Mr Rupinder Patel is a 73 year old retired businessman. You have previously met Rupinder
Mr Rupinder Patel is a 73 year old retired businessman. You have previously met Rupinder during the Intensive 1 workshop when he was aged 62. The present moment is 11 years later. Please review all information in the Intensive 1 workbook you have already received. Rupinder has a medical history of Heart Failure with reduced ejection fraction. This developed after he experienced the two myocardial infarctions 11 years ago. Both ventricles were affected. Previous chest radiography showed left ventricular hypertrophy. The death of his wife 2 years ago has led to Rupinder experiencing several episodes of depression that has been exacerbated by his sons both moving to Western Australia for work. The loneliness and sadness makes it difficult for him to be concordant with his heart failure management and sustain the necessary lifestyle adjustments required to prevent exacerbations. This has resulted in several admissions to hospital for management and review of his heart failure. For this current admission, Rupinder was referred to hospital by his Nurse Practitioner, after recently rapidly gaining weight (currently 110kg), since his previous visit. ……………………………………………………………………………………………………………………………………………………………………………………………………. The time now is 0800 and you have just come on for your morning shift. Rupinder has been on the ward for only two hours after spending approximately 12 hours in emergency waiting for a bed to become available. Rupinder appears slightly disoriented. He tells you that he has spent the night in the recliner chair beside the bed, sitting upright because ‘this is the only way I can get my breath’. He tells you he feels terribly tired. You observe that the 1 litre water jug that he has been drinking from, since coming to the ward, is nearly empty. Upon undertaking a further assessment of Rupinder you obtain the following new information: Vital Signs RR: 28 bpm Sp02: 94% on 2lt via nasal prongs BP: 105/82 mmHg HR: 122 bpm Temp: 36.5oC Other information BGL within normal range GCS 14 – Eye opening – 4; Verbal response – 4; Best motor response – 6 Cardiac assessment ECG: indicative of atrial fibrillation Skin is cool and clammy Fluid status assessment Peripheral pulses difficult to palpate Presence of pitting oedema bilaterally Capillary refill (toes) – 5 seconds Raised JVP Urine output since midnight: 150 mL Abdominal assessment Abdomen soft and non-tender. Bowel sounds present. Respiratory assessment Bibasilar posterior crackles Reduced breath sounds in the bases of both lungs Increased work of breathing Patient producing pink-tinged frothy sputum. Rupinder’s ECG is indicative of atrial fibrillation. How might this have impacted his blood pressure. Explain the pathophysiological mechanisms involved. In your answer, identify in brackets ( ) the data or observations from the case scenario that support your explanations. For example: “… which causes vasoconstriction (pale skin) leading to…” 300 words excluding compulsory in-text references. CXA240 AT2 short -answer questions Criteria High Distinction (80-100%) Distinction (70-79%) Credit (60-69%) Pass (50-59%) Fail (0-49%) Criterion 1 – Pathophysiology 20 points 20 points Documented a comprehensive and detailed understanding of the links between assessment findings and underlying anatomy, physiology, and pathophysiology, including explanations at the cellular and tissue level when relevant. Documented a detailed understanding of the links between assessment findings and underlying anatomy, physiology, and pathophysiology, including explanations at the tissue level when relevant. Documented a general understanding of the links between assessment findings and underlying anatomy, physiology, and pathophysiology, including explanations at an organ level when relevant. Outlined the links between assessment findings and underlying anatomy, physiology, and pathophysiology, at a functional anatomy level. Provided insufficient AND/OR incorrect information that does not clearly demonstrate an understanding of the links between assessment findings and the underlying biological processes AND/OR outlined mechanisms that demonstrate a misunderstanding of cause and effect AND/OR did not refer to relevant patient cues. Criterion 2 – Therapy 20 points 20 points Documented a comprehensive and detailed understanding of the aim and mechanisms of action of therapeutic approaches, as well as their intended and unintended consequences (if required), based on current evidence-informed knowledge appropriate for the situation or patient. Documented a detailed understanding of the aim and mechanisms of action of therapeutic approaches, as well as their intended or unintended consequences (if required), based on evidence-informed knowledge appropriate for the situation or patient. Documented a general understanding of the aim and mechanisms of action of therapeutic approaches, as well as their intended consequences (if required), based on evidence-informed knowledge appropriate for the situation or patient. Outlined the aim and mechanisms of action of therapeutic approaches, as well as its intended consequences (if required), appropriate for the situation or patient. Provided insufficient and/or incorrect information that does not clearly demonstrate an understanding of the aim and mechanisms of action of therapeutic approaches, and/or their intended consequences AND/OR provided information not based on evidence-informed knowledge AND/OR not appropriate for the situation or patient. Criterion 3 – References 5 points 5 points Provided a submission that is clearly informed by current scholarly literature, by following the recommendations in the assessment task instructions; current textbooks; relevant standards; and/or clinical guidelines, policies and protocols when appropriate for the situation or patient. These have been accurately used as an evidence base for your clinical reasoning. AND The referencing is consistent and complies with the APA 7th referencing guide. Used current scholarly literature, by following the recommendations in the assessment task instructions; current textbooks, relevant standards; and/or clinical guidelines, policies and protocols when appropriate for the situation or patient. These have been used as an evidence base for your clinical reasoning. AND The referencing complies with the APA 7th referencing guide. Used scholarly literature, by following the recommendations in the assessment task instructions; textbooks; relevant standards; and/or clinical guidelines, policies and protocols when appropriate for the situation or patient. These have been used as an evidence base for your clinical reasoning. AND The referencing complies with the APA 7th referencing guide. Used scholarly literature, by following the recommendations in the assessment task instructions; textbooks; relevant standards; and/or clinical guidelines, policies and protocols when appropriate for the situation or patient. These have been used as an evidence base for your clinical reasoning. AND The referencing mostly complies with the APA 7th referencing guide. Documented your reasoning with reference to outdated, irrelevant or insufficient literature, by not following the instructions in the assessment task instructions. AND/OR Provided statements not supported by the literature referenced AND/OR Referencing is absent or generally inconsistent and does not comply with the APA 7th referencing guide. Criterion 4 – Communication 5 points 5 points Your writing: Is consistently clear and fluent and has few or no spelling, typographical or grammatical errors. You have always used discipline specific language and clinical terminology. Your writing: is usually clear but unambiguous and has minor spelling, typographical and or grammatical errors. You have mostly used discipline specific language and clinical terminology. Your writing: is mostly clear but unambiguous and has minor spelling, typographical and or grammatical errors. You have sometimes used discipline specific language and clinical terminology Your writing: is sometimes clear but mostly unambiguous and has some spelling, typographical and or grammatical errors. You have limited use of discipline specific language and clinical terminology. Your writing: Is unclear OR has spelling AND/OR grammatical errors that make it difficult for the reader to understand your intended meaning. You have rarely used discipline specific language and clinical terminology.
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