Short Answer Assessment 1

Short Answer Assessment 1

Subject Name: Health Variations 3 - Acute Exacerbations of Chronic Conditions

Weight: 30%

Type of Collaboration: Individual

Due: Week 7- Monday 2nd of September 2024 at 23:59 hours

Submission: Refer to instructions below

Format: Short Answer

Length: 1000 words

Use of Artificial Intelligence: In this assessment task, you will not be able to meet the learning outcomes related to analysing the causes, pathogenesis, clinical manifestations and appropriate selection and prioritisation of nursing interventions as appropriate to NURS2016 by using generative artificial intelligence (AI) tools. Working with another person or technology in order to gain an unfair advantage in assessment or improperly obtaining answers from a third party including generative AI to questions in an examination or other form of assessment may lead to sanctions under the Student Misconduct Rule . Use of generative AI tools may be detected. More information is available on the Library web page

Instructions:

Word Count- There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% the marker will stop marking at 1100 words.

Aim of Assessment- The aim of this assessment is to enable students to:

Demonstrate knowledge by analysing the information provided in the case study

Explain the underlying pathophysiology related to the clinical manifestations of a patient with exacerbation of

COPD

Demonstrate understanding of nursing strategies and evidence-based rationales to manage a patient with exacerbation of COPD

Details -You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past 10 years with at least two references from the resources provided in the vUWS site. Resources must include peer-reviewed journal articles, textbook material or other appropriate evidence-based published resources.

Case Study ISBAR Handover: Chronic Obstructive Pulmonary Disease

Introduction-David Nazzal a 62-year-old male with no known allergies (NKA)

Situation- David presented to the Emergency Department at 2200 hrs. Upon assessment he was sitting in a tripod position and found to have a barrel chest. David presents with fever, sore throat, productive cough, yellow phlegm and dyspnoea.

Background- David tested positive for COVID-19 three days ago through a rapid antigen test. Wife Linda indicated symptoms had progressively worsened with no relieving factors noted. David had similar episode a year ago with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring hospitalisation. David has an increasing amount of purulent mucus which appears as yellow phlegm. He self-medicated with a Ventolin inhaler prior to admission but this had not resolved his symptoms

Past Medical History- COPD, hypertension, hyperlipidaemia. He was a previous smoker for 30 years however he quit when he was diagnosed with COPD 10 years ago.

Current Regular Medications taken:

Ipratropium (Atrovent) via nebulizer once a day

Salbutamol (Ventolin) puffer PRN

Lipitor 40mg daily

Not up to date on his annual pneumococcal and influenza vaccinations

A to G Assessment

Airway- Patent, own

Breathing- RR-30 b/min, SPO2 78% on room air, Increased Shortness Of Breath (SOB)

Auscultation: Diminished breath sounds bilaterally, with wheezing and crackles in the lung bases. Using accessory muscles of respiration ++.

Circulation- Heart Rate (HR) Regular- 128 b/min-Sinus tachycardia. BP- 168/85 mmHg.

Capillary Refill Time 3 sec, peripherally cool, heart sounds dual no murmur.

Disability- GCS-14/15 E4V4M6, confused and distressed +

Exposure- Febrile, skin intact, IV cannula right cubital fossa

Abdo: bowel sounds present in all four quadrants with a soft, nontender abdomen

Fluid- IVF fluids in progress TKVO, Nil by mouth

Glucose- BSL- 5.8 mmol/L

Imaging: Chest X-ray showing hyperinflated lungs with increased interstitial markings consistent with COPD exacerbation.

Lab tests

CBC

Result Reference Range

Haemoglobin 153 g/L 120-140 g/L

White blood cells 15.0x10^9/L 4.0-11.0x10^9/L

Neutrophils 11.0x10^9/L 2.0-7.5x10^9/L

Platelets 200x10^9/L 150-400x10^9/L

C Reactive Protein

(CRP) 25 mg/L <3mg/L

2- COVID-19 PCR Test: Positive

ABG on room air (at 2200hrs)

Result Reference Range

pH 7.30 7.35-7.45

PaO2 55 mmHg 80-100 mmHg

PaCO2 60 mmHg 35-45 mmHg

HCO3- 28 mmol/L 22-26 mmol/L

SpO2 78% (88-92% COPD)

BE -4 mmol/L -2 to +2 mmol/L

Clinical Impression: Infective Exacerbation of COPD COVID 19 +veRecommendations

Continuous monitoring of vital signs- Transfer to High Dependency Unit

COVID-19 Management: Isolate the patient in a negative pressure room, implement infection control precautions, and monitor for progression of COVID-19 symptoms

Controlled oxygen therapy -Continuous pulse oximetry, to keep O2 between 88% to 92%

Sit patient in high fowlers position

4/24 ABGs

Salbutamol (Ventolin) nebuliser 2/24

Ipratroprium (Atrovent) via nebuliser 6/24

Prednisolone (4050 mg daily)

12- lead ECG 6th hourly

Blood troponin

Sputum culture

IV Azithromycin (Zithromax) 500 mg on day 1 , followed by 250 mg once daily for the next four days.

300 mg nirmatrelvir with ritonavir 100 mg taken together orally every 12 hours for 5 days.

Pulmonary function tests Spirometry when patient is stable

Question 1 (600 words- worth 50 marks)

Explain the pathophysiology leading to all the clinical manifestations with which David Nazzal presents. Use the information from the deranged vital signs shown in the A to G assessment and the ISBAR handover.

You must critically analyse the available evidence-based literature to support your response and provide intext in-text references

Question 2 (400 words- worth 30 marks)

I.Select 1 (one) intervention, from 2 (two) of three categories listed in the table below.

II.Provide rationales for each of the interventions listed for Mr Nazzal in the categories that you have selected.

You must critically analyse the available evidence-based literature to support your response and provide intext in-text references

Category 1

Non-pharmacological interventions

Category 2

Pharmacological interventions Category 3

Diagnostic

interventions

Administer controlled oxygen therapy to maintain O2 saturation between 88% and 92%.

Position the patient in a high Fowler's position.

Perform continuous monitoring of vital signs. 1. Salbutamol, Ipratropium, and Prednisolone

2. Azithromycin

3. Nirmatrelvir and Ritonavir 4th hrly ABGs

Sputum culture

Pulmonary function test- Spirometry

Blood Troponin level

Submission Refer to Submission Requirements Format

All assignments are to be typed

Typing must be according to the following format:

3 cm left and right margins, double spaced.

Font: Arial or Times New Roman

Font size: 12pt

Submission Requirements

Electronic copy only. Students are to submit an electronic copy of the assessment. Students are not required to submit the original hard copy of their assessment on campus .Place a screenshot of your search terms used in your chosen database after the reference list in your assessment (criteria 4).

Submit your assessment electronically through the Turnitin link on the unit vUWS site.

Students are to upload the assessment with the following title: Surname_Firstname_assessment title

Your assessment must be submitted in .doc, docx format.

This assessment is marked online; no paper copy will be accepted. Marks, comments and the marking criteria will be released online. If you do not receive your marked assessment when all others have been returned, it is your responsibility to contact the Subject Coordinator for assistance.

Resources: There are a number of textbooks and resources available through the Western Sydney University Library that may assist you. Please refer to the subjects vUWS site for specific subject resources. Assessments listed as individual assessments must be completed independently. Students are advised to refer back to their notes, textbooks or appropriate academic, peer-reviewed resources utilised during subject delivery.

Marking Criteria:

Criteria High Distinction Distinction Credit Pass Unsatisfactory

Criteria 1 Explain the pathophysiology causing all the clinical manifestations using the information from the case study Analyses information from a discerning selection of sources and provides an accurate, clear and comprehensive explanation of the pathophysiology causing the clinical manifestation of the patient in the case study. The explanation is developed in a logical sequence and incorporates all clinical manifestations presented in the case study. The discussion is clearly and accurately supported by appropriate sources. Analyses information from a discerning selection of sources and accurately and clearly explains the pathophysiology causing the clinical manifestations of the patient in the case study. Mostly synthesizes the information effectively in own words and in a logical sequence including all clinical manifestations presented by the patient. The discussion is clearly and accurately supported by appropriate sources. Analyses information from relevant sources and generally provides an accurate explanation of the pathophysiology causing the clinical manifestations of the patient in the case study. The explanation is often developed in a logical sequence but there may be one or two omissions of significant information or all clinical

manifestations are accurately explained but there is little logical

development in the discussion. The discussion is clearly and accurately supported by appropriate sources Using information from relevant references provides a basic description of the

pathophysiology in relation to the case study with some links to the clinical manifestations 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 of the

pathophysiology of

exacerbation of

COPD. The

discussion is mostly supported by appropriate sources. A superficial description of the pathophysiology in relation to the case study is provided with a number of significant inaccuracies, repetition or lack of clarity. Has not accurately related the clinical manifestations to the pathophysiology of exacerbation of COPD. The sources of information are not accurate or not clearly evident.

Mark: /50 42.5-50 37.5-42 32.5-37 25-32 24.5

Criteria 2 -

Student selects 2 (two) interventions out of Category 1 or 2 or 3.

Student accurately discusses and explains the rationales for each of the selected interventions. Critical analysis is evident using evidence-based literature to support their rationale then concisely explains rationales in own words and cites evidence as in-text references to support answers Accurately and comprehensively, discusses the rationales for both interventions used to manage the patient with

exacerbation of

COPD.

Excellent understanding and level of critical analysis using current evidence-based literature to support rationales. Accurately, and concisely explains rationales in own words Answers well-supported by current evidence. Accurately discusses the rationales for both interventions used to manage the patient with

exacerbation of

COPD.

Commendable understanding and level of critical analysis using evidence-based literature to support rationales. Accurately, and explains rationales in own words

Answers mostly well supported by current evidence. Provides good rationales for both interventions used to manage the patient with

exacerbation of

COPD.

Commendable understanding and level of critical analysis using evidence-based literature to support rationales. Accurately, and explains rationales in own words

Answers mostly well supported by current evidence. Provides basic rationales for both interventions used to manage the patient with

exacerbation of

COPD.

Provides a basic level of critical analysis using some evidence-based literature to support rationales. A basic attempt is made to explain rationales in own words. More details to support the discussion required. Provides superficial discussion with little or inaccurate explanation of rationales to manage the patient with exacerbation of COPD. Information predominantly copied or quoted from inappropriate sources.

The sources of information are not accurate and clearly evident.

Mark: /30 25.5-30 22.5-25 19.5-22 15-19 14.5

Criteria High Distinction Distinction Credit Pass Unsatisfactory

Criteria 3- Referencing

Uses a minimum of six recent (less than

10 years old) 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 7 style. 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 minor errors.

Uses a selection of appropriate references. Evidence of cited sources are mostly clear and accurate. Referencing technique follows APA 7th ed conventions but contains infrequent errors. Uses at least the

minimum number

of required references provided in the vUWS site. Evidence of cited sources clear and accurate. There may be frequent minor errors in APA 7th ed referencing convention in in-text referencing and/or the reference list. Uses at least the

minimum number

of required references. Use of cited sources 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.

Mark: /5 4.5-5 4 3.5 2.5-3 2

Criteria 4

Academic Integrity Search terms/ Student provides a screen shot of search engines and search terms used to access literature via the nursing e-resources via the library

For exampleCINAHL

MEDLINE (Ovid)

Clinical Key for Nursing

Cochrane library

JBI

Scopus 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 provided the search terms and names of search engines used to locate literature, but is not accurate Student has NOT provided the search terms and full names of search engines used to locate literature

Mark: /5 4.5-5 4 3.5 2.5-3 2

Criteria 5

Academic Integrity

Turnitin (Similarity Percentage)

Student aims for Similarity percentage via Turnitin of

15% Turnitin Similarity

Index Percentage of

15% Turnitin Similarity

Index Percentage of

16% - 17% Turnitin Similarity

Index Percentage of

18-21% Turnitin Similarity

Index Percentage of

22-25% Turnitin Similarity

Index Percentage

26%

Mark: /5 4.5-5 4 3.5 2.5-3 2

Criteria High Distinction Distinction Credit Pass Unsatisfactory

Criteria 6

Academic writing Writes in a clear succinct academic style using correct grammar, spelling and punctuation. Writes in an advanced style exhibiting highly coherent and logical flow of ideas. No errors in spelling or grammar.

Organisation of material exhibits an advanced level of clarity. Writes clearly and succinctly with a coherent, logical flow of ideas exhibiting advanced clarity. No errors in spelling, or grammar. Writes clearly and uses language that enables effective flow of ideas. Minor, infrequent errors in spelling or grammar 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 or grammar sometimes impedes the flow of ideas. Writes in an elementary style with very basic use of language and poor articulation of ideas. Writing 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.

Mark: /5 4.5-5 4 3.5 2.5-3 2

General tips:

- Sentence structure no bullet points etc

- Be guided by your marking criteria and rubric

- Highlight all the abnormalities in the case study and aim to discuss something about each one. Theyre all relevant, and they all coincide with each other.- Start with a brief intro to COPD what it is, how it evolves etc

- Reference EVERY SINGLE THING. I was always taught if you had to read about it, you have to reference it.

- Analyse/ing = Interpretate the literature to gain a better understanding.An analysis is an in-depth evaluation of a specific work or topic. It involves examining different components of the topic, thinking about how ideas relate to one another and making inferences. You support your claims in an analysis by quoting evidence and explaining how you came to your conclusion. Analyses are usually subjective and state your evidence-based opinion rather than summarizing the information in the original document.8-Step Guide On How To Critically Analyse An Article (crowdwriter.com)

Question 1:

Break down his clinical picture and relate it back to pathophysiology.A Nil issues noted

B - Tachypnoec, hypoxic, hypercapnic, dyspnoeic, increased WOB with tripod positioning, decreased breath sounds, wheezing, basal creps, barrel chest, productive cough, day 3 COVID.Discuss:- impaired gas exchange (CO2 retention), oxygenation vs ventilation, type I and type II respiratory failure, alveolar function (ventilation, diffusion, perfusion) and dysfunction (how the viability is compromised etc).- WOB and how that eventuates (subcostal recessions intercostal substernal tracheal tug)- why the patient positioned himself in the tripod position- diminished breath sounds air not moving appropriately (pulm hyperinflation)- inflammation and the cause of wheezing (airway narrowing)- crackles in the bases (basal crackles/crepitations) caused by increased mucous production mucous floods the alveoli gas exchange impaired CO2 retained etc

Physiology, Pulmonary Ventilation and Perfusion - StatPearls - NCBI Bookshelf (nih.gov)Alveoli Function, Structure, and Lung Disorders (healthline.com) (dont use this resource as a reference, but it simplifies the explanations).

Physical signs in patients with chronic obstructive pulmonary disease - PMC (nih.gov)C Tachycardic and hypertensive, with mildly impaired perfusion- Discuss how the heart is working harder to compensate for the lungs- Large amounts of ventolin causes tachycardia if you need to increase your word count, you can touch on this.- Youll find info on COPD causing arrythmias (AF, SVT etc), but this pt is in a sinus tachy so theres no arrythmia, its just fast. But you can discuss this as a reasoning for 6th hourly ECGs.- Hes not up-to-date with his flu vax this increases COPD patients risk of cardiovascular compromise.- Pulmonary hyperinflation can also lead to heart failure discuss that his heart sounds are dual - heart failure may create a 3rd heart sound (S3), and what the absence of the S3 indicates.

D GCS 14 (E4V4M6) confused and distressed - Discuss the effects of hypoxia and hypercapnia

E Febrile- Discuss the inflammatory process on a cellular level (cytokines etc)

Results:COVID +ve - Chronic obstructive pulmonary disease and COVID-19: interrelationships - PMC (nih.gov)Abnormal CXR -Pulmonary hyperinflation discuss air trapping, elasticity, static and dynamic hyperinflation, CO2 retentionWCC elevated - Full blood count (FBC) a common blood test | healthdirectBlood and pathology tests - Better Health ChannelSystemic White Blood Cell Count as a Biomarker Associated with Severity of Chronic Obstructive Lung Disease - PMC (nih.gov)CRP elevated - ?is it the start of pneumoniaC-reactive protein (CRP) blood test levels, high, low and normal | healthdirect- Specifically, how to interpret WCC & CRP to identify if the underlying cause is bacterial or viral

ABG:Partially compensated respiratory acidosisHypercapnia- Arterial Blood Gas (ABG) Analysis | Ausmed Explains...- Chronic Obstructive Pulmonary Disease and Its Effect on Red Blood Cell Indices - PMC (nih.gov)- Acute Exacerbations of Chronic Obstructive Pulmonary Disease: APrimer for Emergency Physicians - Journal of Emergency Medicine (jem-journal.com)

Other:Risk of acute pulmonary oedema (APO), and if thats relevant (associated with heart failure)

References:Chronic obstructive pulmonary disease (COPD) | healthdirectCOPD | Emergency Care Institute (nsw.gov.au)COPD exacerbations: Management - UpToDate (hcn.com.au)Stable COPD: Initial pharmacologic management - UpToDate (hcn.com.au)Management of infection in exacerbations of chronic obstructive pulmonary disease - UpToDate (hcn.com.au)COPD exacerbations: Clinical manifestations and evaluation - UpToDate (hcn.com.au)Chronic Obstructive Pulmonary Disease: Epidemiology, Pathophysiology, Pathogenesis | Fishmans Pulmonary Diseases and Disorders, 6e | AccessMedicine | McGraw Hill Medical (hcn.com.au)Chronic Obstructive Pulmonary Disease | Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e | AccessMedicine | McGraw Hill Medical (hcn.com.au)Treating and preventing acute exacerbations of COPD | Cleveland Clinic Journal of Medicine (ccjm.org)WSU references

Question 2a:

Intervention 1: Administer controlled oxygen therapy to maintain O2 saturation between 88%-92%- Discuss:- venturi mask and titration- option of BiPAP (PEEP etc)- CO2 retention and its physiological effects- ventilationThe outcomes and acceptance of pressurized metered-dose inhaler bronchodilators with venturi mask modified spacer in the outpatient emergency department during the COVID-19 pandemic. - OvidDSDifference in PaO2/FiO2 between high-flow nasal cannula and Venturi mask in hypoxemic COVID-19 patients - OvidDSEpidemiology, Ventilation Management and Outcomes of COPD Patients Receiving Invasive Ventilation for COVID-19Insights from PRoVENT-COVID - OvidDSIntervention 2: Salbutamol, ipratropium and prednisolone- Discuss:- bronchodilation and use of a nebuliser- steroid use targets inflammation Steroids for COPD: Uses, Side Effects, Risks (verywellhealth.com)

Questions 2b: Provide rationales for each of the interventions

- Respiratory - Therapeutic Guidelines (hcn.com.au)- New developments in optimizing bronchodilator treatment of COPD: a focus on glycopyrrolate/formoterol combination formulated by co-suspension delivery technology - OvidDS