In this assessment task you will be provided with two scenarios containing relevant patient information.

In this assessment task you will be provided with two scenarios containing relevant patient information.

You will apply clinical reasoning to your knowledge of anatomy, physiology, pathophysiology, therapeutic interventions, and pharmacotherapy to answer a variety of questions.

You'll be required to complete two (2) short answer questions that will need to be submitted via Turnitin. The questions will require you to:

Consider the patient situationand identify cues(signs and symptoms, as well as other cues) from clinical information provided.

process this informationby analysing and explaining the relevant physiology and pathophysiology underpinning the patient presentation and progression.

apply knowledge of physiology and pathophysiology toexplain the rationaleof suggested therapeutic approaches for that patient.

It is expected that you willengage with MyLO content and scholarly literature to substantiate your clinical reasoningin the long answer question.

How to research for this task

Review the presentations "Bioscience and the clinical reasoning cycle". These presentations discuss the type of resources which are regarded as scholarly for bioscience.

Read BEFORE you write. Read to understand, and learn. Do not write your assignment based on what you already believe you know, and then go looking for references to support what you have said.

Go to MyLO first.Engage with the content on MyLO. Module 1 > pages 1.5 to 1.9. You do not need to reference MyLO content.

Use the followingtextbooks,which you can access as eBooks and/or as hard copies in the UTas library. Textbooks should be no more than 10 years old.

Amerman, E. 2019.Human Anatomy & Physiology. 2nd Global ed. Pearson: UK.

Bullock, S. & Hales, M. 2019.Principles of Pathophysiology.2nd Ed. Pearson: MelbBullock, S. & Manias, E. 2017.Fundamentals of Pharmacology. 8th Ed. Pearson: Melb (eBook)

Bullock, S. & Manias, E. 2022.Fundamentals of Pharmacology. 9th Ed. Pearson: Melb (hard copy)

Bauldoff et al. 2020.Lemone & Burke's Medical-Surgical Nursing. Pearson: Melb.

Norris, T. 2020.Porth's Essentials of Pathophysiology. 5th Ed. Wolters Kluwer: Phil

Websites- ensure that you are only using informationfor health professionals. Do NOT use consumer information. Wherever possible, identify an author, and that the work has been peer reviewed. Acceptable sources will have a date of authorship. Is the website a recognised source of information eg the Australian Medicines Handbook? If in doubt, you can always ask the Unit Coordinators.

Journal articles- use these very judiciously. Ensure that the article is relevant and that the author is actually supporting what you have written. Have you read, and understood the article? Is the article discussing HUMAN physiology? are the findings applicable to your patient's age and disease process? Journal articles should be no more than 5 years old. You will be marked down for using inappropriate Journal articles.

Assessment criteria and marking rubric

Your submission will be assessed against the following criteria. You are strongly encouraged to review the marking rubric for this assessment task as it provides more detailed information about the assessment criteria.

Explain the pathophysiological basis for the patients health condition by demonstrating a clear understanding of physiological and pathophysiological mechanisms, relevant to patient cues (signs and symptoms).

Explain the rationale for therapeutic approaches for the patient

Substantiate statements and justify suggested clinical interventions by using appropriate literature, cited using APA 7 referencing style.

Communicate in an academic style using discipline specific language by using appropriate terminology to explain the patients health condition and rationale for therapeutic approaches

Marking rubric

Carefully review the marking rubric for assessment task 2 short answer questions. Markers will be assessing your work against the assessment criteria in this rubric.

Assessment task 2 - short answer questions submission rubricAssessment due dates and submission details

Assessment task due dates:

17:00 (5pm), 21st February 2024 (Wednesday of Week 4)

Assessment weighting: 25% of your overall unit grade

Task length: The case study will have two questions to be answered in a written submission of 550 words. Recommended 300 words for Q1 (SCI pathophysiology) and 250 words for Q2 (Stroke Therapy).

In your submission, include the total word count excluding in-text referencing. If your submission exceeds the word limit, only the first 550 words will be marked.

Submission details:

Submit your short answers (SAQs) by the due date to Assessments > Assignments >Assessment Task 2: Nervous System Case StudiesDelivery of this assessment task: how to find your short answer questions

The questions will be delivered via aMyLO quiz.You will need to:

locate your questions in the quiz called:SAQs for Assessment Task 2 - Nervous System Case Studies - Get your questions here.answer the first question that confirms you have understood what is required

copy and paste the other two questions to a WORD document.Ensure your submission contains these questions.If not, you will be asked to resubmit the assessment.

submit the quiz.

work on your questions and answers and submit through Turnitin to the MyLO assignment folder by the due date.

The SAQs are available now.

Task format

You should write in complete sentences and structured paragraphs. Do not use bullet-point lists, tables, or flow-charts to present your response. Do not include pictures.

Ensure that you effectively paraphrase by writing inYOUR OWN WORDS. Direct quotes arenotaccepted for this assignment of short answers.

Generally, submissions are expected to be in Microsoft Word or in pdf format (not text scanned into pdf). To see a full list of the file types accepted by Turnitin, view this link:https://help.turnitin.com/feedback-studio/turnitin-website/student/submitting-a-paper/file-requirements.htm

Referencing

The entire university is moving from UTAS Harvard to APA 7 as the official referencing style. Utilisethis resourceto learn more about researching, citing, and referencing.

This 3min video explains the basics of APA 7:Introduction to APA 7th referencing - H5P.com

Intended Learning Outcomes assessed

This task evidences progression towards achievement of the Unit learning outcomes:

ILO1: Apply knowledge of the alterations to anatomy and physiology of the digestive, nervous, endocrine, musculoskeletal and reproductive systems of the body across the life-span to explain pathophysiological processes.

ILO2: Integrate biological information to explain common diagnostic procedures and therapeutic interventions used in the management of patients with acute and chronic health conditions affecting the digestive, nervous, endocrine, musculoskeletal, and reproductive systems, and multiple body systems.

ILO3: Communicate using scientific and clinical terminology relevant to alterations in the digestive, nervous, endocrine, musculoskeletal and reproductive systems, and pathophysiological processes that affect multiple body systems.

Marking and feedback

There is amarking rubricfor this assessment task. You are strongly encouraged to review the rubric before completing your submission.

You will receive your results and feedback via MyLO, in accordance with the timescales outlined in the School of Nursing assessment guidelines.

Academic Integrity: Turnitin and use of Artificial Intelligence

Ensure that all of the answer is your own words.Ensure that you review your Turnitin scorebefore submitting your work.

Any part of your answer that is completely or partially text-matched to another source by Turnitin may not be considered as part of your answer, as these are not your words.

Artificial intelligent agents such as ChatGPT, CoPilot or Bard arelanguage generators, not generators of content. As demonstrated in CXA240, they make significant mistakes.Do not use them to answer your questions.However,they can check on the clarity and accuracy of your language.

For example, when you have answered your SAQs with the right information and have a first draft, you can ask them to determine if the presentation of ideas is logical. You can ask them to identify grammatical mistakes or places where lay terms are used instead of clinical terminology. Follow their advice about the language if you think it is appropriate, but do not copy/paste their output as that constitutes a breach of academic integrity and, when detected, will be reported for investigation.

JOURI'S HORSE-RIDING ACCIDENT

CASE 1

Consider the person - Acute Phase

On a mild, sunny November afternoon, 23-year-old Jouri Khatib was enjoying a horse ride in the Tasmanian hills around Deloraine. Suddenly, her horse got spooked by a snake and bucked, causing Jouri to lose her balance and fall off. She landed awkwardly on her back, and immediately felt a sharp pain in her upper back.

Her friend Maya, who was watching from a distance, rushed to her side. Seeing Jouri in pain and unable to move, Maya quickly dialed the emergency number to call for paramedics. The paramedics arrived about 1h later and performed the patient assessment:

Collect cues

Paramedics

Neurological assessment:

GCS:eye opening spontaneous; verbal oriented although drowsy; motor can obey commands (blinking eyes, poking tongue out); some recall of the accident

Pupillary assessment:PERRLA (pupils equal, round, and reactive to light and accommodation)

Motor function:unable to move legs or thorax

Sensation:reporting no sensation below the armpits, including thorax, abdomen and legs. Normal sensation in arms, neck, face and head

Deep tendon reflexes: normal biceps and triceps reflex. Minimal quadriceps (knee jerk) and gastrocnemius (Achilles tendon) reflexes

Vital signs:

RR: 28 bpm, abdominal expansion but thorax not expanding, some use of accessory muscles.

SpO2: 93%, started oxygen administration 15L/min via non re-breather mask

BP: 100/72mmHg (MAP 81 mmHg)

HR: 82 bpm

T: 35.2oC

After the initial assessment, the paramedics stabilized Jouris spine with a cervical collar and placed her on a long spine board to prevent any further injury during transport. They called for a transport helicopter, which took 30min to arrive. The paramedics carefully loaded her into the helicopter and transported her to the Royal Hobart Hospital for further evaluation and treatment. Throughout the journey, they continuously monitored her vital signs to ensure her condition remained stable. They also reassured Jouri and kept her informed about what was happening, which helped to keep her calm during this stressful situation.

Triage

Vital signs on arrival:

RR: 26 bpm, some use of accessory muscles.

SpO2: 97%, O2 titrated to 5L/min via Hudson mask

BP: 98/70mmHg(MAP 79 mmHg)

HR: 64 bpm

T: 36.8oC (tympanic)

Primary survey 10min later:

Airway intact and unobstructed. Jouri's voice was loud and clear.

BreathingRR 28; nasal flaring;absence of chest movements;O2 required to maintain SpO2.

Circulation BP 96/64 mmHg (MAP 75 mmHg); HR: 62 bpm; peripheries warm and pink.

DisabilityJouri reported a loss of sensation below her chest. reflexes normal biceps and triceps, all other muscle stretch reflexes in the lower extremities were absent.

Sensory perception of sensory stimuli ended bilaterally at an imaginary line drawn across her chest 2 cm above the nipples, some sensation in her arms, but could not localise touch or describe texture with any consistency.

Motor- able to elevate shoulders and isometrically contract biceps and triceps in both arms; lower limbs flaccid, nil ability to move.

Deep tendon reflexes: normal biceps and triceps reflex. Absent quadriceps (knee jerk), gastrocnemius (Achilles tendon) and plantar (Babinski) reflexes.

Blood glucose 6.2 mmol/L

Exposure - nil evidence of injuries

Pain assessment:

Provoking/palliating - nothing particularly provokes the pain, it is just present

Quality - stabbing and aching

Region/radiation - upper chest and medial surface of the arms

Severity - 7/10

Timing - worsening since the accident

Neurological assessment:

GCS: eyes - 4; Verbal - 5; Motor - 6

Pupils: PERRLA, pupils 3 mm

Limb movements: as above in "Disability" notes

Assessment and investigation data

Computerised Tomography report

Exam InformationModality: CTBody Part: NEURODescription: CT Brain and C-SpinePerformed Date: 11/11/Year Time: 1330Final ReportCT BRAIN AND C-SPINECLINICAL NOTES:Witnessed fall from a horse. Immediately unable to stand up or reposition herself.Findings:A non- contrast CT has been acquired.T2 lesion with no vascular haemorrhages noted but some bloodevident at T1-T3 with small bone fragments in the spinal canal.

Mild contusionon L scapular area

IMPRESSION:Hyperextension thoracic spine fracture (HTSF) at T2

X-ray

Chest absent lateral chest expansion during inhalation; normal diaphragmatic excursion; mild pulmonary oedema

Actions and interventions

spinal precautions and then immobilisation and stabilisation of spine

intravenous therapy

vasopressor therapy to maintain MAP >85 mmHg

1/24 (hourly) neurological assessment (Glasgow Coma Scale, Pupillary response, Limb strength), for 12 hours

1/24 (hourly) vital sign assessment

telemetry

mechanical ventilation

analgaesia & 2/24 (second hourly pain assessment)

insertion of indwelling urinary catheter and fluid balance monitoring

pressure risk management

thermoregulation support - maintain body temperature between 35.5 - 38.0oC

Clinical documents

These documents are currently used in the Tasmanian Health Service. You may find them useful for completion of your assignment.

Spinal assessment chart (pdf, 785.2KB)International Standards for Neurological Classification of Spinal Cord Injury (pdf, 828.5KB)Ventilation (Non-Invasive and Invasive Mechanical - Clinical Practice Standard (pdf, 864.1KB)

Consider the person - Chronic Phase

[6 months later]

Six months ago, Jouri sustained a significant spinal cord injury after falling from a horse while riding, causing a Hyperextension thoracic spine fracture (HTSF) at T2, leaving bone fragments in the spinal canal.

Collect cues

After spinal shock had resolved, the extent of her injury could be determined.Jouri has the following deficits;

Sensory Complete loss of sensation bilateral in dermatomes below T2

MotorParalysis of the lower limbs and trunk.Normal strength in the muscles that move arms, hands, shoulders and head (neck)

Usual vital signs for Jouri.RR: 20 22 bpm

SpO2: 97 99%

BP: 93 96 / 61-64 mmHg (MAP 72 - 74 mmHg)

HR: 60 70 bpm

T: 35.8 36.5oC

Actions and interventions

Jouri lives at home with her parents and attends a spinal cord injury rehabilitation facility on a daily basis.

Jouri uses a wheelchair and is waiting to be assigned a self-propelled wheelchair.

Jouri has a permanent indwelling urinary catheter and uses a bowel management programme.

Jouri receives counselling and assisted by his family, has joined online spinal cord injury support groups.

Today - 0830 - hygiene support

While receiving hygiene support, Jouriasks for a tissue to blow her nose as it has started to run. She also asks for an aspirin, because she feels a headache that is getting worse very quickly. She It is noticed that she is sweating on her forehead and arms and has become rather red in her face.

Collect cues

Vital signs:RR: 20 22 bpmSpO2 98 100%BP: 132/90 mmHg (MAP 104 mmHg)HR: 57 bpmT: 36.8oCPain: 7/10 (headache)

Visual assessment:diaphoresis and flushing on head and arms; pallor in legs and nailbeds of toes; excess mucus production from nasal passages.

Assessment task 2: the person - Case 2

AMELIA'S STRONG HEADACHE

Consider the person

Amelia Frankish is 67 years old.

She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT (computerised tomography) of Amelia's head and neck.

Medical history

Diabetes mellitus Type 2:

Management:

metformin 1000mg, daily

enalapril 10 mg daily

rosuvastatin 10mg, daily

Atrial fibrillation (AF)

Management:

apixaban 2.5 mg, BD

sotalol 40 mg, BD

Cigarette smoking: 20 - 30 cigarettes/day, quit 5 years ago.

GP - diagnostic assessment and management - one week ago

Amelia underwent a CT scan of the head and neck, but the results were normal.

Amelia was assessed asrequiring changes to herhypertension & AF management andthe following changes made:

enalapril ceased

the following medications commenced or changed;irbesartan/ hydrochlorothiazide300/25, daily

amlodipine 5mg, daily

apixaban 5mg, BD.

Today:

Amelia woke early this morning at 0600 hours with a 5/10 headache. At 0700 hours shebegan to feel weak in her limbs, and her headache increased to 7/10.One side of her face began to "feel strange". She was able to call her neighbour, who brought her to hospital.

Collect cues

Triage

Time is now 0800.

Vital signs:

RR: 18 bpm

SpO2: 98%

BP: 180/92 mmHg (MAP 121 mmHg)

HR: 98bpm

Temp: 37oC

Pain assessment:

Provoking/palliating: pain is worse when Amelia moves her head suddenly, nothing seems to relieve the pain

Quality: the pain feels like extreme pressure on theleftside of her head

Region/radiation: the pain is confined to her head

Severity: 9/10

Timing:firstpain onsetwas about 2 hours ago

Neurological assessment:

GCS: 15

Pupils: PERRLA

ROSIER (Recognition of stroke in the emergency room) Scale

Loss of consciousness or syncope: NO

Seizure activity: NO

Asymmetric facial weakness: YES

Asymmetric arm weakness: YES (rightupper limb paralysis-unable to respond to movement request)

Asymmetric leg weakness: YES (rightlower limbparesis mild weakness)

Speech disturbance: YES (some slurring of words (dysarthria) is noted)

Visual field deficit: NO

Other:

Limb sensation:rightupper limbanaesthesia;rightlower limb- paraesthesia (tingling feeling).

Amelia appears pale and anxious.

She has not had her medications today.

Investigation data - performed AFTER triage

Cardiovascular assessment

An ElectroCardioGram (ECG) is undertaken which showsnormal sinus rhythm.

Blood tests are ordered including full blood count (FBC), urea & electrolytes (U&Es), liver function tests (LFTs), coagulationstudies (COAGs) including Anti-Xa levels.

Metabolic assessment

Blood Glucose Level (BGL): peripheral 9.8 mmol/L (Ameliareports not having eaten since yesterday, nor has she had her medications today)

Computerised Tomography report

Exam InformationModality: CTBody Part: NEURODescription: CT BrainPerformed Date: 25/3/Year Time: 0830Final ReportCT BRAINCLINICAL NOTES:Patient presents with severe headache, dysarthria, limb anaesthesia, paresis, and paralysis. CT 7 days ago - no adverse findings

Findings:A non- contrast CT has been acquired.Nil intracranial haemorrhage noted.

Complete occlusion of the left middle cerebral artery noted.

IMPRESSION:Middle cerebral artery thrombosis (not conclusive).

-207010190500 INCLUDEPICTURE "https://mylo.utas.edu.au/content/enforced/621010-AW_CHX_24A1_33700_0_0_0_1_5/Assessment-and-resources/Assessment-help-and-resources/MCAangio-450x260.jpg?ou=621010" * MERGEFORMATINET

Actions and interventions

Interventions

review by stroke team

nil by mouth until swallow assessment

1/24 (hourly) vital signs and then as per "Thrombolysis for ischaemic stroke pathway" after commencement of thrombolysis therapy

1/24 (hourly) neurological assessment for 4 hours, then 4/24 (four hourly) for 72 hours

6/24 (six hourly) blood glucose monitoring for 72 hours

alteplase infusion as per protocol

telemetry for at least 24 hours

nurse patient with bed head elevated to 30o

intravenous therapy-fluid orders

Clinical pathways

These documents are currently used in the Tasmanian Health Service. You may find them useful for completion of your assignment.

Possible Acute Stroke Assessment & Initial Management Clinical Pathway (pdf, 233.1KB)Acute Stroke Care Plan - Day One to Day Five (pdf, 316.1KB)Thrombolysis for Ischaemic Stroke Clinical Pathway (pdf, 820.6KB)

QUESTIONS:

Question 2(1 point)

Consider the collected cues in the section'Today 0830 hygiene support'(at the bottom of the MyLO page).

Using physiological and pathophysiological mechanisms, and describing anatomical structures involved, provide the most likely explanation for Jouri's presentation of "flushing on head and arms; pallor in legs and nailbeds of toes". In your answer, indicate in brackets ( ) the data from the case scenario that support your arguments.

Word limit: suggested 300 wordsexcluding in-text references for this answer. Overall word limit is 550 words for both AT2 Short Answer Questions.

Question 2 options:

Question 3(1 point)

Take Action

Amelia is prescribed an alteplase infusion.

a) Provide rationale for this therapy by:

describing the mechanism of action, aim of therapy for Amelia, and identifying guidelines for this medication, and

identifying ONE risk of this therapy.

Evaluate Outcomes

b) Describe what would be observed in Amelia's assessment data (signs and symptoms) to indicate effectiveness of this therapy.

Word limit: suggested 250 words excluding in-text references for this answer. Overall word limit is 550 words for both AT2 Short Answer Questions.