Case Study ISBAR Handover:
Case Study ISBAR Handover:
Introduction: Mrs Mary Fenech is a 78-year-old lady with no known allergies (NKA)
Situation: She arrived in the Emergency Department at 09:30 hrs with slurred speech and right sided weakness since 0530 hrs while at home.
Findings from the CT perfusion assessment using Mean Transit Time (MTT) and Time to Peak (TTP) images showed reduced blood flow in the left middle cerebral artery (MCA) vascular territory extending from the medial cerebellum to the deep white matter at the centrum semiovale above the lateral ventricle. A CT angiogram showed an acute left Internal Carotid Artery (ICA) occlusion. Thrombolysis with Alteplase was administered at 11:30hrs
Background: Atrial Fibrillation (AF), Hypertension (HTN), Type 2 Diabetes Mellitus (IDDM), No head trauma, no prior stroke within the previous 3 months
Regular medications-
Atenolol 50mg daily, Aspirin 100mg daily, Lipitor 40mg daily, Magnesium 200mg daily, Amlodipine 5mg daily, Perindopril 5mg daily, NovoRAPID insulin
Assessment:
Airway: slight inspiratory stridor
Breathing: Respiratory rate 24, bilateral air entry, clear sounds. SpO2 90% on room air
Circulation: BP 149/69, irregular rate - 80 bpm
Disability: GCS 12 (E 4, V 3, M 5) Pupils equal and reacting to light (PEARL). Sluggish eye gaze. Temp 36.9
Exposure: x2 IVC in Right & Left cubital fossa
Fluid: IV Compound sodium lactate (Hartmans) at 20 mL /hr TKVO
Glucose blood level: 9.5mmol/L
Weight approx. 86kg
Stroke Assessment:
F: Face- Right sided facial droop
A: Arms- Right sided weakness
S: Speech- Aphasia
T: Time of onset 0530hrs, Time of thrombolysis 1130hrs, time of ECR planned at 1300hrs, Door-to-Needle time 150 minutes, Symptom to needle time 390 minutes
Results: A diagnosis of left MCA stroke with totally occluded left Internal Carotid Artery (ICA)
Nursing Interventions:
Initiate Stroke Pathway
Keep in resuscitation bay (Triage category 2)
Connect to continuous cardiac monitoring
Record a 12 lead Electrocardiograph (ECG)
Initiate supplemental oxygen if SpO2 < 93%
Monitor airway patency
Record Glasgow Coma Scale hourly
Prepare for endovascular clot retrieval (ECR) to restore blood flow
Arrange for a Speech Pathology consult
Maintain head of the bed elevated to 30 degrees
Insert a nasogastric tube
Maintain nil by mouth
Collect requested pathology
Monitor for haematemesis, melaena and haematuria
Blood tests:
Coagulation profile and cross match (PT, APTT, INR), FBC, LFT, EUC,
Medications:
Alteplase (IV)
Heparin 5000iu (IV)
Labetalol
Insulin NovoRAPID (SC)
Short Answer Question Format:
Complete your answers for the questions in a Word document.
List each question number and then your answer.
All answers must relate to the Mrs Mary Fenech case study.
Assessment: Presentation related to a Case Study
Transcript Length: 1000 words
Weighting: 30%
Due:Monday 9th October 2023(Week 12)
Aims of the Assessment:
To extend on the knowledge gained from completing the Short Answer Question Case Study - Mrs Mary Fenech and the feedback received from your marker.
Encourage evidence based research and critical thinking skills.
Develop a transcript that answers the questions specifically related to Mrs Mary Fenechs case study.
Pre-record your presentation discussing your answers to the case study questions.
Your transcript and presentation must answer the following questions:
Question 1: What is the pathogenesis of ischemic stroke? Specifically relate your answer to the risk factors associated with Mrs Mary Fenech.
Question 2: What is the ischaemic penumbra ? and then, explain the importance of timely reperfusion therapy specifically related to Mrs Mary Fenech.
Question 3: What are the specific nursing resposibilities related to the administration of the following medications?
Alteplase IV
Heparin 5000iu IV
Labetalol
Insulin NovoRAPID subcutaneous
Question 4: Which diagnostic procedures are commonly used to diagnose ischemic stroke?
Oral Presentation Details:
You are to record and submit your oral presentation based on the case study from assessment one; Mrs Mary Fenech.
For your oral presentation: - you can use a slide show (such as PowerPoint) to support your presentation by sharing your screen. You can record your presentation in ZOOM. If you have difficulties with ZOOM or technology in general, there will be webinars and workshops to help you. Please check announcements for dates and times.
The recorded presentation should take no more than 10 minutes. There is no word limit however as a guide 1000 word is the suggested maximum. If you exceed the time limit by more than 10%, the marker will stop marking at 11 minutes.
References: You must include references. These should be listed at the end of your presentation using APA 7 referencing style. References are to include at least ten recent (2015-2023) academic sources such as journal articles, textbook material and evidence-based resources.
A note on ACADEMIC references: References to support your discussion must be from peer-reviewed and/or published sources that are less than 10 years old. This includes textbooks, journal articles, MIMS and evidence-based guidelines produced by expert bodies such as the Stroke Foundation. Please do not refer to patient information sites to support your discussion (example WebMD).
Your presentation should be uploaded to the assessment 2 link available on vUWS
Supporting Resources:
Record a slide show with narration and slide timings (Microsoft, 2019).
American Psychological Association (APA) referencing style guide (PDF 725 KB) (Western Sydney University Library, 2020a).
Library Study SmartLinks to an external site.a library resource that helps you complete assignments (Western University Library, 2021).
Western Sydney University Library has further information about referencing on theirReferencing and citation page.
Please begin by referring to text references provided on vUWS when covering this module and complete a wider search using your online library https://library.westernsydney.edu.au/You may also read more widely using the following supporting resources
Emergency Care Institute NEW SOUTH WALES
https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/strokehttps://vimeo.com/290191822https://strokefoundation.org.au/About-Stroke/Learn/signs-of-strokePrince of Wales Hospital and Community Health Services
The Royal Hospital for Women: Management of patients with acute stroke symptoms
https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Campusacutestrokesymptoms.pdfOral Presentation
Criteria Mark High Distinction Distinction Credit Pass Fail
Question 1 - Provides an explanation of the pathogenesis of ischemic stroke referring specifically to the case study /10 Accurate and comprehensive explanation of the pathogenesis causing the ischemic stroke. Synthesises the information in a logical sequence. Supported by relevant academic referencesAccurate explanation of the pathogenesis causing the ischemic stroke. Mostly synthesises the information in a logical sequence.
Supported by relevant academic referencesDemonstrates a good level of knowledge of the pathogenesis causing the ischemic stroke. The explanation is mostly developed in a logical sequence but there may be one or two omissions of significant information.
Supported by relevant academic referencesBasic description of the pathogenesis causing the ischemic stroke. There may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow of the process.
Supported by relevant academic referencesSuperficial description of the pathogenesis causing the ischemic stroke with a significant number of inaccuracies, repetition, or lack of clarity or logical flow of the process.
Not supported by relevant academic sources
8.5-10 7.5-8 6.5-7.0 5-6 4.5
Question 2 - Provides an explanation of the ischaemic penumbra and the role and importance of reperfusion /20 Accurate and thorough scientific explanation of the ischaemic penumbra and the role and importance of reperfusion. Description is thoroughly supported by relevant academic resourcesAccurate scientific explanation of the ischaemic penumbra and the role and importance of reperfusion. Description is well supported by relevant academic reourcesProvides a good scientific explanation of the ischaemic penumbra and the role and importance of reperfusion. Description is mostly correct with more detail needed in the explanation.
Description is supported by relevant academic reources. Provides a basic scientific explanation of the ischaemic penumbra and the role and importance of reperfusion however, more detail is needed.
Description is supported by somerelevant academic reourcesPoor evidence-based or scientific explanation of the ischaemic penumbra and the role and importance of reperfusion. Information lacks detail or is inaccurate.
17-20 15-16.5 13-14.5 1012.5 9.5
Oral Presentation
Criteria Mark High Distinction Distinction Credit Pass Fail
Question 3 - Describes nursing considerations after administration of the medications. /20 Accurate summary of the nursing considerations of the drugs given in the case study.
The information is synthesised and presented in a succinct way.
Nursing actions are clearly identified. Information is technically accurate and supported by relevant academic references Accurate summary of the nursing considerations of the drugs given in the case study.
The information is synthesised and presented in a mostly succinct way. Nursing actions are clearly identified. May be missing minor detail missing. Responses are supported by relevant academic references Good summary of the nursing considerations of the drugs given in the case study.
The information is synthesised and presented in a somewhat succinct way.
Nursing actions are identified with some details missing.
Responses are supported by relevant academic references Basic summary of the nursing considerations of the drugs given in the case study.
Information is synthesised in a somewhat succinct way.
Some nursing actions are identified with many detaila missing. Responses are supported by relevant academic references Poorly summarises the nursing considerations of the drugs given in the case study.
Information is not synthesised or poorly presented.
Nursing actions are missing or inaccurate.
Responses are NOT supported by relevant academic references.
17-20 15-16.5 13-14.5 1012.5 9.5
Oral Presentation
Criteria Mark High Distinction Distinction Credit Pass Fail
Question 4 Explanation of the diagnostic procedures are commonly used to diagnose ischemic stroke? /10 An accurate and thorough explanation of the diagnostic procedures commonly used to diagnose ischemic stroke.
Responses are supported by relevant academic references An accurate explanation of the diagnostic procedures commonly used to diagnose ischemic stroke with minor details missed.
Responses are supported by relevant academic references Provides a good explanation of the diagnostic procedures commonly used to diagnose ischemic stroke with some details missing.
Responses are supported by relevant academic references Basic explanation of the diagnostic procedures commonly used to diagnose ischemic stroke however, more detail is needed.
Responses are supported by relevant academic references Poor superficial description or inaccurate description of the diagnostic procedures commonly used to diagnose ischemic stroke.
Responses are NOT supported by relevant academic references
8.5-10 7.5-8 6.5-7.0 5-6 4.5
Academic Style
Criteria Mark High Distinction Distinction Credit Pass Fail
Presentation Style
/20 Engaging presentation style. Discussion is supported by visual aids that are of very high quality and effective in relaying complex information (i.e., diagrams/ pictures).
Presenters were confident with their material and covered each section within the time permitted. Excellent contribution noted on Contibution Log. Meets all goals/tasks set. Presentation style at times engaging. Discussion supported by visual aids that are effective in relaying complex information (i.e., diagrams/ pictures).
Presenters were confident with their material and covered each section within the time permitted. Very good contribution noted on Contibution Log. Meets all goals/tasks set. Presentation style was effective and, easy for the listener to engage.
Visual aids are used to support the presentation.
Presenters were confident with their material and covered each section within the time permitted. Good contribution noted on Contibution Log. Meets the majority of goals/tasks set. Presentation style was effective but basic.
Minimal use of visual aids.
Presenters were confident with their material and covered each section within the time permitted. Moderate contribution noted on Contibution Log. Meets at least half of the goals/tasks set. Presentation style does not engage the listener.
No use of visual aids or they are not effectively used throughout the presentation.
Presenters were not confident with their material presented. Minimal contribution noted on Contibution Log. Meets very few goals/tasks set.
17-20 15-16.5 13-14.5 1012.5 9.5
Academic Style
Criteria Mark High Distinction Distinction Credit Pass Fail
Oral Communication /10 Spoke fluently and consistently coherent at a continuous rate of connected speech. Exceptional range of vocabulary to express meaning.
Exceptional grammatical accuracy in sentence structuring throughout the presentation .Consistently pronounced a range of words and sounds comprehensible to the listener. Spoke somewhat fluent and coherent, continuous and connected speech.
Very good range of vocabulary to express meaning.
Very good grammatical accuracy in sentence structuring throughout the presentation.
Pronounced a range of words and sounds comprehensible to the listener. Spoke coherently at a continuous rate of connected speech. Uses a range of vocabulary to express meaning.
Demonstrates mostly good grammatical accuracy in sentence structuring throughout the presentation.
Mostly pronounced a range of words and sounds comprehensible to the listener. Spoke coherently at a continuous rate of connected speech at most. Uses range of basic vocabulary to express meaning.
Demonstrates basic grammatical accuracy in sentence structuring throughout the presentation.
Pronounced a limited range of words and sounds but comprehensible to the listener. Had difficulty speaking fluently and coherently. Uses limited vocabulary to express meaning.
Did not demonstrate grammatical accuracy in sentence structuring consistently.
Had difficulty pronouncing words and sounds and words sometimes incomprehensible to the listener.
8.5-10 7.5-8 6.5-7.0 5-6 4.5
Academic Writing and Academic Integrity
Criteria Mark High Distinction Distinction Credit Pass Fail
Referencing and in-text citations:
Uses a minimum of ten recent (2015-2023) 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. /10 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 are 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 are mostly 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 are 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.
Evidence of cited sources may not consistently be clear. 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.
Evidence of cited sources are not clear or correctly acknowledged.
8.5-10 7.5-8 6.5-7.0 5-6 4.5
