygen, Tab Frusemide 40 mg in the morning and Tab
Spironolactone 25 mg orally once a day.
Biochemistry results are:
 Na 135 mmol/L [134 to 145 mmol/L]  K 4.2 mmol/L [3.5 to 5.0 mmol/L]  Urea 8.9 mmol/L; [2.5 to 7.1 mmol/L]  Creatinine 98 μmol/L [53 to 106 μmol/L]  Total cholesterol (TC) 6.8 mmol/l, [<5.5 mmol/L]  Low density lipoprotein (LDL) 5.0 mmol/L [2.0 mmol/L]  High density lipoprotein (HDL) 1.0 mmol/L [> 1.0mmol/L]  Triglycerides (TG) 2.1 mmol/L [< 2.0 mmol/L] Full blood count is normal Chest X-ray A chest X-ray shows an increased cardiothoracic ratio (dilated heart) and obliteration (not visible) of cardiophrenic and costophrenic angles in the lung fields suggestive of pulmonary oedema and heart failure Echocardiogram shows a dilated left ventricle with severe systolic dysfunction (left ventricular ejection fraction (LVEF) 25%. Russell’s dyspnoea improves with Frusemide and Spironolactone Case scenario questions Q1. Discuss risk factors that contributed to Russell developing heart failure (10 marks) Q2. Describe pathophysiology of right and left sided heart failure using clinical presentation and examination findings of Russell (20 marks) Russell has long history of COPD. Q3. Explain the term ‘acute exacerbation of COPD’ [8 marks] What factors put patients like Russell at high risk for exacerbations of COPD? [8 marks] Q4. Use the table below (or something similar) to discuss the following drugs: Perindopril, Spironolactone, Budesonide/Fomoterol fumarate dehydrate puffs. 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 Russell (24 marks for medications) Generic name Perindopril Spironolactone Budesonide/Fomoterol fumarate dehydrate puffs Drug group (1 mark) Mechanism of action (3 marks) Complications/side effects (2 major) (1 mark each) Nursing considerations (2 major) (1 mark each) Q5. What non-pharmacological recommendations, if any, do you make for Russell? (20 marks – 5 marks for each) a. For heart failure b. To prevent exacerbation of COPD c. To prevent pneumonia d. To reduce his high cholesterol level Presentation, readability and ref – [10 marks]