Explain in Detail the Pathophysiology of Margaret’s Condition of APO

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List all of the nursing observations using a prioritised approach

SKU: Repo929381

Margaret, aged 78, is admitted by ambulance to the emergency department of a metropolitan hospital where you are in your first placement as a graduate nurse. The time is 2345 hours and you are working the third shift of your first rotation onto night duty.

 

The ambulance records show Margaret experienced a sudden attack of acute breathlessness and was coughing frothy, blood-streaked sputum. She had suffered a myocardial infarction 15 years ago and was subsequently diagnosed with CHF classified as NYHA III.

Margaret had visited her GP the previous day to monitor her condition. She had also been attending the GP every two or three days over the previous two weeks because of increased symptoms, limitations on her activities, and increasing anorexia. Margaret managed her anorexia by relying on home-made soup. Her medical records show this is her third admission in the last six months.

Margaret lives alone in a three-bedroom home and her next of kin is her daughter Mary, aged 54.

The initial triage assessment revealed acute dyspnoea with respirations 45/minute and use of accessory muscles; Sats 93%; pulse rate 110/minute; BP 150/ 80mmHg; moderate chest creps bilaterally with reduced air entry; mild pitting oedema at ankles but none at sacrum. Provisional diagnosis is acute pulmonary oedema (APO).

 

Section A: Questions 1-8

Q.1 Congestive heart failure refers to:

A) Failure of the ventricles to eject blood efficiently resulting in volume overload, ventricular dilatation, and elevated intracardiac pressure.

B) Failure of the R) atrium to eject blood efficiently resulting in volume overload, ventricular dilatation, and elevated intracardiac pressure.

C) Failure of the pulmonary organs to eject blood efficiently resulting in volume overload, ventricular dilatation, and elevated intracardiac pressure.

D) None of the above

 

 

Q.2 Common medical management of congestive heart failure includes the administration of :

A) Sodium Chloride

B) Frusemide

C) Prednisolone

D) None of the above

 

 

Q.3 Dyspnoea refers to:

A) Rapid heart rate

B) Fluctuating blood pressure

C) Difficulty with breath

D) None of the above

 

Q.4 The most likely reason for Margaret’s initial rapid heart rate on admission is:

A) Intercostal bleeding

B) Infection

C) Low oxygen saturation

D) Pitting oedema

 

 

Q.5 On the basis of being ‘the next of kin’, Mary is legally entitled to:

A) Provide consent to medical treatment on behalf of her mother?.

B) Refuse medical treatment on behalf of her mother?.

C) Receive detailed information about her mother’s medical condition from the HCT.

D) None of the above

 

 

Q.6 On the basis of being ‘the next of kin’, Mary is ethically entitled to:

A) Provide consent to medical treatment on behalf of her mother.

B) Refuse medical treatment on behalf of her mother.

C) Receive detailed information about her mother’s medical condition from the HCT.

D) None of the above

 

 

Section B: Questions 7-10

Q.7 Explain in detail the pathophysiology of Margaret’s condition of APO

 

Q.8 Write a comprehensive but succinct progress note prior to Margaret’ transfer to the ward in accordance with standards around nursing documentation in patient case notes

 

Q.9 List all of the nursing observations using a prioritised approach that will be required for Margaret for your upcoming early shift. Provide a succinct clinical rationale/s for each of these observations ensuring you reflect your understanding of why these particular observations would be required for Margaret.

 

Q.10.It is now 10 days since Margaret was admitted and she is about to be discharged home. Outline in detail the specific patient education that Margaret will require before discharge

 

Section C: Questions 11-12

Mr Rowe is a 58-year- old man who was involved in a car accident three days ago. He is the manager of an export company and he was driving the company car when it crashed into another vehicle. More severe injuries were prevented by the airbags which inflated on impact. He suffered a mild traumatic brain injury, fractured ribs, fractured left ulna and fractured right tibia and fibula. He sustained bruising and soft tissue damage to his face, chest, arms and legs.

He has been to theatre to have his fractures reduced and the R) leg is in a plaster back slab, awaiting a full plaster after the wound on his knee is debrided. Mr Rowe is transferred to an orthopaedic ward where you are a graduate RN currently working 12-hour night shifts. He has an IVT, oxygen via nasal cannula at 2L/min, and urinary
IDC in situ.

At about 0500 the enrolled nurse suddenly calls out for your help. You rush to the bedside to find Mr Rowe squeezing through the cot sides and trying to get out of bed.You both roll him back into bed once you free the plaster back slab from the cot side.He is very distressed and angry and won’t listen to your requests to stay in bed. He insists on going to the toilet and says you have come to hurt him. You try to calm him down but he insists on throwing his fractured leg over the cot sides with considerable force and you are concerned he will hurt himself and put the nursing staff at risk of injury.

Eventually you free yourself and call a code black. The security team and relevant health care staff arrive quickly and restrain Mr Rowe with hand and foot shackles. You sign the request for restraint and document in the case notes that restraint was necessary. Mr Rowe is very angry but lies in bed restrained and quiet. At 0700 he eventually goes to sleep.

Q.11

Outline 5 post-operative patient care requirements to be performed within the first 4 hours of Mr Rowe’s return to the ward. Provide clinical rationale/s for each of these requirements that reflect the specific nursing management needs of Mr Rowe.

Q.12 (A)

Using the ISBAR method write a comprehensive clinical handover at the end of late shift having cared for Mr Rowe since he returned from theatre at 1600.

Q.12 (B)

Explain what Patient Advocacy is and provide a detailed explanation of how you would ensure this Ethical aspect of competence in nursing practice whilst caring for Mr Rowe.

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