Nur 3030-management of deteriorating patient: Clinical Features Risk

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Case Study

This assessment task allows students to demonstrate theoretical clinical knowledge around nursing assessment, pathophysiology of factors impacting on clinical deterioration, planning of nursing care, nursing and medical management, and evaluation of care. Students are required to answer the case scenario questions provided. Students should attempt all questions in the case study:

Sharon is a 66-year-old, admitted to the medical ward with a diagnosis of Right Pulmonary Embolism She has been commenced on Apixaban 10mg PO BD for 7 days to treat her PE. Nur 3030-management of deteriorating patient: Clinical Features Risk

• History of presenting complaint: increased right sided chest pain and increased shortness of breath for 1 week.

• Past Medical History: Previous Deep Vein Thrombosis (DVT) & hypertension

• Regular Medications: Micardis

• Nil Known Allergies.

Task

Question 1: Provide a description of the pathophysiology of a pulmonary embolism and in your answer make links to the patient history to highlight relevant risk factors and clinical features.

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Question 2: Explain the use of Apixaban in the management of a PE. In your answer include – mechanism of action, indications, side effects and contraindications.

Sharon is resting in bed. You attend to her routine vital signs, which reveal the following:

• Conscious state – Alert

• Temperature: 36.3

• Pulse: 98 bpm and regular

• Blood Pressure: 110/62mmHg

• Respiration: 22 bpm

• SpO2: 91% on room air (Fi02 21%)

• Pain: 3/10

Question 3: Review Sharon’s vital signs above. Using your knowledge of reversible causes of patient deterioration (one of the 4H’s & 4T’s), discuss the following:

• Describe onereversible cause Sharon is experiencing and describe the pathophysiology that occurs which results in patient deterioration.

• Describe the impact of a pulmonary embolism on the Ventilation/Perfusion Ratio and link to the above vital signs.

Question 4: Discuss two prioritiesd nursing assessments that would be prioritised for Sharon’s present deterioration (excluding vital signs). For each nursing assessment, ensure your discussion includes a description of the assessments in the context of Sharon condition and clear rationale as to why these assessments would be priority. Nur 3030-management of deteriorating patient: Clinical Features Risk

Question 5: Discuss two prioritised nursing interventions that you as a Registered Nurse could initiate to manage Sharon’s deterioration. For each intervention, ensure your discussion includes link to evidence-based practice and provides rationale as to how it would improve the physiological outcomes of Sharon’s condition.Nursing interventions would include nursing activities or actions that the nurse could initiate in response to nursing assessment findings. Note: please be aware of the difference between an assessment and an intervention.

Question 6: Describe two relevant nursing evaluations that you would complete in response to the interventions you have just described. For each evaluation, provide a brief rationale as to how these evaluations will assist in preventing the further clinical deterioration of Sharon. Nur 3030-management of deteriorating patient: Clinical Features Risk

Nur 3030-management of deteriorating patient: Clinical Features Risk