NRSG635: Mr Peter Fox is a 55-year-old Gentleman Who is Admitted to the Neurosciences Ward from the Emergency Department (ED): Extended Clinical Nursing Case Study, ACU, Australia

University Australian Catholic University ACU
Subject NRSG635: Extended Clinical Nursing

This problem-solving exercise is worth fifty (50) per cent (%) of the total mark for Extended Clinical Nursing. The student is responsible for retaining a copy of the submitted exercise. The assessment task case study and
instructions can be found on the Learning Hub platform.

Assessment Task 1 PSE: studentID_PSE_NRSG633_S2_2021.docx

There is a penalty of five (5) per cent (%) for each day the assignment is overdue. Please refer to the Graduate Certificate in Clinical Nursing Handbook for the process for requesting an extension. If you encounter any problems
with submission, please contact the Post Graduate Coordinator via email

Problem Solving exercise

Mr Peter Fox is a 55-year-old gentleman who is admitted to the neurosciences ward from the Emergency Department (ED) for observation post a fall at home. He is semi-retired and working from home as he is the main carer for his wife who is currently unwell.

Past history: COPD
Ex-smoker (Smoker for 25 years)
Newly diagnosed Type 2 diabetic (no medications diet controlled)

Current medications: Amlodipine 5mg daily
Atorvastatin calcium 20mg daily
Tiotropium Bromide inhaler
Salbutamol inhaler
Prednisolone 5 mg daily
Roxithromycin 300mg daily
Mr Fox’s initial ED assessment findings were as follows:

  • CNS: – GCS 15
    – Full power in all four limbs
    – Nil altered sensations in limbs
    – Noted to a tremor in his left little finger
  • CVS: – HR 85 beats/minute
    – BP 145/70
    – Temp 37.4 degrees centigrade
  •  RESP: – RR 30 breaths/minute
    – On Auscultation noted to have bilateral basal crackles and wheeze, with decreased air entry
    – Productive cough with thick yellow sputum.
    – Arterial blood gases were as follows:

Ph: 7.36
PCO2: 58 mmHg
PO2: 79 mmHg
HCO3: 30 mmol/L
Sa02: 92%

Q1. Applying theoretical knowledge, given the arterial blood gas results, describe what type of respiratory failure Mr Fox is suffering from.

Q2. In relation to chronic obstructive pulmonary disease (COPD) evaluate the pathophysiology (including the two distinct types) as it relates to Mr Fox’s signs and symptoms. Admission is completed by the neurology resident during which Mr Fox reveals he has had a couple of falls over the last several months and his wife had noticed he is always tired and that his movements are much slower than usual. He also felt like he was constantly stiff and has been having
trouble buttoning his clothes and has noticed that his handwriting has become much smaller and difficult to read.

Q3. On reading the neurology registrars admission notes, identify a probable neurological diagnosis for Mr Fox.

The Neurologist orders Mr Fox an MRI/CTB and the following blood tests: FBC, ESR, Thyroid function, Vitamin B12, and Copper levels.

Q4. Mr Fox has been ordered specific tests by his neurologist. As a specialist neuroscience nurse, explain the rationales for each of these tests and the expected findings for the diagnosis identified in

Q 3. On day 2 of his admission, you are looking after Mr Fox. He develops chest pain at rest, he described it as ‘tightness’ across the front of his chest, radiating to his neck and to the left arm. He rates the pain intensity as between 3-7/10. The pain is treated with

– one dose of Arginine 600mcg S/L
– Aspirin 300mg
He is currently pain-free, and a 12 lead ECG was taken. The Coronary Care Registrar reviewed the patient and documented in his medical progress notes that he is a probable candidate for high-risk NSTEACS.

Q5. Discuss the diagnosis of High-risk NSTEACS in relation to Mr Fox.

Q6. Taking into account Mr Fox’s 12 lead ECG. Analyse the ECG attached, diagnosing the rhythm and identifying any abnormalities.
After a review of the presenting clinical information documented by the Neurologist and the results of the tests ordered, Mr Fox’s provisional diagnosis is confirmed.

Q7. Discuss the anatomy and pathophysiology related to Mr Fox’s diagnosis

Q8. Discuss four of the most prevalent symptoms of this disease; as a specialist nurse include strategies and interventions to minimise the impact of these on Mr Fox. (Do not discuss the on/off phenomenon).

Q9. Compare and contrast the difference between essential tremor and resting tremor.

Q10. Compare the five main groups of medications used to treat this disease. Outline their modes of action, the rationale for use, side effects and give examples of each

Q11 Identify a current medication of Mr Fox’s that will possibly need to be changed. Identify and discuss at least one common class of medication that are avoided in this disease

Q12 Explain the on / off phenomenon. There are many other disruptive symptoms that Mr Fox will experience as part of this disease

Q13. Provide interventions and rationales that as a specialist nurse you can implement into your daily nursing practice, to reduce the occurrence and risks associated with this phenomenon.

Q14. Given the nature of this disease, discuss 3 important community supports you need to ensure are in place upon discharge from the hospital for the Fox family. Give rationales for your answers

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