NURBN3030: Case Study Assignment Help
Question
NURBN3030: This is a case-study-based assessment for Federation University Australia where the student is required to evaluate the clinical scenario provided and answer the questions given in the task file accordingly. The assessment is aimed at fostering learning related to the practical application of nursing care among students. Additionally, the assignment also urges the students to research and present their writing comprehensively.
Solution
The solution is based on a case study where the student is supposed to imagine themselves in the role of a graduate nurse posted in an Emergency Department. The scenario revolves around Robert, who is a 78-year-old male brought to the ER and is depicting symptoms of a cerebrovascular accident. The patient’s case history and pathology are also provided to the students based on which the questions need to be approached.
The solution incorporates answers to six of the questions asked in the assignment, which our described and written in detail by our experts. You can read half of the answers written by our experts below:
Question 1
The first question prompts the student to think about and determine the pathophysiology of Cerebrovascular Accident in Robert’s case based on the subject’s knowledge regarding CVA. Our experts have proposed the answer based on a careful analysis of the CVA assessments provided for Robert.
A cerebrovascular accident (CVA), which is commonly referred as a stroke can be described as an emergency medical situation. There are two major types of CVA, which can be listed as ischemic stroke (IS) and hemorrhagic stroke (HS) (Khaku & Tadi, 2021). Commonly a CVA is characterised by sudden weakness, numbness and/or paralysis at one side of the body. These signs can also be accompanied by speech problems, dizziness, impaired movement and headache (Murphy & Werring, 2020). However, the specific diagnosis for IS and HS cannot be made from these clinical presentations. The case scenario involving Robert states that the patient experienced weakness on the left side of the body, which was followed by facial drop on the same side and aphasia. There is a study by Ojaghihaghighi et al., (2017), found that the lower GCS scores (mean 8.97) and acute onset of headache had a higher prevalence in the HS patients, compared to IS patients. The patient’s GCS score was recorded to be 12 and no onset of headaches was reported. While it might not be a definite characteristic to make a diagnosis, these findings might indicate the higher likeliness of IS in Robert rather than HS.
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Question 2
In the next question, the students are asked to propose two assessments related to nursing that need to be prioritized in Robert’s case.
There are two abnormal findings present in the CVA assessment taken for Robert. Thus, the assessments suggesting hypertension and a low GCS score can be considered as two of the priority assessments in terms of the deterioration in the patient. Hypertension is a serious consideration in the IS patients, even though it is a common finding in them. It is a potential risk factor for the first onset IS occurrence. Even in post-stroke phases, it presents a risk of CVA reoccurrence (Green et al., 2021). A rapid increase in the blood pressure post an event of CVA may cause further neurological damage to the patient, leading to deterioration. Additionally, the finding of elevated blood pressure might also indicate a transformation of IS into HS, enhancing the risk of mortality further in the patient (Amatangelo & Thomas, 2020). In some situations, an elevation of systolic blood pressure in post CVA phases is actually recommended as a therapeutic measure, even for older adult individuals. However, that elevation is allowed until it is below 140 mm/Hg for the systolic blood pressure (Wajngarten & Silva, 2019).
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Question 3
In the third question, our experts have imagined the role of a graduate nurse to propose three particular nursing interventions that could help in supporting Robert’s airway and ventilation for the initial period.
Post-stroke seizure or epilepsy implies the severity of the situation (Ferreira-Atuesta et al., 2021). The most important management considerations in a patient experiencing a seizure can be the airway, breathing and circulation management. Three interventions in relation to these considerations can be mentioned. The first intervention to ensure an open airway can be the positioning of the head of the patient. Patient positioning is vital to ensure adequate ventilation also. The patient must be placed on his CASE STUDY ASSESSMENT 5 left side, with his head resting comfortably to maintain an open airway (Al Sawaf, Arya & Murr, 2021). Prone positioning has been found to have some additional benefits in improving respiration in patients. That particular position increases the elastance of chest walls and thus, improves respiratory mechanics in the cases of ventilation patients (Mezidi & Guérin, 2018). However, prone positioning is not advised in the cases of patients having seizures. There is a significant risk of sudden unexpected death in cases of epilepsy. However, the risk is minimal if the seizing patients are maintained in a supine or lateral position rather than in a prone position (Mahr et al., 2020). This is why it is recommended for Robert to be placed on his left side during the onset of a seizure. Assessing and managing any risk of oropharyngeal airway blocks can be considered as another immediate seizure management intervention. As part of this intervention, the clothing of the patient around the neck should be loosened (Al Sawaf, Arya & Murr, 2021).
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Question 4
In this question, the students are required to take into account Robert’s deteriorating case to elaborate on the mode of action, indications, nursing administration, adverse effects, and contraindications of Lorazepam.
Mode of Action:
Lorazepam drug has a rather fast onset of action. It is a benzodiazepine drug that binds to its respective receptors present on some specific post-synaptic neurons. This drug affects the central nervous system by enhancing the inhibitory effects of the neurotransmitter GABA.
Indications:
Lorazepam drugs are used most commonly as anxiolytic and sedative medications (Ghiasi, Bhansali & Marwaha, 2022).
Administration:
In the cases of status epilepticus, lorazepam is administered via an intravenous route, as it can be found in the recommendation for Robert.
Adverse effects:
There is a range of adverse effects that can be mentioned in the context of lorazepam use. In the cases of higher doses, as it was in Robert (8 mg), the major risks involve respiratory depression.
Contraindications:
The major contraindications for lorazepam administration include allergic reaction to benzodiazepines, premature infants and the patients with sleep apnea, severe respiratory impairment or insufficiency and acute narrow-angle glaucoma (Ghiasi, Bhansali & Marwaha, 2022).
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Question 5
Our experts have approached this question by describing three of the evaluations related to nursing that the graduate nurse needs to administer after Lorazepam is administered to the patient.
The primary nursing evaluation following the administration of lorazepam will involve the efficacy of the drug in managing the seizure symptoms. As part of this evaluation process, the nurse must observe the patient for any risk of seizure. The rationale for this evaluation is based on the goal of medication administration, which involves complete neutralisation of the symptoms. The pharmacological interventions through evidence-based might vary in their level of efficacy for every patient. It is the role of a nurse to ensure that the administered medication is sufficiently effective in the patient (Mardani, Griffiths & Vaismoradi, 2020). Thus, this evaluation is necessary.
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Question 6
The last question requires the student to reflect and determine ways through which family-centered care can be provided to Robert’s wife Agnes in such a pressured situation.
The goals of family-centred care can be listed as reducing the distress of the family members and enabling them to become effective support systems in patient care (Park et al., 2018). Thus, the first nursing intervention addressing the goal of distress management in family members can be providing them effective emotional and psychological support. It has been found that appropriate family-supportive behaviour by the nurses improves the quality of care (Babaei & Abolhasani, 2020). The nurse may utilise an effective communication approach to console and reassure Agnes about Robert’s situation. Providing her with reliable and meaningful information about Robert’s prognosis may also reduce some of her worries.
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