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Assessment One: Short answer questions on a case study Length: 750 words Weighting: 30% Due: Week 5, Monday 22nd August 2022 at 12 midnight Aim of the assessment The purpose of this assessment is to enable you to: 1. Explain the underlying pathophysiology related to the clinical manifestations of ST elevation myocardial infarction (STEMI) 2. Discuss the importance of reperfusion in the management of a patient presenting with STEMI 3. Identify evidence -based strategies whe n caring for a patient presenting with STEMI Case Study Introduction: Mr Raj Kumar is a 64 -year -old male with no known allergies (NKA) Situation: Mr Raj Kumar arrived at the Emergency Department at 1130 hrs with central crushing chest pain radiating to his jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4 . 300mg Aspirin administered on route to hospital. Backg round: Hypertension ( Captopril 12.5mg bd) Hyperlipidaemia (Simvastatin 40mg nocte). Type 2 Diabetes Mellitus (DM) (diet controlled) Assessment: – Airway patent – Breathing: R espiratory rate 18 , bilateral air entry, breath sounds clear. SpO 2 on room air 95% – Circulation: Sinus Tachycardia 102bpm. BP 140/90. Diaphoretic and p eripherally cool. Central crushing chest pain radiating to the jaw. COLDSPA: Character: crushing chest pain Onset: 11am Location: Central, radiating to jaw Duration: ongoing Severity: 7/10 Pattern: at rest, not relieved by SL Anginine Spray Associated symptoms: diaphoresis – Disability: Alert & oriented. P upils equal and reacting to light (P EARL ). Pain score 7/10. Equal strength in all four limbs. – Exposure: IVC Left cubital fossa. – Fluid: NBM. NO IVF – Weight 88kg Results: – Elevated Troponin 35ng/L troponin – 12 lead ECG: ST elevation (>2mm) V2, V3, V4 A diagnosis of acute anterior STEMI is made Recommendations: Supplemental oxygen if SpO2 < 93% Continuous cardiac ECG monitoring 12 -lead ECG now, then every 30 minutes Keep in resuscitation bay (Triage category 2) Blood tests : Troponin now, then again in 2 hours Medications: Morphine 2.5mg IVI 2/24 (PRN maximum dose 10mg ) Nitro -glycerine 600mcg SL (PRN maximum 3 doses ); if pain persists , consider IV G lyceryl Trinitrate infusion Clopidogrel 300mg PO STAT Heparin 5000 IU IV STAT As per STEMI reperfusion flowchart: Transfer to Cardiac Cath Lab for urgent primary PCI when ready (<90mins). If PCI delayed , give Tenecteplase 45mg IV as per PACSA @ 1230pm Guided Questions: Question 1: ( 250 words) Pick one (1) clinical manifestation and discuss the related pathogenesis: (i) Central crushing chest pain with radiation to the jaw or; (ii) ST elevation or; (iii) elevated Troponin (35ng/L) Question 2: ( 500 words) • Pick one (1) intervention from EACH of the three (3) categories below. • Provide one rationale for intervention s selected form each category . Use evidence and/or pathophysiology to support your answer. Category 1 Non -pharmacological interventions Category 2 Pharmacological interventions Category 3 Reperfusion interventions • Supplemental oxygen if SpO2<93% • 12 lead ECG within 10 minutes of arrival and then every 30 minutes • Troponin at 0 and 2 hours • Morphine 2.5mg IV • Nitro -glycerine 600mcg SL • Aspirin 300mg • Heparin 5000iu IV • Clopidogrel 300mg • Tenecteplase 45mg IV • Primary Percut aneous Coronary Intervention Supporting resources American Psychological Association (APA) referencing style guide (PDF 725 KB) (Western Sydney University Library, 2020). Library Study SmartLinks to an external site. —a library resource that helps you to complete assignments (Western University Library, 2021). Western Sydney University Library has further information about referencing on their Referencing and citation page. Suggested readings • Pathway for Acute Coronary Syndrome Assessment (PACSA) (New South Wales Health, 2019). • National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016 (Chew et al., 2016, pp. 895 –951). Guided Questions Criteria Mark High Distinction Distinction Credit Pass Fail Criteria 1: Question 1 – Demonstrates comprehensive and detailed knowledge of the pathogenesis of one (1) clinical manifestation of ST - elevation Myocardial Infarction /20 Provides an accurate and clear explanation of the pathogenesis causing the clinical manifestation of the patient in the case study. Synthesises the information effectively in own words , explanation is developed in a logical sequence and is technically correct . The dis cussion is clearly and accurately supported by appropriate sources. Explains the pathogenesis causing the clinical manifestation of the patient in the case study. Mostly synthesises the information effectively in own words and in a logical sequence . The d iscussion is clearly and accurately supported by appropriate sources. Generally, provides an accurate explanation of the pathogenesis causing the clinical manifestation of the patient in the case study. The explanation is mostly developed in a logical seq uence but there may be one or two omissions of information or manifestation is accurately explained but there is little logical development in the discussion. The discussion is supported by appropriate sources. Provides a basic description of the pathogene sis of the clinical manifestation presented by the patient in the case study. There may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow of the process. The discussion is mostly supported by appropriate source s. Gives either a superficial description or inaccurate description of the pathogenesis of the clinical manifestation. There are significant inaccuracies, repetition, or lack of clarity. Has not accurately related the clinical manifestations to the pathogenesis. 17 -20 15 -16.5 13 -14.5 10 -12.5 ≤9.5 Criteria 2 Question 2 -Category 1 Demonstrates understanding of one (1) non - pharmacological intervention for the patient presenting Accurately identifies one (1) non - pharmacological intervention to manage a patient presenting with STEMI. The answer Accurately identifies one (1) non - pharmacological intervention to manage a patient presenting with STEMI. The answer Accurately identifies one (1) non - pharmacological intervention to mana ge a patient presenting with STEMI. The answer Accurately identifies one (1) non - pharmacological intervention to manage a patient presenting w ith STEMI. The answer Does not accurately identify one (1) non - pharmacological intervention to manage a patient presenting with Guided Questions Criteria Mark High Distinction Distinction Credit Pass Fail with STEMI using current evidence /pathophysiology to support answer /20 is well -supported by current evidence . The answer is accurate and clearly explains the rationale /s. is well -supported by current evidence. The answer is accurate and clearly explains the rationale /s May be missing minor detail or requires further elaboration required is supported by a rationale. The answer explains the rationale/s but more depth/technical information required . is not well -supported by current evidence . More details to support the discussion required. STEMI or provides little or inaccu rate explanation of rationales. Information predominantly copied or quoted from inappropriate sources. 17 -20 15 -16.5 13 -24.5 10 -12.5 ≤9.5 Guided Questions Mark High Distinction Distinction Credit Pass Fail Criteria 3 Question 2 -Category 2 Demonstrates understanding of one (1) pharmacological intervention for the patient presenting with STEMI using current evidence /pathophysiology to support answer /20 Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is well -supported by current evidence . The answer is accurate and clearly explains the rationale /s. Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is well -supported by current evidence. The answer is accurate and clearly explains the rationale /s. May be missing minor detail or further elaboration required. Accurately identifies one (1) pharmacolo gical intervention to manage a patient presenting with STEMI. The answer is supported by a rationale. The answer explains the rationales but more depth/technical information required . Accurately identifies one (1) pharmacological intervention to manage a patient presenting with STEMI. The answer is not well -supported by current evidence . More details to support the discussion required. Does not accurately identify one (1) pharmacological intervention to manage a patient presenting with STEMI or provides little or inaccurate explanation of rationales. Information predominantly copied or quoted from inappropriate sources. 17 -20 15 -16.5 13 -24.5 10 -12.5 ≤9.5 Guided Questions Mark High Distinction Distinction Credit Pass Fail Criteria 4 Question 2 -Category 3 Demonstrates understanding of one (1) reperfusion strategy for the patient presenting with STEMI using current evidence /pathophysiology to support answer /20 Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is well - supported by current evidence . The answer is accurate and clearly explains the rationale /s. Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The an swer is well - supported by current evidence. The answer is accurate and clearly explains the rationale/s. May be missing minor detail or further elaboration required Accurately identifies one (1) reperfusion strategy to manage a patient presenting with ST EMI. The answer is supported by a rationale. The answer explains the rationale /s but more depth/technical information required . Accurately identifies one (1) reperfusion strategy to manage a patient presenting with STEMI. The answer is not well - supported by current evidence . More details to support the discussion required. Does not accurately identify a reperfusion strategy to manage a patient presenting with STEMI or provides little or inaccurate explanation of rationales. Information pre dominantly copied or quoted from inappropriate sources. 17 -20 15 -16.5 13 -24.5 10 -12.5 ≤9.5 Academic Writing Mark High Distinction Distinction Credit Pass Fail Language use Writes in a clear and succinct academic style using correct grammar , spelling , and punctuation Writes in an advanced style exhibiting highly coherent and logical flow of ideas. Organisation of material exhibits an advanced level of clarity. No errors in spelling, grammar, punctuation or Writes clearly and succinctly with a coh erent, logical flow of ideas exhibiting advanced clarity. No errors in spelling, punctuation, grammar or Writes clearly and satisfactory use of language enables effective flow of ideas. Minor, infrequent errors in spelling, punctuati on, grammar and sentence construction that do Writing is reasonably clear, but at times the effective flow of ideas and meaning is hindered. Minor, frequent errors in spelling, punctuation, grammar and sentence Writes in an elementary style with very basic use of language and poor articulation of ideas. It may be verbose, convoluted or difficult to read. Organisation of material and main points is unclear. /5 sentence construction. sentence construction. not impede flow of ideas. construction someti mes impede the flow of ideas. The errors in spelling, pun ctuation, grammar and sentence construction impede meaning. 4.5 -5 4 3.5 2.5 <2 Academic Writing Mark High Distinction Distinction Credit Pass Fail Referencing and in -text citations Uses a minimum of six recent (2017 -2022) academic sources such as journal articles, textbooks, government reports, or creditable organisational websites). All sources of information must be clearly relevant and accurately cited applying conventions of in -text referencing for APA 7 style. A complete refer ence list is correctly formatted according to APA style. /5 Referencing technique is flawless and follows APA 7 convention s both in - text and in the reference list. Uses a selection of appropriate references. Evidence of cited sources is always clear and accurate. Referencing technique follows APA 7 convention s but contains infrequent minor errors. Uses a selection of appropriate references. Evidence of cited sources is always clear and accurate. Referencing technique follows APA 7 convention s but contains infrequent errors. Uses at least the minimum number of required references. Evidence of cited sources is clear and accurate. There may be frequent minor errors in APA 7 referencing convention in in -text referencing and/or the reference list. Uses at least the required number of required references. Use of cited sources is not always clearly evident. There may be absent or incorrect use of APA referencing technique. Does not use the minimum number of required references, or uses predominantly inappropriate or non -authoritative sources. Sources of information are not correctly acknowledged. 4.5 -5 4 3.5 2.5 <2 Academic Integrity Search terms/ Search engines used Mark 5 4 2-3 1 0 • Indicates search terms used to access literature via the nursing e-resources via the library • Provides names of search engines and search terms used to locate literature. For example - CINAHL - MEDLINE (Ovid) - Clinical Key for Nursing - Cochrane library - JBI - Scopus /5 Student carefully provides a very thorough list of search terms and provides names of search engine /s used to locate literature Student provides a comprehensive list of search terms used and provides names of search engines used to locate literature Student i ndicates search terms used and provides names of some of the search engines used to locate literature Student has NOT provided ONE of the items i.e., the NOT provided the search terms and OR the names of search engines used to locate literature. Student ha s NOT provided NEITHER the search terms and or full names of search engines used to locate literature 5 4 2-3 1 0 Academic Integrity Turnitin (Similarity Percentage) Mark 5 3-4 2.5 -3 0.5 0 Student aims for Similarity percentage via Turnitin of ≤ 15% /5 Turnitin (Similarity Percentage of ≤ 15%) Turnitin (Similarity Percentage of 16% - 17%) Turnitin (Similarity Percentage of 18 -21%) Turnitin (Similarity Percentage of 22 -25%) Turnitin (Similarity Percentage ≥ 26% 5 3-4 2.5 -3 0.5 0

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