NUST08011 Nursing Care And Decision Making


Case study

Mrs EB is a 98 years old lady from Residential Aged Care Facility (RACF), presenting to the emergency department following an unwitnessed fall with head strike, no Loss Of Consciousness and skin tear to left lower leg

Past medical history

Angina, Chronic Renal Failure (CRF), Peripheral Vascular Disease (PVD), Spinal Stenosis, Ischemic Heart Disease (IHD), Left Popliteal artery angioplasty, Osteoarthritis, Falls and recurrent Urinary Tract Infection (UTI).

Drug History

Aspirin 150mg Monday, Wednesday + Friday

Metoprolol 25mg twice daily

Panadol Osteo 2tablets three times a day (TDS)

ISMN 30mg daily

Glucosamine 1000mg daily

Social history

Mrs EB lives is a low level care RACF

Independent with mobility, using 4 wheel walking frame (4WW)

Independent with personal hygiene

Ex-smoker, quit 50 years ago

Have three adult children- all live close by-supportive and attentive

Physical examination

Settled in bed complaining of sacral discomfort

Maintain own airway

Air entry equal, no crepitation

Warm and well perfused

No chest pain

Abdomen soft and non- tender to palpate

Non-tender C-spine, fully able to mobilise neck in all directions, flexion, extension, medical and lateral rotation

GCS 15/15

Power 5/5 in upper and lower limbs but it was suspected that may be related to her not relaxing her legs

Skin tear on left lower shin- V shaped with skin flap is proximal- approximately 3cm in size

Skin edges are opposable


Elderly fall likely pre-syncopal episode


Intravenous (IV) access

Computed Tomography of Brain (CTB)

Chest X ray (CXR)

Electro-Cardio-Gram (ECG)


Lying and standing blood pressure


Blood report:

Troponin 8

CRP 0.9

WCC 6.8

EUC- shows impaired renal function-likely chronic

K 5.6

Urea 17.3

Creat 124

Egfr 31

Bicarb 16 (last bloods from 2010 Urea 10, Creat 130 and K 5.0) 


Shows sinus arrhythmia with no ST segment changes

CTB formal report

There is no intracranial haemorrhage.  There is no evidence of acute infarction.  Widespread low density changes present in the periventricular white matter.

There is minor dystrophic calcification in the basal ganglia and cerebellum bilaterally.

Soft tissue swelling is present over the right parietal region.  There is no evidence of underlying skull fracture.

Conclusion:  No acute abnormality 

Chest X-ray

The heart is moderately enlarged.  There is pulmonary venous distension.  There is no consolidation or collapse


For the above case study please assess the literature, critically analyse and synthesis a range of views to underpin the advance practice role and how the increased scope of practice, diagnostic knowledge and skills that is required, to assist you in the decision making process. Expand your argument to include any barriers you encounter in your advance practice role and how you can mitigate those barriers.

This assignment will need to include the following

  • Identifying the literature on evidence-based or best practice to support your decision making process (Australian literature)
  • A developed argument on the rationale for your choice of diagnostics, demonstrating your theoretical and clinical knowledge with a focus on your ability to critically analyse how you determined which diagnostics are best suited to this presentation
  • Explanation of how you have made a diagnosis by exclusion
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