Assignment task
There are two scenarios, the aim of the assignment is to test your knowledge as outlined in learning outcomes 1, 2, 3 and 4.
1. Utilise and apply knowledge of anatomy and physiology, pathophysiology and pharmacology to critically understand the nursing assessment and holistic management of adults.
2. Demonstrate a critical understanding of a range of nursing skills to deliver safe and effective care to adults.
3. Identify and analyse the best available evidence to care for adults in a range of care environments.
4. Critically reflect on the use of effective communication skills with colleagues, people and their families
The two scenarios should be separately presented in an academic essay format, with a clear introduction, body, conclusion, and use an appropriate formal academic style. Do not include headings and sub-headings.
The structure of each answer to the care delivery should include the following:
Introduction (Approximately, 150 words*). This will acknowledge which scenario you are addressing. Please do not just lift from the assignment brief/question, think of the fundamental care delivery as a whole. Briefly describe what the assignment will encapsulate. You may also consider:
How would you address the patient, confidentiality and dignity?
How would you seek consent?
How would you maintain infection control?
Main body (Approximately, 900 words*). In this section, you should consider:
The definition of the condition
The pathophysiology of the condition
A-E assessment applying to the patient, their observations…
Medical interventions, including tests
Pharmacology (medications, including side effects)
Nursing care
Evaluation of the care delivery (Approximately, 100 words*). In this section, you should consider
NEWS, SBAR and what you would do in case of improvement and
Conclusion and possible recommendations (Approximately, 100 words*). In this section, you should consider:
Briefly describe what you’ve discussed, thinks of what next for the individual, being cared in the community.
Scenario 1
Maria Carr is a 67-year-old retired teacher. She has been admitted to the accident and emergency (A&E) department with left sided arm and facial weakness, which started an hour ago. While in A&E an emergency CT scan was performed and confirms the diagnosis of an ischaemic stroke. As Maria had been in A&E less than 4.5 hours, the medical team administered Alteplase 900 micrograms/kg as prescribed. GCS and BP to be monitored at 30-minute intervals to check for deterioration. If BP increases above 180 mmHg systolic or 105 mmHg diastolic, Maria is to be reviewed by the medical team. She has been transferred to the acute stroke unit. You have been assigned to her care.
On admission Maria is very drowsy but responding to verbal stimuli, she is snoring loudly, and her left sided weakness remains.
Medications as per drug chart
• Dipyridamole 200 mg BD (twice a day)
• Aspirin 75 mg OD (once a day)
Ward baseline Observations
• Pulse: 90 beats per minute
• Respiration rate: 9 breaths per minute
• Blood Pressure: 170/95mmHg
• Temperature: 36.50C
• Oxygen saturation: 94% on Room Air
• Verbal on ACVPU scale
• Her pupils are size 3mm equal and reacting to light (PEARL)
• Glasgow Coma Scale: 11
Considering relevant pathophysiology, discuss Maria’s acute management and nursing care in the first 24 hours after admission.
Scenario 2
Harry Ware is a 45-year-old gentleman who has recently visited his General Practitioner (GP) complaining of a ‘chest infection’. He was admitted immediately to your ward where he was diagnosed as suffering from acute bronchopneumonia. On admission, he had a productive cough and complained of general pain in his chest when breathing deeply, felt lethargic and tired.
Ward baseline Observations
• Oxygen saturations 85% on 2 litres (24%)
• Temp 390C
• Blood Pressure 110/60mm Hg
• Pulse 125 beats per minute
• Respiratory rate 32 breaths per minute
Medications as per drug chart;
• Oxygen 2 litres continual via nasal or mask
• Amoxicillin 500mg IV tds (three times a day)
• Paracetamol 1g qds (four times a day)
Six hours after admission, Harry’s condition deteriorated, and he became pyrexia and was sweating. His breathing was noisy and rapid, with a faint expiratory wheeze. His tachycardia was increasing, and his pulse felt weaker than it did earlier (and his respiration rate was increasing). Harry was also more lethargic than he was on admission.
Discuss Harry’s acute management and nursing care in the first 24 hours following the deterioration with reference to the relevant pathophysiology.