Faculty of Health Sciences

Faculty of Health Sciences

School of Nursing and Midwifery

Applied Bioscience for Health Instability 2

GROUP PRESENTATION CASE STUDY

ASSESSMENT 2

ANGINA & MYOCARDIAL INFARCTION CASE STUDY

Learning Outcomes

Discuss the pathophysiology of this condition.

Explain therapeutic clinical management strategies employed by the health care team for the unstable client.

Evaluate the role of the nurse in the management of the unstable client.

Integrate the relationships between aetiology, pathophysiology, clinical manifestations and therapeutic management of conditions that are associated with the client instability and implications for clinical practice

Satisfy the unit syllabus with regards to describing the clinical presentation, diagnosis (interpretation) and clinical decision making for individuals with adverse health events.

Discuss the quality use of medicines in this case study.

ANGINA & MYOCARDIAL INFARCTION CASE STUDY

A 68 year old female, Marge Tomson, is admitted to the Emergency Department of a General Hospital at 0930hrs following a two-hour period of crushing retrosternal chest pain (pain that occurs in the space behind the sternum) Soluble Aspirin 300mg was administered to the patient in the ambulance, on the way to hospital.

The clinical staff notes that Marges peripheries are cold and clammy with a pale appearance. On anterior auscultation ( listening to the sounds of her lungs) of her lungs, whilst she is sitting up her lung fields are clear. Marge states she had been feeling nauseous the day before and had very little to drink.

Marge states that she has been having chest pain over the last six months which initially only occurred after moderate exercise and was relieved by rest. Over the last two weeks she had noticed that the pain came on more frequently with less exertion and was difficult to ease. Her GP had put her on isosorbide mononitrate 20 mg daily (Imdur) six months ago and half an anginine tablet sublingual as required (prn).

Marge also stated she smokes about 15 cigarettes a day and has done so since she was a teenager. Past medical history and surgical history include mild osteoarthritis of lower back and both hips, mild hypertension, fractured right forearm as a teenager, and meningitis 10 years ago. Her weight is 95kg and height is 175cms.

On admission the Marges observations are:

Temp:37 C

Pulse:22/min/irregular

BP:84/60 mm Hg

Resps:24/min

O2 Sats: 94% on 4 l/min via nasal prongs

Pain:8 out of 10 chest pain

Peripheries: cool, pale, capillary refill greater than 3 seconds

Urine output: 25ml/hr

A 12 lead ECG showed anterior myocardial infarction and the following blood tests were:

Creatine Kinase 2000 (normal <150)

Troponin T 5.2 (normal < 0.01)

Total Cholesterol 7.6 (normal < 5.2)

Marge was prescribed oxygen therapy at 6 litres/min via a Hudson Mask and Reteplase 2 x 10 units bolus 30 minutes apart, before being transferred to Coronary Care Unit (CCU).

In CCU she was commenced on Heparin infusion 5000 units bolus followed by 25 000 units in 500 mls at 30mls/hr. Normal Saline 1000mls @ 60 mls per hour for 24 hours. Marge is initially nil by mouth to prepare for any procedures.

Marges chest pain was initially described as central crushing pain 8 out of 10. The Dr prescribed Morphine 5mg as a slow IV push over 5 mins. She can have the morphine every 2 to 4 hrs for chest pain.

Marge responded well to medical treatment and stabilised on day 2. Marge was commenced on oral fluids and continued on an IV infusion of Normal saline.

On day 3 the Marges vital signs were:

Temp: 36.8 C

Pulse: 90/min/irregular

BP:110/70 mm Hg

Resps: 19/min

O2 Sats: 98% on oxygen 2 l/min via nasal prongs

Pain: nil chest pain on day 3

Peripheries: warm, pink, capillary refill less than 3 seconds

Urine output: 50 mls/hr

Marge was commenced on Metoprolol 50 mg BD, Ramipril 5 mg daily, Aspirin 300mg daily and Pravastatin 40mg nocte. And was discharged home 5 days after admission with follow up appointment to see a Cardiologist in four weeks time.

Assessment Task: You are required to review and interpret the above case study. Each group is allocated asinglecase study focus area to answer e.g. Focus Area One questions or Focus Area Two questions etc. In your group you will develop a PowerPoint presentation to answer the assigned Focus Area Question.

Group Case Study Focus Area Allocations are located on Blackboard, your group number reflects the Focus Area Question your group must answer.

For Example: Group 1= Focus Area One.

Case Study Focus Areas

Focus Area Two

What typical abnormalities would you expect with a patient that presents with anterior MI? Justify your answers by referring to current literature.

Not achieved

0% Minimal achieved

10-30% More achieved

31-49% Satisfactory

50-64% Good

65-79% Very good

80-89% Exceptional

90-100%

1. Content Focus. How clearly does the presentation reflect the focus area questions? Well researched, clearly written, accurate content and other.

30% The presentation does not reflect the case study focus area questions allocated to your group. The presentation minimally addresses the case study focus area questions. The presentation addresses some of the case study focus area questions. Some content is inaccurate. The presentation addresses most of the case study focus area questions, but some content requires clarification. Some content is inaccurate. The presentation answers the case study focus area questions clearly. Content mostly accurate and complete. The presentation has a title slide. A case study outline or summary links to the focus area questions. The presentation has a contents slide. The presentation is clear and accurate. The information is well researched. Content is consistent. Presentation displays critical thinking about the focus area questions. The entire presentation is very well researched, clear, highly accurate and consistent. Includes motivating questions for the reader. The standard is excellent to exceptional.

2. The organisation of information. Information well planned, in a logical sequence, flow, clear titles, headings, paragraphs, borders and other.

20% Nil slides were adequately planned or in the correct sequence when presented. Minimal poor presentation of slides. Some information adequately planned and presented. Some of the information is presented in a logical sequence. Some of the information is satisfactorily planned and presented. Some of the titles, headings, paragraphs, and bullet point information are satisfactory. Some of the information is presented in a logical sequence, is well planned and well presented. Some of the titles, headings, paragraphs, and bullet point information are well presented but requires improvement. Many of the slides are well planned, well presented in a logical manner. Many of the titles, headings, paragraphs, bullet point information are well planned and well presented. E.g. 3 or 4 errors noted. The information transitions logically from one slide to the next slide. The majority of the slides are well planned, well presented in a logical manner with satisfactory titles, headings, paragraphs, bulleted information. E.g. 1 or 2 errors noted. Transitions are effective. All slides are well planned, well presented in a logical manner. Well-presented titles, headings, paragraphs, bulleted information. Transitions are smooth, interesting and enhance the presentation. Excellent to an exceptional standard.

3. Comprehensive information effectively presented. Enough detailed information to support answers to focus area questions.

30% Content is ineffective. There is highly limited information to support answers to the case study focus area questions. Presentation content is limited. Is not detailed or comprehensive enough. Some graphics and images are decorative and are not describing relevant information. There is a minimal amount of supporting information and content. Slides do not adequately describe enough information to answer the focus area questions. There is a reasonable amount of supporting information and content, but overall the content is too sparse. More information is required to adequately answer the focus area questions. The presentation provides enough supporting information and content; however some information and graphics require further clarification. The level of detail is satisfactory. The presentation provides comprehensive, and detailed supporting information and content. Presentation effectively answers case study focus area questions. Objectives draw the audience into the presentation by relating to the case study to the focus area questions. The presentation provides a contents slide, describes detailed, comprehensive and complete information to support the answers to the focus area questions. An original effective conclusion. The conclusion links to the objectives. Excellent to an exceptional standard.

4. Style of content and appearance of the presentation. Language choice, sentence fluency, layout, the design of slides, fonts, graphics and other

10% Colour, fonts, slide layout not logical. Design confusing and content difficult to read and comprehend. Use of graphics or visual tools are irrelevant. Presentation content is limited. Is not detailed or comprehensive enough. Some graphics and images are decorative and are not describing relevant information Some of the design, layout, graphics, colours, are engaging and interesting. Most of the graphics and images are irrelevant. The layout of slides inconsistent and makes comprehension difficult. Much of the design, layout, graphics, colour, are engaging and interesting. Some of the design, layout and colour choices distract from the content. Some of the graphics and images are irrelevant. The text and visual design is clear and interesting. The overall design and appearance are satisfactory. The style is mostly consistent. Design mostly enhances the readers ability to comprehend the information. All graphics are related to content. Appropriate use of headings, subheadings and white space. The text, visual design is clear interesting, engaging. The graphics help the audience understand the flow of the content. The fonts, colours, design; layout is well chosen to enhance readability. The majority of the graphics, images and visual tools enhance the content. The presentation displays a variety of good quality visual tools and graphics. The design is unique, original and appealing. The graphics make clear connections to key points. Use of italics, bold, indentations enhances readability. Excellent to an exceptional standard.

5. Conventions. Grammar, spelling, text legibility and usage, APA referencing, direct quotes & end text, footer, slide numbers, appendices/ contract and other.

10% The grammar, spelling, text usage, layout and font choices make this presentation incomprehensible. Content does not apply APA referencing standards. Wikipedia and non-credible Google references used. Group contract not present in appendix The presentation displays many errors in spelling, grammar, text usage, layout, font choices, APA in-text referencing and the reference list. E.g. 10 or more errors noted. This detracts from the content. Group contract not present in appendix There are consistent errors in grammar, spelling, text usage, slide layout, font and image usage. APA referencing is mostly inconsistent. E.g. 8 or more errors noted. There are several errors in grammar, spelling, text usage, slide layout, font and image usage. APA referencing is inconsistent. E.g. 6 or 7 errors noted. Requires improvement in this area. Group contract included in appendix Much of the grammar, spelling, text usage is accurate. E.g. 3 -5 errors noted. Use APA referencing effectively. Nursing, medical, bioscience or allied health references used. Up to 4 sources in the reference list. The majority of grammar, spelling, and text usage are accurate. E.g. 1 or 2 errors noted. Correct use of APA referencing standards with direct quotes, paraphrasing or end text referencing. Up to 8 sources in the reference list. The presentation is easy to read and text free of any errors. The presentation provides slide numbers, a footer on all slides. All graphics, images, visual tools are correctly labelled and correctly APA referenced. 12 or more sources in the reference list. Excellent to exceptional standards.

Note: The presentation file must be submitted via Blackboard before the due date, to be assessed.

Marks Assessment mark _________________ /100 = 30%

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