NUR241 Contexts Of Practice: Health Alteration 2


In this task you will provide a response to a case study. There are 2 case studies; you will select and answer questions for only one of these Case studies. Please follow the steps below:

Step 1: Choose a clinical scenario

Clinical scenario 1: Chronic Obstructive Pulmonary Disease

Mr. Krum is a 70yr/old male who presented to the ED at 8am today.

He was c/o SOB, dyspnoea, wheezing, and had a productive cough with yellow sputum. He is tachypneic with a RR 30 and has decreased sats of 87% on Room Air. Intercostal and substernal accessory muscle use is evident.


Ax: nil

Meds: Ventolin 4 puffs via spacer PRN. Atrovent 500 mg BD.

Past illnesses: Current cigarette smoker, emphysema, malnutrition

Last meal: Dinner Last Night

Events leading up to presentation: trying to shower this morning

His vital signs are a Temp 39, GCS 15, HR 105, NiBP- 140/90, Sp02- 87%, RR 30.

He was given his regular meds and a PIVC is insitu in R) ACF – patent.  

Clinical scenario 2: Gestational Diabetes Mellitis- Hyperglycaemia

Ms Cho Chang is an 28-year-old female who presented to the hospital with GCS- 14 confused to time and place and a BGL of 26mmol.

A- Nil allergies, M- nil meds, P- nil past illnesses, Last meal- this morning at 0800 fruit loops, E- She is 30 weeks gestation and has had symptoms of increased thirst, increased urination, increased hunger have been ongoing and increasing over the last 2 months.

Her vital signs are a Temp 36.8, GCS 14, HR 95, NiBP- 140/80, Sp02- 96%, RR 20. PIVC insitu R) ACF- patent.   

Step 2: Answer the following questions for your selected case

Question 1: Identify 2 priority problems for your patient. Refer to the ABCDE framework to justify your decision.

Question 2: Explain how these problems developed and their clinical manifestations (signs and symptoms) from the case using your knowledge of pathophysiology. 

Question 3: Identify 2 interventions (one for each priority problem). Provide a rationale for each intervention that refers to pathophysiology, as well as a discussion of related nursing care.

Monitoring such as completing vital signs and fluid balance charting is not an intervention. An intervention needs to effect a pathophysiological change. Monitoring is a related nursing consideration 

Question 4: Outline and discuss appropriate discharge planning for this patient that Is guided by the social justice framework.

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