Answer 2 Case Study Questions- Pathophysiology for Health Care-Nursing. 1.Spinal Injury 2.Stroke

Task Description PLEASE READ THIS INFORMATION CAREFULLY, ALL THE WAY TO THE BOTTOM OF THE PAGE where we discuss the use of AI. In this assessment task you will be provided with two scenarios containing relevant patient information. You will apply clinical reasoning to your knowledge of anatomy, physiology, pathophysiology, therapeutic interventions, and pharmacotherapy to answer a variety of questions. You'll be required to complete two (2) short answer questions that will need to be submitted via Turnitin. The questions will require you to: Consider the patient situation and identify cues (signs and symptoms, as well as other cues) from clinical information provided. Process this information by analysing and explaining the relevant physiology and pathophysiology underpinning the patient presentation and progression. Apply knowledge of physiology and pathophysiology to explain the rationale of suggested therapeutic approaches for that patient. It is expected that you will engage with MyLO content and scholarly literature to substantiate your clinical reasoning in the long answer question. How to research for this task • Read BEFORE you write. Read to understand and learn. Do not write your assignment based on what you already believe you know, and then go looking for references to support what you have said. • Use the following textbooks, which you can access as eBooks and/or as hard copies in the UTas library. Textbooks should be no more than 10 years old. o Amerman, E. 2019. Human Anatomy & Physiology. 2nd Global ed. Pearson: UK. o Bullock, S. & Hales, M. 2019. Principles of Pathophysiology. 2nd Ed. Pearson: Melb o Bullock, S. & Manias, E. 2017. Fundamentals of Pharmacology. 8th Ed. Pearson: Melb (eBook) o Bullock, S. & Manias, E. 2022. Fundamentals of Pharmacology. 9th Ed. Pearson: Melb (hard copy) o Bauldoff et al. 2020. Lemone & Burke's Medical-Surgical Nursing. Pearson: Melb. o Norris, T. 2020. Porth's Essentials of Pathophysiology. 5th Ed. Wolters Kluwer: Phil • Websites - ensure that you are only using information for health professionals. Do NOT use consumer information. Wherever possible, identify an author, and that the work has been peer reviewed. Acceptable sources will have a date of authorship. Is the website a recognised source of information eg the Australian Medicines Handbook? If in doubt, you can always ask the Unit Coordinators. Assessment criteria and marking rubric. Your submission will be assessed against the following criteria. You are strongly encouraged to review the marking rubric for this assessment task as it provides more detailed information about the assessment criteria. Explain the pathophysiological basis for the patient’s health condition by demonstrating a clear understanding of physiological and pathophysiological mechanisms, relevant to patient cues (signs and symptoms). Explain the rationale for therapeutic approaches for the patient. Substantiate statements and justify suggested clinical interventions by using appropriate literature, cited using APA 7 referencing style. Communicate in an academic style using discipline specific language by using appropriate terminology to explain the patient’s health condition and rationale for therapeutic approaches. Marking rubric Carefully review the marking rubric for assessment task 2 short answer questions. Assessment task 2 - short answer questions submission rubric Assessment due dates and submission details Task length The case study will have two questions to be answered in a written submission of 550 words. Recommended 300 words for Q1 (SCI pathophysiology) and 250 words for Q2 (Stroke Therapy). In your submission, include the total word count excluding in-text referencing. If your submission exceeds the word limit, only the first 550 words will be marked. Task format You should write in complete sentences and structured paragraphs. Do not use bullet-point lists, tables, or flow-charts to present your response. Do not include pictures. Ensure that you effectively paraphrase by writing in YOUR OWN WORDS. Direct quotes are not accepted for this assignment of short answers. Generally, submissions are expected to be in Microsoft Word or in pdf format (not text scanned into pdf). To see a full list of the file types accepted by Turnitin, view this link: https://help(dot)turnitin(dot)com/feedback-studio/turnitin-website/student/submitting-a-paper/file-requirements.htm Referencing The entire university is moving from APA 7 as the official referencing style. Utilise this resource to learn more about researching, citing, and referencing. Marking and feedback There is a marking rubric for this assessment task. You are strongly encouraged to review the rubric before completing your submission. Academic Integrity: Turnitin and use of Artificial Intelligence Ensure that all the answer is your own words. Ensure that you review your Turnitin score before submitting your work. Any part of your answer that is completely or partially text-matched to another source by Turnitin may not be considered as part of your answer, as these are not your words. Artificial intelligent agents such as ChatGPT, CoPilot or Bard are language generators, not generators of content. As demonstrated in CXA240, they make significant mistakes. Do not use them to answer your questions. However, they can check on the clarity and accuracy of your language. For example, when you have answered your SAQs with the right information and have a first draft, you can ask them to determine if the presentation of ideas is logical. You can ask them to identify grammatical mistakes or places where lay terms are used instead of clinical terminology. Follow their advice about the language if you think it is appropriate, but do not copy/paste their output as that constitutes a breach of academic integrity and, when detected, will be reported for investigation. 2 Short Answer Questions Case Study 1 JK Horse Riding Accident Question Consider the collected cues in the section 'Today – 0830 – hygiene support' Using physiological and pathophysiological mechanisms, and describing anatomical structures involved, Provide the most likely explanation for JK presentation of "flushing on head and arms; pallor in legs and nailbeds of toes". In your answer, indicate in brackets ( ) the data from the case scenario that support your arguments. Word limit: suggested 300 words excluding in-text references for this answer. Overall word limit is 550 words for both AT2 Short Answer Questions. Answer: Case Study 2 Amelia Strong Headache Question Take Action "1/24 (hourly) neurological assessment for 4 hours" has been requested for Amelia. Referring only to the limb movement component of the assessment Provide a rationale for this intervention by: Referring to relevant anatomical structures and discussing the pathophysiological mechanisms of deterioration that would cause observed changes to Amelia's limb movement assessment. Identifying TWO other assessment data (signs or symptoms) that might be evidence of neurological deterioration, and Identifying the guidelines that support this intervention of hourly neurological assessment. Word limit: suggested 250 words excluding in-text references for this answer. Overall word limit is 550 words for both AT2 Short Answer Questions. Answer: Case Study Information Assessment task 2: the person - Case 1 JK Horse Riding Accident Consider the person - Acute Phase On a mild, sunny November afternoon, 23-year-old JK was enjoying a horse ride in the Tasmanian hills around Deloraine. Suddenly, her horse got spooked by a snake and bucked, causing Jouri to lose her balance and fall off. She landed awkwardly on her back, and immediately felt a sharp pain in her upper back. Her friend May who was watching from a distance, rushed to her side. Seeing Jouri in pain and unable to move, May quickly dialled the emergency number to call for paramedics. The paramedics arrived about 1h later and performed the patient assessment: Collect cues. Paramedics Neurological assessment:   GCS: eye opening – spontaneous; verbal – oriented although drowsy; motor – can obey commands (blinking eyes, poking tongue out); some recall of the accident.  Pupillary assessment: PERRLA (pupils equal, round, and reactive to light and accommodation) Motor function: unable to move legs  or thorax. Sensation: reporting no sensation below the armpits, including thorax, abdomen, and legs. Normal sensation in arms, neck, face, and head Deep tendon reflexes: normal biceps and triceps reflex. Minimal quadriceps (knee jerk) and gastrocnemius (Achilles tendon) reflexes Vital signs:  RR: 28 bpm, abdominal expansion but thorax not expanding, some use of accessory muscles. SpO2: 93%, started oxygen administration 15L/min via non re-breather mask. BP: 100/72 mmHg (MAP 81 mmHg) HR: 82 bpm T: 35.2oC  After the initial assessment, the paramedics stabilized Jouri’s spine with a cervical collar and placed her on a long spine board to prevent any further injury during transport. They called for a transport helicopter, which took 30min to arrive. The paramedics carefully loaded her into the helicopter and transported her to the Royal Hobart Hospital for further evaluation and treatment. Throughout the journey, they continuously monitored her vital signs to ensure her condition remained stable. They also reassured Jouri and kept her informed about what was happening, which helped to keep her calm during this stressful situation. Triage Vital signs on arrival:  RR: 26 bpm, some use of accessory muscles. SpO2: 97%, O2 titrated to 5L/min via Hudson mask. BP: 98/70 mmHg (MAP 79 mmHg) HR: 64 bpm T: 36.8oC (tympanic)  Primary survey 10min later:  Airway – intact and unobstructed . Jouri's voice was loud and clear. Breathing – RR 28; nasal flaring; absence of chest movements; O2 required to maintain SpO2. Circulation – BP 96/64 mmHg (MAP 75 mmHg); HR: 62 bpm; peripheries warm and pink. Disability – JK reported a loss of sensation below her chest. reflexes – normal biceps and triceps, all other muscle stretch reflexes in the lower extremities were absent. Sensory– perception of sensory stimuli ended bilaterally at an imaginary line drawn across her chest 2 cm above the nipples, some sensation in her arms, but could not localise touch or describe texture with any consistency. Motor- able to elevate shoulders and isometrically contract biceps and triceps in both arms; lower limbs flaccid, nil ability to move. Deep tendon reflexes: normal biceps and triceps reflex. Absent quadriceps (knee jerk), gastrocnemius (Achilles tendon) and plantar (Babinski) reflexes. Blood glucose – 6.2 mmol/L  Exposure  - nil evidence of injuries Pain assessment: Provoking/palliating - nothing particularly provokes the pain, it is just present. Quality - stabbing and aching Region/radiation - upper chest and medial surface of the arms Severity - 7/10 Timing - worsening since the accident Neurological assessment: GCS: eyes - 4; Verbal - 5; Motor - 6 Pupils: PERRLA, pupils 3 mm Limb movements: as above in "Disability" notes Assessment and investigation data Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain and C-Spine Performed Date: 11/11/Year Time: 1330 Final Report CT BRAIN AND C-SPINE CLINICAL NOTES: Witnessed fall from a horse. Immediately unable to stand up or reposition herself. Findings: A non- contrast CT has been acquired. T2 lesion with no vascular haemorrhages noted but some blood evident at T1-T3 with small bone fragments in the spinal canal.  Mild contusion on L scapular area IMPRESSION: Hyperextension thoracic spine fracture (HTSF) at T2 X-ray Chest – absent lateral chest expansion during inhalation; normal diaphragmatic excursion; mild pulmonary oedema    Actions and interventions spinal precautions and then immobilisation and stabilisation of spine intravenous therapy vasopressor therapy to maintain MAP >85 mmHg. 1/24 (hourly) neurological assessment (Glasgow Coma Scale, Pupillary response, Limb strength), for 12 hours 1/24 (hourly) vital sign assessment telemetry mechanical ventilation analgesia & 2/24 (second hourly pain assessment) insertion of indwelling urinary catheter and fluid balance monitoring pressure risk management. thermoregulation support - maintain body temperature between 35.5 - 38.0o Clinical documents These documents are currently used in the Tasmanian Health Service. You may find them useful for completion of your assignment. Spinal assessment chart (pdf, 785.2KB) International Standards for Neurological Classification of Spinal Cord Injury (pdf, 828.5KB) Ventilation (Non-Invasive and Invasive Mechanical - Clinical Practice Standard (pdf, 864.1KB) Consider the person - Chronic Phase [6 months later] Six months ago, JK sustained a significant spinal cord injury after falling from a horse while riding, causing a Hyperextension thoracic spine fracture (HTSF) at T2, leaving bone fragments in the spinal canal. Collect cues. After spinal shock had resolved, the extent of her injury could be determined. JK has the following deficits. Sensory Complete loss of sensation bilateral in dermatomes below T2 Motor Paralysis of the lower limbs and trunk. Normal strength in the muscles that move arms, hands, shoulders, and head (neck) Usual vital signs for Jouri. RR: 20 – 22 bpm SpO2: 97 – 99% BP: 93 – 96 / 61-64 mmHg (MAP 72 - 74 mmHg) HR: 60 – 70 bpm T: 35.8 – 36.5oC Actions and interventions JK lives at home with her parents and attends a spinal cord injury rehabilitation facility daily. JK uses a wheelchair and is waiting to be assigned a self-propelled wheelchair. JK has a permanent indwelling urinary catheter and uses a bowel management programme. JK receives counselling and assisted by his family, has joined online spinal cord injury support groups. Today - 0830 - hygiene support While receiving hygiene support, JK asks for a tissue to blow her nose as it has started to run. She also asks for an aspirin, because she feels a headache that is getting worse very quickly. It is noticed that she is sweating on her forehead and arms and has become rather red in her face. Collect cues Vital signs: RR: 20 – 22 bpm SpO2 – 98 – 100% BP: 132/90 mmHg (MAP 104 mmHg) HR: 57 bpm T: 36.8oC Pain: 7/10 (headache) Visual assessment: diaphoresis and flushing on head and arms; pallor in legs and nailbeds of toes; excess mucus production from nasal passages. Case Study Information Assessment Task 2: the person - Case 2 Amelia’s Strong Headache Consider the person. Amelia Frankish is 67 years old. She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT (computerised tomography) of Amelia's head and neck. Medical history Diabetes mellitus Type 2: Management: • metformin 1000mg, daily • enalapril 10 mg daily • rosuvastatin 10mg, daily Atrial fibrillation (AF) Management: • apixaban 2.5 mg, BD • sotalol 40 mg, BD Cigarette smoking: 20 - 30 cigarettes/day, quit 5 years ago. GP - diagnostic assessment and management - one week ago Amelia underwent a CT scan of the head and neck, but the results were normal. Amelia was assessed as requiring changes to her hypertension & AF management and the following changes made: • enalapril ceased. the following medications commenced or changed. • irbesartan/ hydrochlorothiazide 300/25, daily • amlodipine 5mg, daily • apixaban 5mg, BD. Today: Amelia woke early this morning at 0600 hours with a 5/10 headache. At 0700 hours she began to feel weak in her limbs, and her headache increased to 7/10. One side of her face began to "feel strange". She was able to call her neighbour, who brought her to hospital. Collect cues Triage Time is now  0800.  Vital signs:  • RR: 18 bpm  • SpO2: 98%  • BP: 180/92 mmHg  (MAP 121 mmHg) • HR: 98 bpm  • Temp: 37oC  Pain assessment:  • Provoking/palliating: pain is worse when Amelia moves her head suddenly, nothing seems to relieve the pain  • Quality: the pain feels like extreme pressure on the left side of her head  • Region/radiation: the pain is confined to her head  • Severity: 9/10  • Timing: first pain onset was about 2 hours ago  Neurological assessment:  • GCS: 15  • Pupils: PERRLA  • ROSIER (Recognition of stroke in the emergency room) Scale • Loss of consciousness or syncope: NO • Seizure activity: NO • Asymmetric facial weakness: YES • Asymmetric arm weakness: YES (right upper limb paralysis - unable to respond to movement request) • Asymmetric leg weakness: YES (right lower limb paresis – mild weakness)  • Speech disturbance: YES (some slurring of words (dysarthria) is noted) • Visual field deficit: NO Other: Limb sensation: right upper limb anaesthesia; right lower limb - paraesthesia (tingling feeling).  Amelia appears pale and anxious. She has not had her medications today.   Investigation data - performed AFTER triage. Cardiovascular assessment An Electrocardiogram (ECG) is undertaken which shows normal sinus rhythm.     Blood tests are ordered including full blood count (FBC), urea & electrolytes (U&Es), liver function tests (LFTs), coagulation studies (COAGs) including Anti-Xa levels. Metabolic assessment Blood Glucose Level (BGL): peripheral 9.8 mmol/L (Amelia reports not having eaten since yesterday, nor has she had her medications today)  Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain Performed Date: 25/3/Year Time: 0830 Final Report CT BRAIN CLINICAL NOTES: Patient presents with severe headache, dysarthria, limb anaesthesia, paresis, and paralysis. CT 7 days ago - no adverse findings Findings: A non- contrast CT has been acquired. Nil intracranial haemorrhage noted. Complete occlusion of the left middle cerebral artery noted. IMPRESSION: Middle cerebral artery thrombosis (not conclusive). Actions and interventions Interventions • review by stroke team • nil by mouth until swallow assessment • 1/24 (hourly) vital signs and then as per "Thrombolysis for ischaemic stroke pathway" after commencement of thrombolysis therapy • 1/24 (hourly) neurological assessment for 4 hours, then 4/24 (four hourly) for 72 hours • 6/24 (six hourly) blood glucose monitoring for 72 hours • alteplase infusion as per protocol • telemetry for at least 24 hours • nurse patient with bed head elevated to 30o. • intravenous therapy-fluid orders Clinical pathways These documents are currently used in the Tasmanian Health Service. You may find them useful for completion of your assignment. Possible Acute Stroke Assessment & Initial Management Clinical Pathway (pdf, 233.1KB) Acute Stroke Care Plan - Day One to Day Five (pdf, 316.1KB) Thrombolysis for Ischaemic Stroke Clinical Pathway (pdf, 820.6KB) Use Textbooks. – In some Referencing ( supporting information) Amerman, E. 2019. Human Anatomy & Physiology. 2nd Global ed. Pearson: UK. Bullock, S. & Hales, M. 2019. Principles of Pathophysiology. 2nd Ed. Pearson: Melb Bauldoff et al. 2020. Lemone & Burke's Medical-Surgical Nursing. Pearson: Melb. Norris, T. 2020. Porth's Essentials of Pathophysiology. 5th Ed. Wolters Kluwer: Phil