Assessment One: Hv3 Short answer questions on a case study (TEMPLATE)

Assessment One: Hv3 Short answer questions on a case study (TEMPLATE)

Search terms used to access literature:

Search engines used to access literature: Example: CINAHL, MEDLINE (Ovid) , Clinical Key for Nursing, Cochrane library, JBI, Scopus

Question 1. (250 words)

Question 2: Category 1 (approx. 165 words)

Question 2: Category 2 (approx. 165 words)

Question 2: Category 3 (approx. 165 words)

References

Assessment One: Short answer questions on a case study

Length: 750 words

Weighting: 30%

Due: Week 5, Monday 22nd August 2022 at 12 midnight

Aim of the assessment

The purpose of this assessment is to enable you to:

Explain the underlying pathophysiology related to the clinical manifestations of ST elevation myocardial infarction (STEMI)

Discuss the importance of reperfusion in the management of a patient presenting with STEMI

Identify evidence-based strategies when caring for a patient presenting with STEMI

Case Study

Introduction: Mr Raj Kumar is a 64-year-old male with no known allergies (NKA)

Situation: Mr Raj Kumar arrived at the Emergency Department at 1130 hrs with central crushing chest pain radiating to his jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4. 300mg Aspirin administered on route to hospital.

Background: Hypertension (Captopril 12.5mg bd) Hyperlipidaemia (Simvastatin 40mg nocte). Type 2 Diabetes Mellitus (DM) (diet controlled)

Assessment:

Airway patent

Breathing: Respiratory rate 18, bilateral air entry, breath sounds clear. SpO2 on room air 95%

Circulation: Sinus Tachycardia 102bpm. BP 140/90. Diaphoretic and peripherally cool. Central crushing chest pain radiating to the jaw.

COLDSPA:

Character: crushing chest pain

Onset: 11am

Location: Central, radiating to jaw

Duration: ongoing

Severity: 7/10

Pattern: at rest, not relieved by SL Anginine Spray

Associated symptoms: diaphoresis

Disability: Alert & oriented. Pupils equal and reacting to light (PEARL). Pain score 7/10. Equal strength in all four limbs.

Exposure: IVC Left cubital fossa.

Fluid: NBM. NO IVF

Weight 88kg

Results:

Elevated Troponin 35ng/L troponin

12 lead ECG: ST elevation (>2mm) V2, V3, V4

A diagnosis of acute anterior STEMI is made

Recommendations:

Supplemental oxygen if SpO2 < 93%

Continuous cardiac ECG monitoring

12-lead ECG now, then every 30 minutes

Keep in resuscitation bay (Triage category 2)

Blood tests: Troponin now, then again in 2 hours Medications:

Morphine 2.5mg IVI 2/24 (PRN maximum dose 10mg)

Nitro-glycerine 600mcg SL (PRN maximum 3 doses); if pain persists, consider IV Glyceryl Trinitrate infusion

Clopidogrel 300mg PO STAT

Heparin 5000IU IV STAT

As per STEMI reperfusion flowchart:

Transfer to Cardiac Cath Lab for urgent primary PCI when ready (<90mins).

If PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1230pm

Guided Questions:

Question 1: (250 words)

Pick one (1) clinical manifestation and discuss the related pathogenesis:

Central crushing chest pain with radiation to the jaw or;

ST elevation or;

elevated Troponin (35ng/L)

Question 2: (500 words)

Pick one (1) intervention from EACH of the three (3) categories below.

Provide one rationale for interventions selected form each category. Use evidence and/or pathophysiology to support your answer.

Category 1

Non-pharmacological interventions Category 2

Pharmacological interventions Category 3

Reperfusion interventions

Supplemental oxygen if SpO2<93%

12 lead ECG within 10 minutes of arrival and then every 30 minutes

Troponin at 0 and 2 hours Morphine 2.5mg IV

Nitro-glycerine 600mcg SL

Aspirin 300mg

Heparin 5000iu IV

Clopidogrel 300mg

Tenecteplase 45mg IV

Primary Percutaneous Coronary Intervention

Supporting resources

American Psychological Association (APA) referencing style guide (PDF 725 KB)(Western Sydney University Library, 2020).

Library Study SmartLinks to an external site.a library resource that helps you to complete assignments (Western University Library, 2021).

Western Sydney University Library has further information about referencing on theirReferencing and citationpage.

Suggested readings

Pathway for Acute Coronary Syndrome Assessment (PACSA)(New South Wales Health, 2019).

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016(Chew et al., 2016, pp. 895951).

Guided Questions

Criteria Mark High Distinction Distinction Credit Pass Fail

Criteria 1:

Question 1

Demonstrates comprehensive and detailed knowledge of the pathogenesis of one (1) clinical manifestation of ST-elevation Myocardial Infarction /20 Provides an accurate and clear explanation of the pathogenesis causing the clinical manifestation of the patient in the case study.

Synthesises the information effectively in own words, explanation is developed in a logical sequence and is technically correct.

The discussion is clearly and accurately supported by appropriate sources. Explains the pathogenesis causing the clinical manifestation of the patient in the case study.

Mostly synthesises the information effectively in own words and in a logical sequence.

The discussion is clearly and accurately supported by appropriate sources. Generally, provides an accurate explanation of the pathogenesis causing the clinical manifestation of the patient in the case study.

The explanation is mostly developed in a logical sequence but there may be one or two omissions of information

or manifestation is accurately explained but there is little logical development in the discussion.

The discussion is supported by appropriate sources. Provides a basic description of the pathogenesis of the clinical manifestation presented by the patient in the case study.

There may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow of the process.

The discussion is mostly supported by appropriate sources. Gives either a superficial description or inaccurate description of the pathogenesis of the clinical manifestation. There are significant inaccuracies, repetition, or lack of clarity. Has not accurately related the clinical manifestations to the pathogenesis.

17-20 15-16.5 13-14.5 10-12.5 9.5

Criteria 2

Question 2 -Category 1

Demonstrates understanding of one (1) non-pharmacological intervention for the patient presenting with STEMI using current evidence/pathophysiology to support answer /20 Accurately identifies one (1) non-pharmacological intervention to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s.

Accurately identifies one (1) non-pharmacological intervention to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s May be missing minor detail or requires further elaboration required

Accurately identifies one (1) non-pharmacological intervention to manage a patient presenting with STEMI. The answer is supported by a rationale.

The answer explains the rationale/s but more depth/technical information required.

Accurately identifies one (1) non-pharmacological intervention to manage a patient presenting with STEMI. The answer is not well-supported by current evidence.

More details to support the discussion required.

Does not accurately identify one (1) non-pharmacological intervention to manage a patient presenting with STEMI or provides little or inaccurate explanation of rationales.

Information predominantly copied or quoted from inappropriate sources.

17-20 15-16.5 13-24.5 10-12.5 9.5

Guided Questions

Mark High Distinction Distinction Credit Pass Fail

Criteria 3

Question 2 -Category 2

Demonstrates understanding of one (1) pharmacological intervention for the patient presenting with STEMI using current evidence/pathophysiology to support answer /20 Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s.

Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s. May be missing minor detail or further elaboration required. Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is supported by a rationale.

The answer explains the rationales but more depth/technical information required.

Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is not well-supported by current evidence.

More details to support the discussion required.

Does not accurately identify one (1) pharmacological intervention to manage a patient presenting with STEMI or provides little or inaccurate explanation of rationales.

Information predominantly copied or quoted from inappropriate sources.

17-20 15-16.5 13-24.5 10-12.5 9.5

Guided Questions

Mark High Distinction Distinction Credit Pass Fail

Criteria 4

Question 2 -Category 3

Demonstrates understanding of one (1) reperfusion strategy for the patient presenting with STEMI using current evidence/pathophysiology to support answer /20 Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s.

Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is well-supported by current evidence. The answer is accurate and clearly explains the rationale/s. May be missing minor detail or further elaboration required

Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is supported by a rationale.

The answer explains the rationale/s but more depth/technical information required.

Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is not well-supported by current evidence.

More details to support the discussion required.

Does not accurately identify a reperfusion strategy to manage a patient presenting with STEMI or provides little or inaccurate explanation of rationales.

Information predominantly copied or quoted from inappropriate sources.

17-20 15-16.5 13-24.5 10-12.5 9.5

Academic Writing

Mark High Distinction Distinction Credit Pass Fail

Language use

Writes in a clear and succinct academic style using correct grammar, spelling, and punctuation

/5 Writes in an advanced style exhibiting highly coherent and logical flow of ideas. Organisation of material exhibits an advanced level of clarity. No errors in spelling, grammar, punctuation or sentence construction. Writes clearly and succinctly with a coherent, logical flow of ideas exhibiting advanced clarity. No errors in spelling, punctuation, grammar or sentence construction. Writes clearly and satisfactory use of language enables effective flow of ideas. Minor, infrequent errors in spelling, punctuation, grammar and sentence construction that do not impede flow of ideas. Writing is reasonably clear, but at times the effective flow of ideas and meaning is hindered. Minor, frequent errors in spelling, punctuation, grammar and sentence construction sometimes impede the flow of ideas. Writes in an elementary style with very basic use of language and poor articulation of ideas. It may be verbose, convoluted or difficult to read. Organisation of material and main points is unclear. The errors in spelling, punctuation, grammar and sentence construction impede meaning.

4.5-5 4 3.5 2.5 <2

Academic Writing

Mark High Distinction Distinction Credit Pass Fail

Referencing and in-text citations

Uses a minimum of six recent (2017-2022) academic sources such as journal articles, textbooks, government reports, or creditable organisational websites).

All sources of information must be clearly relevant and accurately cited applying conventions of in-text referencing for APA 7 style. A complete reference list is correctly formatted according to APA style. /5 Referencing technique is flawless and follows APA 7 conventions both in-text and in the reference list.

Uses a selection of appropriate references. Evidence of cited sources is always clear and accurate. Referencing technique follows APA 7 conventions but contains infrequent minor errors.

Uses a selection of appropriate references. Evidence of cited sources is always clear and accurate. Referencing technique follows APA 7 conventions but contains infrequent errors. Uses at least the minimum number of required references.

Evidence of cited sources is clear and accurate. There may be frequent minor errors in APA 7 referencing convention in in-text referencing and/or the reference list. Uses at least the required number of required references. Use of cited sources is not always clearly evident. There may be absent or incorrect use of APA referencing technique. Does not use the minimum number of required references, or uses predominantly inappropriate or non-authoritative sources. Sources of information are not correctly acknowledged.

4.5-5 4 3.5 2.5 <2

Academic Integrity

Search terms/ Search engines used Mark 5 4 2-3 1 0

Indicates search terms used to access literature via the nursing

e-resources via the library

Provides names of search engines and search terms used to locate literature. For example

CINAHL

MEDLINE (Ovid)

Clinical Key for Nursing

Cochrane library

JBI

Scopus

/5 Student carefully provides a very thorough list of search terms and provides names of search engine/s used to locate literature

Student provides a comprehensive list of search terms used and provides names of search engines used to locate literature Student indicates search terms used and provides names of some of the search engines used to locate literature Student has NOT provided ONE of the items i.e., the NOT provided the search terms and OR the names of search engines used to locate literature. Student has NOT provided NEITHER the search terms and or full names of search engines used to locate literature

5 4 2-3 1 0

Academic Integrity

Turnitin (Similarity Percentage) Mark 5 3-4 2.5-3 0.5 0

Student aims for Similarity percentage via Turnitin of

15% /5 Turnitin (Similarity Percentage of

15%) Turnitin (Similarity Percentage of

16% - 17%) Turnitin (Similarity Percentage of

18-21%) Turnitin (Similarity Percentage of

22-25%) Turnitin (Similarity Percentage 26%

5 3-4 2.5-3 0.5 0