2.4.1 Short Answer Exam based on one case study of acute life-threatening and/or traumatic complex health condition
Type of Collaboration:
30/04/2020, 23:59 hrs
Refer to section 2.5 of the Learning Guide - General Submission Requirements
Short answer questions based on a case study of an acute life-threatning and/or traumatic complex health condition.
There is a word limit of 1250 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% (1375 words) the marker will stop marking.
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 5 years including journal articles, textbook material or other appropriate evidence based resources.
Aim of assessment
The purpose of this assessment is to enable students to:
1. Demonstrate knowledge by analysing the information provided in the case study.
2. Apply the clinical information provided in the case study and describe this clinical information within a pathophys- iological and patient focused framework.
3. Discuss nursing strategies and evidence based rationales to manage a patient with an acute episode of asthma.
4. Discuss the pharmacological interventions related to the management of a patient with an acute episode of asthma.
Poppy is a 9 year old female, weight 40Kg.
She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with 6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation of asthma.
EXCERPT OF RELEVANT ICU NOTES
Diagnosed with asthma age 2 (infrequent intermittent asthma).
Current medications: - Ventolin PRN. IUTD (immunisations up to date)
A. Clear, speaking in single words
B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and expiratory wheeze
C. HR 160bpm, ST, peripherally warm D. GCS 14/15 (E4, V4, M6)
E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug
F. IVF NaCl 53 ml/hr G.
a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.
b. BGL 9.0mmol/L
c. Beta-agonist- Salbutamol
d. Anticholinergic - Atrovent
e. IV Hydrocortisone
f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate
- Keep SpO2 92-95%%
- Beta- antagonist Salbutamol continuous via nebuliser
- Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24
- Hydrocortisone 100mg 6/24
- MgSO4 6.4mmol/20 minutes
- IVF 53ml/hr
- Repeat ABGs in 1hour
- Monitor BGL
- Peakflow /spirometry
Explain the pathogenesis causing the clinical manifestations with which Poppy presents.
1. Sit Poppy in a High Fowlers position
– How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress?
2. Apply and titrate oxygen
– What oxygen delivery device will you use?
– Why did you choose this device?
– How does providing supplemental oxygen work and, how will it assist Poppy?
For each medication below explain
– The mechanism of action.
– Why your patient is receiving this medication in relation to her symptoms and diagnosis?
– What are the nursing considerations for this medication?
– What clinical response you expect?
– What continuing clinical observations will you need to undertake?
Ipratropium Bromide via nebuliser
Minimum of 6 references needed…from the past 5 years