代写 RMIT NURS2100 Acute Care Nursing

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    • RMIT University
    School of Health and Biomedical Sciences
    Discipline of Nursing
    Bachelor of Nursing
    NURS2100 Acute Care Nursing 1
    Case Study
     
     
    Mrs Dorothy (Dotty) Beecham is 74 years old, and has been admitted with community-acquired pneumonia (CAP) and query Deep Vein Thrombosis (DVT). Mrs Beecham arrived in the emergency department, concerned about her increasing shortness of breath, high temperature, fatigue, ‘strange’ coloured sputum as well as pain and swelling in her right calf. Her clinical manifestations on admission were dyspnoea, fever, and chills. Mrs Beecham’s current medical history includes Chronic Obstructive Pulmonary Disease (COPD), Myocardial infarction 2012, osteoarthritis (poor mobility and awaiting a Total Knee replacement), hypertension, hypercholesterolaemia, type 2 diabetes mellitus, varicose veins and 4 episodes of DVT in the last 2 years. Mrs Beecham states that she has been smoking  upto 5 cigarettes/day since 2012 and prior to this 20 per day for 25 years despite knowing about her emphysema, heart disease and risks for further DVT’s. Her alcohol intake is limited to the1 small glass of port per day. Mrs Beecham is a retired machinist, who lives alone since her husband’s death 2 months ago. Her two children live in Qld and visit infrequently. She has one sister Ruby who brought her to the emergency department. 
     
    Mrs Beecham’s observations on arrival to the ward are:
    Temperature: 37.9°C
    Pulse: 92 beats per minute
    Respirations: 28 breaths per minute
    BP: 135/75 mmHg
    Weight: 85 kg
    Height: 174 cm
    Random blood glucose 9.6 mmol/L
     
    The following Blood tests were taken within 24 hours of admission to hospital and the following results were found:
     
    Clinical Examination                            Result          Units            Reference Range
    Fasting Glucose                       7.8         mmol/L  (3.9–6.4)
    Cholesterol                               7.1         mmol/L  (desired < 5.2)
    Triglycerides                                  3.2         g/L         (0.4–1.5)
    HDL                                          0.79              mmol/L  (0.80–2.05)
    LDL                                          5.3         mmol/L  (1.55–4.65)
    Thyroxine                                 55          mmol/L  (58–154)
    Sodium:                             136              mmol/L        (135-145)
    Potassium:                               4.1               mmol/L  (3.5-5)
    Chloride:                                   97         mmol/L  (95-105)
    Bicarbonate:                             27          mmol/L  (22-31)
    Creatinine:                                78          umol/L          (60-110)
     
    Haemoglobin:                                 12         g/dL             (12-15 women)
    Haematocrit                                    38          %           (36%-47% women)
    GlycosylatedHaemoglobin                     5            %           (4%-6%)
    Red blood cell count                             3.5         x 1012/L (3.8-4.8 for adult females)
    Haematocrit                                    38          %           (36-46 % for adult females).
    Mean corpuscular volume (MCV):               91          fL           (80-100)
    Mean corpuscular hemoglobin (MCH):        29          pg          (27-32)
    MCH concentration (MCHC):                34          g/dL              (32-36)
     
    White blood cells (WBC)                      13                     x 109/L          (4-11)
    Neutrophils:                                    7.9         x 109/L          (2-8)
    Lymphocytes:                                 3.8         x 109/L          (1-4)
    Monocytes:                               0.8         x 109/L (0.0-1.0)
    Eosinophils:                                    0.4         < 0.5 x 109/L
    Platelets:                                  235        x 109/L          (150-450)
     
    Creatine kinase:                             32          U/L              (25-200)
    Creatine kinase MB (CKMB):         0            ng/mL         (0-4)
    Troponin                                   0            ng/mL:       (0-0.4)
     
    C-reactive protein:                          9.2         < 5 mg/L
    D-dimer:                                  126        < 500 ng/mL
     
     
    Her arterial blood gas results on admission were as follows:
    Result                              Normal ranges
    pH: 7.27                             pH: 7.35-7.45
    PCO2: 56 mmHg                            Partial pressure of carbon dioxide (pCO2): 35-45 mm Hg
    PO2: 70 mmHg                        Partial pressure of oxygen (pO2): 75-100 mm Hg
    HCO3: 25 mmol/L                           Bicarbonate (HCO3): 22-26  mmol/L
    SaO2: 89%                              Oxygen saturation: 96%-100%
     
    Doppler Ultrasound on her right calf has confirmed a Deep Vein thrombosis A chest x-ray taken when she was in the emergency department shows right lower lobe consolidation. A sputum specimen has been sent to the pathology department for gram stain, and culture and sensitivity. In the interim, Mrs Beecham has been commenced on intravenous antibiotics Azithromycin and Ceftriaxone. Additionally a Heparin infusion has been commenced
     
    Mrs Beecham has been placed on oxygen via a mask at 6litres
     
    Medication regimen for Mrs Elsa Beecham:
     
    As per usual at home medication regime:
     
    Salbutamol 5 mg nebule by nebuliser 3-4 hourly PRN
    Fluticasone 250 mcg / salmeterol 50 mcg (Seretide) 2 inhalations by inhaler (MDI) bd
    Tiotropium 1 capsule (18 mcg) daily by Handihaler
    Lisinopril 5 mg per orally daily
    Gliclazide (Diamicron MR) 30 mg mane per orally
    Metformin (Diabex XR) 500 mg mane per orally
    Frusemide 40 mg mane per orally
    Simvastatin 40 mg nocte per orally
    Oxycodone Hydrochloride controlled release 10 mg per orally daily when required.
     
    Commenced since admission to hospital
    Azithromycin 500 mg IVI daily
    Ceftriaxone 1 g IVI daily
    Heparin infusion IV bolus dose of 5,000 units of heparin, followed by an infusion of 1,000 units per hour. 25,000 units of Heparin have been added to a 500mls Bag of Normal Saline
     
    The following Blood tests were taken:
     
    Clinical Examination                            Result          Units            Reference Range
    Fasting Glucose                       7.8         mmol/L  (3.9–6.4)
    Cholesterol                               7.1         mmol/L  (desired < 5.2)
    Triglycerides                                  3.2         g/L         (0.4–1.5)
    HDL                                          0.79              mmol/L  (0.80–2.05)
    LDL                                          5.3         mmol/L  (1.55–4.65)
    Thyroxine                                 55          mmol/L  (58–154)
    Sodium:                             136              mmol/L        (135-145)
    Potassium:                               4.1               mmol/L  (3.5-5)
    Chloride:                                   97         mmol/L  (95-105)
    Bicarbonate:                             27          mmol/L  (22-31)
    Creatinine:                                78          umol/L          (60-110)
     
    Haemoglobin:                                 12         g/dL             (12-15 women)
    Haematocrit                                    38          %           (36%-47% women)
    GlycosylatedHaemoglobin                     5            %           (4%-6%)
    Red blood cell count                             3.5         x 1012/L (3.8-4.8 for adult females)
    Haematocrit                                    38          %           (36-46 % for adult females).
    Mean corpuscular volume (MCV):               91          fL           (80-100)
    Mean corpuscular hemoglobin (MCH):        29          pg          (27-32)
    MCH concentration (MCHC):                34          g/dL              (32-36)
     
    White blood cells (WBC)                      13                     x 109/L          (4-11)
    Neutrophils:                                    7.9         x 109/L          (2-8)
    Lymphocytes:                                 3.8         x 109/L          (1-4)
    Monocytes:                               0.8         x 109/L (0.0-1.0)
    Eosinophils:                                    0.4         < 0.5 x 109/L
    Platelets:                                  235        x 109/L          (150-450)
     
    Creatine kinase:                             32          U/L              (25-200)
    Creatine kinase MB (CKMB):         0            ng/mL         (0-4)
    Troponin                                   0            ng/mL:       (0-0.4)
     
    C-reactive protein:                          9.2         < 5 mg/L
    D-dimer:                                  126        < 500 ng/mL
     

     
    Case Study Written Assignment
     
    You are to each select only one of the following topics for your written assignment:
     
    1.    Mrs Beecham has a history of deep vein thrombosis and will continue to be at risk on discharge. Using the current literature and pathophysiology explain the risk that recurrent DVT may pose to her future health. Using evidence, develop a discharge plan in relation to her educational needs and support requirements. Outline how you would explain the symptoms to look out for and when to seek medical advice to Mrs Beecham.
    2.    Mrs Beecham has a history of cardiovascular and respiratory disease where smoking is a clear risk factor. Using the current literature and pathophysiology explain the risk that smoking poses to her future health. Identify the challenges and reasons why some patients are reluctant to quit and evidenced based strategies that could assist Mrs Beecham to address this. Outline how you would explain the risks and potential outcomes to Mrs Beecham.
     
     
    Submission Due Date of Written Assignment:
     
    • The word count for this written assignment will be 1500-2000 words.
    • You will be expected to use research or evidence-based journal articles (a minimum of five), textbooks and appropriate authoritative web sites (not Better Health Channel, Virtual Hospital, etc.), and all references used are to be no older than five years.
    • All referencing is to be formatted intext and final list using the APA 6th Edn referencing style.
    • You are required to submit an electronic copy of your completed Case Study Assignment through the Assignment Folder in the course Blackboard site which will be submitted via Turn it in.
    • Please use the template provided which provides  a Title page, with your first and last given names clearly written, along with course/program details and the chosen topic as well as a comprehensive version of the marking matrix.
    • A Table of Contents is required if headings are used in your assignment.
    • Assignments are not to be emailed to the Course Coordinator, or submitted by hard copy; unless prior arrangement and approval has been given to do so.
    • An electronic copy of your assignment must be retained by you until after your final course grade has been processed by the University, and this copy must be available on request if resubmission is required.
     
     
    代写 RMIT NURS2100 Acute Care Nursing 
     

     
     
     
    Student Identification:  
    Criteria for Marking Weight Self Assess Fail Comments Pass Comments Credit Comments Distinction Comments High Distinction Comments  
    Style & Presentation                
    Adheres to style requirements; including use of assignment guidelines; such as word limit, double-spacing, use of header & footer, page numbers, and size-12 font 2 Please rank what you perceive your performance to be You have not adhered to the style requirements in accordance with the assignment guidelines; with one or more of the following: no double spacing; incorrect font size, word limit not adhered to; no cover sheet; no title page; no page numbers; no use of headings. [0-0.9] You have adhered to the style requirements at a basic level although you have not followed the guidelines fully; with one or more of the following: no page numbers, no or inadequate / incorrect use of headings, no double spacing, font size not readable, and word limit not adhered to. [1.0-1.25] You have met the assignment guidelines satisfactorily, although you have not followed two or more of the required criteria.
    [1.25-1.5]    		 The majority of style requirements have been adhered to, although there are still some minor formatting errors.
    [1.5-1.75]    		 All style requirements and assignment guidelines adhered to.
    [1.75-2.0]    		  
    Spelling, grammar and paragraph structure meets academic standards 2   Many spelling and punctuation errors. Errors may include unclear sentence structure, no use of meaningful paragraphs to allow logical flow of content, poor use of professional language, and no definition of terms. You need to consult with the Study and Learning Centre for assistance with writing skills; before completing any further academic writing assessments. [0-0.75] There are a number of spelling and grammatical errors throughout, which detract from your content and flow of ideas. Errors may include inadequate definition of terms, limited use of professional language, paragraphs not structured correctly, and too much use of point form in your responses. You need to review correct paragraph structure. [1.0-1.25]] Your submission reads well, though there is not a logical flow of ideas. Problems may include some sentences being a bit confusing and/or rambling; good use professional language, but missing some definition of terms; and paragraphs missing a key idea or focus, to enable a flow of information. [1.25-1.5] You have generally met the academic standards for writing, with few spelling and punctuation errors evident.
    Your paragraph structure is good, with good use of professional language. You still need to consistently define terms.
    [1.5-1.75]    		 Excellent paragraph structure.
    Professional language used throughout, with well-defined terms. [1.75-2.0]    		  
    Topic is introduced clearly and succinctly 2   Your introduction is either absent or too brief, and doesn’t state what the topic is or what you intend to cover in your submission. [[0-0.75] Your introduction is only a restatement of what the case study is about, and doesn’t adequately state how you are going to set out your response to the question. [1.0-1.25] You introduce the case study well, making clear links to the topic question. You have not stated clearly enough how you intend to set out your response. [1.25-1.5] Your general introduction is good, with a clear summary of the key points to be covered. [1.5-1.75]] You provide an excellent introduction to your submission, and clearly explain how you intend to answer the topic question. [1.75-2.0]  
    Conclusion provides a concise summary of main points covered 2   No conclusion is evident.
    You have not summarised the main components of your paper. [0-0.75]]    		 Concluding comments are too brief, and do not summarise the main components of your paper adequately. [1.0-1.25] You sum up the major focus of the case study satisfactorily, but need to also contextualise the key points of your responses. [1.25-1.5] You summarise the main components of your responses, but need to link them more consistently to your discussion. [1.5-1.75] Your conclusion provides a high quality summary of the major points covered in your responses. [1.75-2.0]  
    Content                
    Provides a comprehensive response to the criteria of the question
     
         		 10   The question is inadequately answered. You have not provided rationales for the points that you identify. Your response is too general and not focused on the topic. [0-5] Your response to the question is answered to a adequate level only, and require more detail and also to be applied more specifically to the topic. [5-5.9] Your answer is satisfactorily researched, and addresses the key criteria. You focus on only one or two key points only, limiting your response to the question. [6.-6.9] You have answered the question well, and in appropriate detail. You could have provided more detail in some areas. [7-7.9] You have comprehensively answered the question to a high standard of detail. [8-10]  
    Effectively links evidence-based information to the case study data
         		 6   Poor use of evidence to support your response. Your lack of supporting evidence indicates inadequate research into the topic question. [0-2.75] ] Your use of evidence-based information is limited to basic references only, and reflects inadequate research. [3.0-4.0] The references used provide adequate evidence for your response, but you have not searched widely enough in some areas. . [4.25-4.75] You provide good evidence for most of your rationales; although you need to be more consistent with your level of research. [5.0-5.75] You effectively linked quality research based evidence to justify each of your rationales. [5.75-6.0]
    References              
    Utilises relevant and contemporary references in response
         		 2   No or inadequate references cited throughout your paper. References used are not contemporary or reflective of current practice. Many of your references are older than 5 years. Many of your references are web-based and are not peer reviewed. [0-0.75] You have met the reference requirements at a basic level only. Some references used are older than 5 years. You have overused non peer-reviewed and web-based information, which does not lend credibility to your responses. [1.0-1.25] References used reflect adequate research into the topic, although your selection indicates a need to use more evidence-based peer reviewed journals, and/or seek assistance with database/information retrieval. [1.25-1.5] You have provided a relevant list of references; though you still need to ensure that the majority of references used are contemporary and peer reviewed. [1.5-1.75] You have provided an excellent list of references; with the majority of references contemporary and peer reviewed. [1.75-2.0]
    Intext referencing used throughout. Referencing formatted in accordance with APA requirements 4   Formatting of intext references incorrect and not according to APA requirements. Reference list is incomplete and is not formatted according to APA requirements. Your reference list does not meet the referencing requirements of the Discipline of Nursing & Midwifery.  [0-2] You have not been consistent in your citation of references throughout this paper.
    You have not formatted your intext referencing according to APA.
    Your reference list is not formatted correctly, and you must review the APA guidelines. [2.0-2.3]    		 Intext referencing is used throughout, but is inconsistent. This may include a need to review the use of quotes and paraphrasing intext, or incorrect use of et al.
    Your reference list does not adhere completely to APA requirements.
    [2.4-2.75]    		 Your use of intext referencing is good, and generally consistent. Reference list indicates good use of APA guidelines for most reference citations.
    Please read comments made throughout where improvements can be made. [2.8-3]    		 Your intext referencing and final reference list demonstrate a high level of consistency and are formatted correctly and according to APA guidelines.
    [3-4]
    Total Marks awarded 30   0-15 15-17 18-20 21-23.5 24-30
    Additional comments:
         		     It is recommended that you review the available resources on referencing. You have not demonstrated adequate analysis of the topic. You must go to the Study and Learning Centre for assistance before submitting any written work. You must also take note of any guidelines and marking criteria as part of your assignment preparation. Your response is generally adequate, but there are still a number of areas that can be improved upon. Review the comments throughout, and also review the available resources on referencing. To improve your mark in future, you are advised to seek assistance with the Study and Learning Centre before submitting any written work. You have presented a satisfactory analysis of the topic. You are let down at times by your referencing inconsistencies and your underutilisation of key references on this topic.
    Please read the comments made throughout your paper; and consider them before submitting any written work in the future.    		 You have presented a good analysis of the topic overall; though there are still some areas where improvement can be made. You are advised to read the comments made throughout the paper. Good job. Your submission is clearly structured and well organised. All referencing is consistent with guidelines. You have answered the topic question thoroughly, and provided a clear understanding of academic research requirements. Well done.
                                           
    Lecturer:                                                                         Date:
    Additional Comments:
     代写 RMIT NURS2100 Acute Care Nursing