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NURS20024 – Applied Nursing Practice 4:
Written assessment task-Patient case scenario
Completing this written task
✓ Read the following case study and provide answers within the WHITE boxes below the
question number on the ANSWER TEMPLATE PROVIDED ON MOODLE. The space will get
bigger as you type. Do not change the formatting or edit boxes that are not white.
✓ Allocated marks for each question are indicated to the right of each question.
✓ Total score to be gained is up to 100 marks which will contribute to 35% of your unit grade.
✓ Where poor grammar and spelling detracts from the graders/markers ability to understand
your answer you are unlikely to receive full marks for this question.
✓ Check that you have used the correct template, format and referencing style.
✓ For question 11 upload the chosen FULL TEXT article along with this answer sheet (using the
link provided). Marks have been allocated for loading the required paper.
Referencing this written task
✓ At least 10 appropriate references should be used. They should be no more than 10 years old.
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where indicated). Provide a reference list at the end of your written tasks following APA
guidelines.
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Correct referencing as per APA Incomplete/inaccurate
referencing within text and/or in
reference list OR reference > 10
years old
No reference listed in text and /
or reference list to support
answer
No deduction/penalty applies The answer you have given will
achieve ½ marks.
The answer you have given for
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plagiarism
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✓ On completing your written task, save this document as a word (.doc / .docx) document.
✓ Please NOTE: This written task MUST be uploaded in the format specified template.
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th September 2022.
Where evidence of collusion and/or plagiarism exists, penalties will be applied according to the
Academic Integrity policy.
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Case study
You are just getting caught up with your work when you received
a call from the emergency department (ED). They are sending you
Mrs Banks, a 69 year old woman with a diagnosis of heart failure.
She was discharged from hospital 10 days ago and has presented
today stating “I cant catch my breath” You note from her medical
record that she was discharged home on the following
medications:
Medications
Captopril 25 mg BD
Bisoprolol 2.5mg Daily
Spironolactone 25 mg Daily
Lead II of the 12 lead ECG show the following
25mm/sec
Previous history:
CAD, Arthritis
Observations on admission were as follows:
Weight: 86 Kg
BP: 138/84 mmHg
HR: 72 beats per minute and regular
RR: 14 breaths per minute
SpO2: 97% on room air
Pain score: 0/10
Social situation:
Retired personal assistant, recently
widowed. She has 3 grown children, none of
whom live at home.
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Questions
1. Consider Mrs Banks history and describe;
a. Two signs that the nurse may have noted when performing a cardiopulmonary
assessment on Mrs Banks.
b. Two symptoms that Mrs Banks may complain of (aside from dyspnoea).
2. Explain what heart failure is and identify the two main types.
3. Describe the pathophysiology of chronic heart failure.
4. Biventricular pacemakers (BIV) can be used in some patients with heart failure.
a. List the indications for insertion of an biventricular pacemeaker in heart failure
b. Discuss five (5) nursing actions related to the pre-operative preparation of a patient for
insertion of a BIV
5. Consider the current medications that Mrs Banks is on, list the rationale (why are they given) for
these medications in her case
a. Captopril
b. Bisoprolol
c. Spironolactone
6. Consider the above rhythm strip
a. What is the rate of this rhythm?
b. Explain how you determined this rate
c. Identify the rhythm
d. What nursing actions if any are needed?
7. Following medical review on the ward, Mrs Banks is commenced on Frusemide 20 mg BD and
Slow K, 2 tabs, BD.
a. Describe the rationale for commencing these medications for Mrs Banks
b. Describe three parameters that you would use to assess/monitor the effectiveness of
these medications for Mrs Banks
c. Describe the education/patient teaching that you need to communicate to Mrs Banks to
ensure she is adequately informed about her heart failure AND the medications she is
now on
The following morning, you are once again allocated the care of Mrs Banks. You note the following
observations and laboratory results.
0600 Observations Laboratory Results
Weight: 90.8kg
BP: 108/58mmHg
HR: 109 beats per minute (irregular)
RR: 15bpm
Temp: 36.6
SpO2: 95% on 1L via NP
Pain score: 0/10
Sodium: 142
Potassium: 3.2
Urea: 6.2
Creatinine: 89
Chloride: 91
Bicarbonate: 19
Magnesium: 0.63
8. Consider the above 0600 hr vital signs.
a. List the vital signs that are a concern to you (if any) and why.?
b. Outline what action you should take next?
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9. Consider the above laboratory results.
a. List the values that are a concern to you and why?
b. Outline what (if any) action you should take next.
Lead II
25mm/sec
10. Consider the above observations and rhythm strip.
a. What rhythm is Mrs Banks in now (describe the rate and rhythm) and how have you arrived at
this decision?
b. Outline your immediate nursing priorities and actions based on this rhythm and the patients
observations?
c. Discuss the impact this rhythms has on a the haemodynamic status of a patient and why.
d. Consider the patients vital signs and laboratory results above, outline other replacement
therapies that should be given in this case.
11. Choose any research article that you feel is relevant to the nursing care of a patient with heart failure.
a. Upload the FULL TEXT article in the link provided when you submit your written work
b. Critically evaluate this article and present a summary of the paper in 150 – 300 words
c. Identify HOW the chosen article relates to the nursing care in this case study
12. Reflect back on the case study and give examples that support 2 of the NMBA standards.
13. Describe 1 legal responsibility of the nurse in relation to this case.
14. Describe 1 ethical responsibility of the nurse in relation to this case.
END OF CASE STUDY AND QUESTIONS