SCENARIO ONE - CARDIOVASCULAR PATHOPHYSIOLOGY
Mr Adams is a 58-year
and gentleman who was admitted to Ward B AT 11.00 hours via the Accident &
Emergency Department with acute chest pain that was described as ‘crushing’ in
nature, which radiated to his left shoulder and around his jaw area. On
admission he was clammy, pale and extremely anxious. His vital signs were
recorded as BP 160/90, P 134/min Respiratory rate 12 / min and Oxygen
Saturation on air 91%. He was dyspnoeic at rest and complained of nausea.
He is accompanied by
a work colleague. Mr Adams is married and has 2 daughters, aged 18 and 20. He
is presently employed as a business executive in an IT unit.
You have been
assigned his named nurse during his stay on Ward B.
At 14.00 hours his BP
was recorded as 110/60, P 62/ min with a ST elevation noted on the ECG. His
main concern was his wife’s reaction to his illness as she is presently being
treated for depression.
Critically discuss
the priorities and management of care from admission until 22.00 hours. Justify
your nursing actions in light of the evidence base for practice.
SCENARIO TWO
David Nelson is a
16-year-old man who was admitted to the Accident & Emergency following an
accident whilst playing football. He was ‘kicked in the right side of his
chest’ and is now complaining of severe pain on inspiration with increasing
difficulty in breathing. A chest X-ray in the department revealed a right-sided
haemopneumothorax with 2 rib fractures.
David is awaiting the
arrival of his parents but the surgical insertion of a chest drain is
imperative.
On admission his
vital signs were recorded as BP 95/55, P135/min, Respiratory Rate 26/min,
shallow & irregular respirations & oxygen saturation 89% on room air.
Critically discuss
the priorities and principles of nursing & medical management in light of
the evidence base for practice
SCENARIO THREE - SURGICAL PATHOPHYSIOLOGY
Mr. Norman Wright is
a 70-year-old retired teacher. He lives with his wife aged 68 years in a
semi-detached house near
Mr. Wright likes to
walk around the
One morning, whilst
preparing to go for his daily walk he suddenly develops pain in his abdominal
region. His wife finds him lying on the front porch in a state of collapse. She
immediately calls for an ambulance.
On admission to the
hospital he is found to be in a state of shock. He is experiencing abdominal
pain, nausea and lack of energy. He is later diagnosed with an acute intestinal
obstruction.
With reference to
your knowledge of normal and disordered physiology, explain the possible causes
of intestinal obstruction. Also, explain the clinical features that Mr. Wright
may exhibit.
With reference to
evidence-based practice, critically discuss the pre-operative preparation
(including the physical, socio-psychological and spiritual dimensions) that Mr.
Wright is likely to have in order that post-operative complications might be
minimised.
SCENARIO FOUR
Mrs Broadbent is a 52
year-old lady with a history of Type I Diabetes Mellitus. She was admitted to
the Day Surgical Unit for an oesophagoscopy. At 1pm she returns from the
endoscopy unit, she is drowsy and her clinical observations were recorded as
B/P 140/90, pulse 90/min and respirations 20/min. she appears a little pale and
sweaty.
Discuss the
priorities and management of Mrs Broadbent during the first two hours following
this procedure.
Later, at 3pm, Mrs
Broadbent complains of severe mediastinal pain accompanied by dyspnoea and
cyanosis. Her B/P is now 90/60, pulse 135/min and respirations 30/min.
Discuss the immediate
nursing and medicinal interventions which may be required.
SCENARIO FIVE
Mr Smith is a 27
year-old bricklayer who is admitted to the Accident and Emergency Department at
1pm following a 20-foot fall from some scaffolding. His colleague who
accompanied him says he was conscious at the time of the fall. On arrival to
Accident and Emergency he is unconscious, has a laceration to his scalp, which
is bleeding profusely but there are no other external signs of injury. His
vital signs were recorded as B/P 160/80, pulse 50/min, respiratory rate 30/min
and he has a
With reference to the
pathophysiological changes, explain the clinical manifestations of head injury.
Critically discuss
the priorities and management of care which will be required in the Accident
and Emergency Department up to Mr Smith’s transfer to ITU at 5pm. Mr Smith is
newly married.
Mr Smith has been
transferred to ITU where he remains unconscious and has required intubation and
ventilation. Following ventilation Mr Smith’s right pupil becomes fixed and
dilated, his B/P rises to 180/120 and his pulse falls to 40.
Identify the
implications of these observations.
SCENARIO SIX
Mrs Smith, a 39
year-old married lady, is admitted to the gynaelogical ward at 1600 hours
following an Antenatal Clinic visit. She is 8 weeks pregnant and is loosing red
blood and clots PV.
Identify and discuss
medical investigations and the physical and psychological care she will require
in the first 12 hours of her admission. Justify your nursing actions in light
of the evidence base for practice.
At 0430 hours, Mrs
Smith complains of severe abdominal pain with further passage of blood clots.
She feels dizzy, nauseated, her B/P is 70/50, pulse 140/min.
Describe the
immediate nursing and medical interventions needed.
Mrs Smith is in a
collapsed state. She has a history of Pelvic Inflammatory Disease. She has not
responded to the intervention. It is suspected that she has an ectopic
pregnancy. She is to be prepared for an emergency operation.
Discuss the
implications of Pelvic Inflammatory Disease and why ectopic pregnancy may be
suspected.
Identify the
pre-operative care of Mrs Smith until she is 6 hours post operation.