Meadow View Medical Centre
Meadow View Medical Centre
S Chen, NP
10 Market St,
Meadow View.
Ph: 8792 6684
Date: 15/9
Re: Mr Rupinder Patel DOB: 25. 12. 1950
To whom it may concern,
Thankyou for seeing Mr Patel, who has been a patient at our clinic for four years.
Past history: myocardial infarction x 2, 10 years ago with development of heart failure. Nil known allergies.
Medications: ramipril 5 mg BD, spironolactone 25 mg BD, metoprolol (controlled release) 23.75 mg BD, mirtazapine 30mg nocte
Mr Patel has been advised to restrict his fluid intake to 1500 ml/day. He cannot tell me whether he is doing this or not.
Mostly his symptoms have been managed well over time although he has had previous admissions for management of exacerbations in the past. He reports that lately he is struggling again with sadness and loneliness. He reports that sometimes he forgets to take his medications and I note that his scripts ran out a week ago. He says he has not taken his medications for the past two days.
He presented today with further significant weight gain (5kg in 2 weeks), peripheral oedema, and increased shortness of breath.
I have been in communication with Mr Patels cardiologist who informed me that Mr Patel has not attended two recent appointments.
Yours sincerely,
SChen
Susan Chen, Nurse Practitioner
Task description
In this assessment task you will be provided with a scenario and relevant patient information (Assessment task 2: the person).
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 short answer questions (SAQs) that you will obtain through a quiz. The answers to these questions will be submitted in a WORD document via a turnitin-enabled assignment box. Ensure thatall of the answer is in 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. Substantial scores will be reported for investigation as possible breach of Academic Integrity, as well as submissions that appear written by artificial intelligent sources.
The questions will require you to:
consider the patient situationandidentify cues(signs and symptoms, as well as other cues) from the case description and clinical information provided.
process this informationby analysing the cues, and explaining the relevant physiology and pathophysiology underpinning the patient presentation and progression.
apply knowledge of physiology toexplain the rationaleof suggested therapeutic approaches for that patient.
It is expected that you willengage with sources of scholarly information and literature to substantiate your clinical reasoningin the long answer questions.
How to research for this task
Review the presentationsBioscience and the clinical reasoning cycleRead BEFORE you write. Read to understand, and learn. Do not write your assignment based on what you believe you already know, and then go looking for references to support what you have said. Read the references first and then use them to construct your answer, citing them.
Go to MyLO first.Engage with the content on MyLO. Module 2 >pages 2.12, 2.13 & 2.14 are directly relevant. Important information is also provided in Module 1. 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: MelbBurston, A. & Corfee, F. 2020. Nursing care of people with cardiac disorders. In G. Bauldoff et al.Lemone & Burke's Medical-Surgical Nursing. Pearson: Melb. p1040 1084
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 e.g. the Australian Medicines Handbook ? If in doubt, you can alwaysask the Unit Coordinators.
Journal articles- use these judiciously. Ensure that the article is relevant and that the author is actually supporting what you have written. Have you actually read, and understood the article? Is the article discussing HUMAN physiology? Is about people of the same age? Journal articles should be no more that 5 years old.
Assessment criteria and marking rubric
Your submission will be assessed against the criteria below. 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 clinical decisions by using appropriate literature, cited using Harvard referencing style.
Communicates in an academic style using discipline specific language by using appropriate terminology to explain the patients health condition and rationale for therapeutic approaches
Assessment due dates and submission details
Assessment due date:
Friday 13 October 2023, at 1700 h (5:00pm)
Assessment weighting:25% of your overall unit grade
Task length:A written submission of 550 words in total +/- 10% (i.e. 495-605 words) excluding in-text referencing.
Submission details:
Submit your short answers (SAQs) by the due date and time to Assessments > Assignments >Assessment Task 2: Case Study SAQsMr Rupinder Patel
Consider the Patient Situation
Mr Rupinder Patel is a 72 year old retired businessman.
You have previously met Rupinder during the Intensive 1 workshop when he was aged 62. The present moment is 10 years later. Please review all information in the Intensive 1 workbook you have already received.
Rupinder has a medical history of Heart Failure. This developed after he experienced the two myocardial infarctions 10 years ago. Both ventricles were affected. Previous chest radiography showed left ventricular hypertrophy.
The death of his wife 2 years ago has led to Rupinder experiencing several episodes of depression thathas been exacerbated by his sons both moving to Western Australia for work. The loneliness and sadnessmakes it difficult for him to be concordant with his heart failure management and sustain the necessary lifestyle adjustments required to prevent exacerbations.This has resulted in several admissions to hospital for management and review of his heart failure.
For this current admission, Rupinder was referred to hospital by his Nurse Practitioner, after recently rapidly gaining weight (currently 110kg), since his previous visit.
...............................................................................................................................................................................................................................
The time now is 0800 and you have just come on for your morning shift. Rupinder has been on the ward for only two hours after spending approximately 12 hours in emergency waiting for a bed to become available.
Rupinder appears slightly disoriented. He tells you that he has spent the night in the recliner chair beside the bed, sitting upright because 'this is the only way I can get my breath'. He tells you he feels terribly tired.
You observe that the 1 litre water jug that he has been drinking from, since coming to the ward, is nearly empty.
Collect cues
You review the following documentation: attached below
Referral letter
ADDS chart
Medication chart
Fluid balance chart
Progress notes
Upon undertaking a further assessment of Rupinder you obtain the following new information:
Vital SignsRR: 28 bpmSp02: 94% on 2lt via nasal prongsBP: 105/82 mmHgHR: 122 bpmTemp: 36.5oC
Other informationBGL within normal rangeGCS 14 - Eye opening - 4; Verbal response - 4; Best motor response - 6
Cardiac assessmentECG: indicative of atrial fibrillationSkin is cool and clammy
Fluid status assessmentPeripheral pulses difficult to palpatePresence of pitting oedema bilaterallyCapillary refill (toes) - 5 secondsRaised JVPUrine output since midnight: 150 mL
Abdominal assessmentAbdomen soft and non-tender.Bowel sounds present.
Respiratory assessmentBibasilar posterior cracklesReduced breath sounds in the bases of both lungsIncreased work of breathingPatient producing pink-tinged frothy sputum
Question 1
Rupinder experienced two AMIs which led to heart failure. Considering this fact, explain the physiological and pathophysiological reasons why Rupinder had a low urine output prior to the administration of his charted oral diuretics.
In your answer, identify in brackets ( ) the data or observations from the case scenario that support your explanations. For example: "...which causes vasoconstriction (pale skin) leading to..."
Suggested word limit: 300 words excluding in-text references.
Question 2
Take ActionRupinder was prescribed three medications (ramipril, spironolactone and metoprolol) for the management of his heart failure instead of just one of these medications
a) Provide a rationale for this triple therapy by briefly describing the mechanism of action for each drug, explaining the aim of therapy for Rupinder, and referring to specific Australian guidelines for the management of heart failure.Evaluate Outcomesb) Describe what would be observed in Rupinder's assessment data (relevant signs and symptoms) to indicate the effectiveness of this therapy.
Suggested word limit: 250 words excluding in-text references.
Use the UTAS Harvard referencing guide. A link to this can be found in the "Assessment help and resources" section on MyLO.
4648200000Progress notes
15/9: 1630
Emergency department
Mr Patel presented to the ED for clinical investigation at 1600 via referral from his GP clinic.
History: heart failure and poor management concordance as per Nurse Practitioner referral letter.
Vital signs: as charted.
Height: 178cm Weight: 110kg
ECG: completed and now on cardiac monitor
2L O2 via nasal prongs commenced
Awaiting cardiology review.
Signed: Registered Nurse
15/9: 1700
Cardiology review
ECG: Atrial fibrillation noted, but no new ischaemic changes. Stat IV frusemide and oral digoxin charted.
Medications:
Regular meds: ramipril, spironolactone and mirtazapine
Add in: digoxin, frusemide, rivaroxaban
Change: metoprolol to 25 mg BD standard release formula
Normal diet; 1000 ml/24 hours fluid restriction
Weigh daily
Will review tomorrow morning.
Signed: Cardiology Registrar
15/9: 1800
Emergency department
IV frusemide administered with good diuresis noted: fluid balance chart commenced
Stat digoxin dose administered.
Mr Patel prefers to sit in a recliner chair. He has been advised about fluid restriction.
Cardiac monitoring continues.
Signed: Registered Nurse
right0Progress notes
16/9: 0530
Emergency department
Patient has passed a reasonably comfortable night. He has remained in the recliner chair, mobilising to the toilet. He has been concordant with using a bottle for accurate fluid balance.
All observations as per charts.
Patient is able to transfer to ward at 0600.
Signed: Registered Nurse
16/9: 0700
Medical ward
Mr Patel received on the ward at 0600. All usual admission tasks undertaken. For weight at 0800.
Patient is using a recliner chair beside the bed.
Signed: Registered nurse
