Forward the details ASAP
2.4.1 Short Answer Exam based on one case study of acute life-threatening and/or traumatic complex health condition Weight: 35% Type of Collaboration: Individual Due: 3rd May Sunday Submission: Refer to section 2.5 of the Learning Guide - General Submission Requirements Format: Short answer questions based on a case study of an acute life-threatning and/or traumatic complex health condition. Length: 1250 words Curriculum Mode: Word Count There is a word limit of 1250 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% (1375 words) the marker will stop marking. 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 5 years including journal articles, textbook material or other appropriate evidence based resources. Aim of assessment The purpose of this assessment is to enable students to: 1. Demonstrate knowledge by analysing the information provided in the case study. 2. Apply the clinical information provided in the case study and describe this clinical information within a pathophys- iological and patient focused framework. 3. Discuss nursing strategies and evidence based rationales to manage a patient with an acute episode of asthma. 4. Discuss the pharmacological interventions related to the management of a patient with an acute episode of asthma. Case study Poppy is a 9 year old female, weight 40Kg. She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with 6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation of asthma. EXCERPT OF RELEVANT ICU NOTES Past History Diagnosed with asthma age 2 (infrequent intermittent asthma). Current medications: - Ventolin PRN. IUTD (immunisations up to date) Nursing Assessment A. Clear, speaking in single words B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and expiratory wheeze C. HR 160bpm, ST, peripherally warm D. GCS 14/15 (E4, V4, M6) E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug F. IVF NaCl 53 ml/hr G. a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal. b. BGL 9.0mmol/L c. Beta-agonist- Salbutamol d. Anticholinergic - Atrovent e. IV Hydrocortisone 9 Plan f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate 1.4) · Keep SpO2 92-95%% · Beta- antagonist Salbutamol continuous via nebuliser · Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24 · Hydrocortisone 100mg 6/24 · MgSO4 6.4mmol/20 minutes · IVF 53ml/hr · Repeat ABGs in 1hour · Monitor BGL · Peakflow /spirometry Question 1 Explain the pathogenesis causing the clinical manifestations with which Poppy presents. Question 2 1. Sit Poppy in a High Fowlers position · How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress? 2. Apply and titrate oxygen · What oxygen delivery device will you use? · Why did you choose this device? · How does providing supplemental oxygen work and, how will it assist Poppy? Question 3 For each medication below explain · The mechanism of action. · Why your patient is receiving this medication in relation to her symptoms and diagnosis? · What are the nursing considerations for this medication? · What clinical response you expect? · What continuing clinical observations will you need to undertake? 1.Salbutamol via nebuliser 2.Hydrocortisone IV 3.Ipratropium Bromide via nebuliser Module 2: Asthma Key concepts At the end of the tutorial today, you should be able to: Describe the pathogenesis of asthma and its clinical manifestations especially in the context of paediatric patients. Clinical Manifestations of asthma and being able to recognise between nursing priorities. Describe how asthma effects gas exchange and what are the triggers of asthma Recognise treatment priorities for the management of patients experiencing acute exacerbation of asthma. Chapter 24 & 25 Asthma Handbook https://www.asthmahandbook.org.au/man agement/children Alterations of pulmonary system across the life span – pages 721-723 https://www.asthmahandbook.org.au/management/children https://www.asthmahandbook.org.au/management/children Plan Mark role Khaoot on resp/asthma – login details go to Kahoot.com Go to login User name crook.benny Password : Surfing1 Find the kahoot , team mode , get the each table to share a device and play Read case study Break groups into 4 tables and define the 4 different features of asthma e.g airway hyperresponsiveness and draw a diagram Do the same for the cells e.g histamine Talk through question 3 Question 4 – let the students look up the asthma handbook to find the answers, about diagnosis CXR and bloods results discus as a class Activity 2.1.: Case studies: Hannah Forrest presents with Exacerbation of Asthma. A new admission has arrived. You receive the following handover: Hannah is a 9-year-old female presenting with an SOB 1100 whilst at school. S Hannah was at school playing in the playground and started to develop some SOB whilst running in the playground. Her friends started to notice that she had an audible wheeze and was only talking in short words and continues to cough. She presented to the school nurse who subsequently called the ambulance. B History of Asthma Uses Ventolin PRN IUTD (Immunisations up to date) A A-G Assessment Airway: Clear Breathing: Severe shortness of breath and coughing Tracheal tug and subcostal recession Using accessory muscles on respiration Unable to speak properly and is only speaking in short words On auscultation expiratory wheeze Respiratory rate 42 breaths/min SpO2 92% on room air Circulation: Heart rate: 130 beats/min Temperature: 37.8 Disability: GCS 15, PEARTL. Equal strength X 4 Exposure: No bruising, wounds Nil cannula Weight: 40kg Fluids: No IV fluids in progress Glucose: BGL: 5.2 mmol/L R Ventolin 5mg x3 every 20mins Prednisone 1mg/kg CXR Bloods FBC, UEC Keep Oxygen saturations above ~94% Activity 2.2: Pathophysiology Review Question 1: What is the definition of Asthma? A clinical definition of asthma in children Asthma is defined clinically as the combination of variable respiratory symptoms (e.g. wheeze, shortness of breath, cough and chest tightness) and excessive variation in lung function, i.e. variation in expiratory airflow that is greater than that seen in healthy children (‘variable airflow limitation’). See: A working definition of asthma There is no single reliable test (‘gold standard’) and there are no standardised diagnostic criteria for asthma. The diagnosis of asthma is based on: history physical examination considering other diagnoses clinical response to a treatment trial with an inhaled short-acting beta2 agonist reliever or preventer The primary event in asthma is airway inflammation and that airway hyperresponsiveness and airflow obstruction are secondary and symptomatic features of the disease. Underlying airway inflammation (which involves cellular infiltration, edema, nerve irritation, and vasodilation) results in constriction of airway smooth muscle, increased production of mucus, and airway hyperresponsiveness. The airflow limitation associated with asthma is caused by a variety of changes in the airway, all of which are influenced by airway inflammation. These changes include bronchoconstriction (bronchial smooth muscle contraction that quickly narrows the airways in response to a variety of stimuli, including allergens and irritants), airway hyperresponsiveness (an exaggerated bronchoconstrictor response to stimuli), and airway edema (hypersecretion of mucus and mucous plugs as the disease becomes more persistent, which further limit flow). With time, remodeling of airways may occur, and reversibility of airway obstruction may be incomplete in some persons. Possible changes in airway structure include sub-basement fibrosis, hypersecretion of mucus, epithelial cell injury, smooth muscle hypertrophy, and angiogenesis (the growth of new blood vessels from existing blood vessels) (polgar-baily, 2017) The key here is trying to make the pathophysiology easy to understand. I SUGGEST DIAGRAMS. Pictures can really show the process clearly. The pathophysiology of asthma includes Bronchoconstriction Airway odema Airway hyperresponsiveness Airway remodeling I have included a lot of detailed just in case you asked some deeper questions from students hopefully this helps, Bronchoconstriction: In asthma, the dominant physiological event leading to clinical symptoms is airway narrowing and a subsequent interference with airflow. In acute exacerbations of asthma, bronchial smooth muscle contraction (bronchoconstriction) occurs quickly to narrow the