You will submit a 3000-word assessment.
This will be comprised of two essay questions that you will choose from the questions below.
Qu 1. Andrew Green is a 50-year-old man who presents to the Emergency Department with nausea, anorexia, occasional vomiting, fever, chills. He has a red and swollen arm as a result of a cat bite one week ago.
The triage nurse takes his vital signs they are as follows: HR = 120; RR = 30; saturations = 90%; temperature = 39.5oC; BP = 90/42 mmHg; Capillary refill time 1 sec.
a) The triage nurse suspects he is suffering from sepsis. Discuss the assessment tools that can be used to support that diagnosis? (10 marks)
b) Explain the pathophysiology involved with sepsis. (10 marks)
c) Discuss his immediate management required using timeframes and referral to evidence and national policy where appropriate. (30 marks)
Qu 2. Mohamed Usman is a 22-year-old student who is asthmatic. He has presented in the Emergency Department with a productive cough. Mohamed is struggling to talk to you and indicates he is feeling short of breath and frightened.
A set of vital signs show: HR = 120 bpm; BP = 125/65 mmHg; RR = 30; saturations = 92 %; temperature = 37.8 C; GCS = 15/15.
Discuss the care and management required for this patient for the next 2 hours. Provide a rationale for any actions and interventions you recommend, referring to physiology, pharmacology, current guidelines and evidence-based practice. (50 marks)
Qu 3. A pre-alert is phoned through by the paramedics to the Cardiac Monitoring Unit (CMU). They have a 49-year-old man with central chest pain. His ECG shows ST elevation in leads II, III, AVF indicating that he has had an inferior STEMI. The estimated time of arrival (ETA) is 10 minutes.
Drawing on your knowledge of pathophysiology, current evidence and guidelines discuss the immediate management plan and treatment options available for this man on arrival to the hospital. (50 marks)
Qu. 4. Previously well, Ash Momood, has been admitted from a care home with a productive cough, fever, shortness of breath and general malaise for the last 7 days. He is alert and his vital signs are RR 22; Sao2 92%; BP 110/60; HR 90; Temp 37.9.
What concerns might you have caring for this patient and what precautions would you take? (10 marks)
What initial assessment and investigations would be required? (10 marks)
Drawing on your knowledge of pathophysiology, current evidence and guidelines discuss what care and management Ash needs in the next 24 hours? (30 marks)
Qu. 5 Amanda Thompson is a 40-year-old teacher, who was hit by a car whilst cycling to work. On admission to the Emergency Department she is diagnosed as having fractures to her left femur and tibia, and left humerus. The doctor diagnoses hypovolemic shock.
A set of vital signs show: she is alert and responding to voice; HR = 120 bpm; BP = 95/50 mmHg; RR = 28; Saturations = 93 % on 5 litres of oxygen via a facemask; temperature = 36.5 C; Urine output< 0.5mls/kg hr for one hour
Blood results show:
Full Blood count: Haemoglobin 110 g/dl eGFR- 85
With reference to the above results, discuss the care and management this patient requires for the next 2 hours. Provide rationale for your actions and any interventions you undertake, referring to pathophysiology, pharmacology, current guidelines and evidence-based practice. (50 marks)
Qu 6. Heidi is a 50-year-old female who is having a total knee replacement. She is given her prophylactic antibiotic, 2g Cefazolin via the intravenous route, 1 hour prior to her procedure. Five minutes after the administration of the antibiotic Heidi complains of feeling unwell. She is having difficulty in breathing; has an audible stridor and has developed a widespread urticarial rash.
Drawing on your knowledge of pathophysiology, explain what has happened to this patient and why? (20 marks)
Using an A to E approach discuss the immediate management and treatment this patient requires referring to evidence, relevant guidelines and your knowledge of pharmacology. (30 marks)
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