NURS2016: Health Variations 3 Acute Exacerbations of Chronic Conditions Assessment 2

 Assessment 2

Aim of the Assessment

The purpose of this assessment is to enable you to:

1. Demonstrate knowledge of a comprehensive assessment for a patient with an embolic stroke, using the A to E (Airway, Breathing, Circulation, Disability, Exposure) 
2. Identify and discuss relevant diagnostic results to inform clinical decision-making and implementing high-priority interventions to optimise patient outcomes.
3. Identify and discuss key evidence based high priority nursing interventions for managing a patient with an embolic stroke
4. Demonstrate effective management to optimise the care of a patient with an embolic stroke by administering prescribed therapies and medications

Students are to use evidence-based literature to support answers for the following questions.

Q1. Discuss the A to E (Airway, Breathing, Circulation, Disability, Exposure) assessment approach for Mrs Teresita Manalo, who is experiencing an Embolic Stroke with decreased level of consciousness, slurred speech and left sided weakness. In your discussion, integrate relevant vital signs and explain how they inform your clinical decision-making.
Q2. List four high priority nursing interventions for managing Mrs Manalo's embolic stroke and briefly discuss your rationales for each.
Q3. Select any 3 of the following medications and discuss each of the nursing considerations (i.e., Assessment, Administration and Side Effects) when administering the following therapies and medications to Mrs Manalo.
• IV Alteplase
• Heparin IV infusion
• Metoprolol 50mg BD
• Pantoprazole 40 mg Daily

Assessment Summary

Assessment Type: Clinical Nursing Assessment – Embolic Stroke Case Study

Aim:
The purpose of this assessment is to evaluate a student’s ability to:

• Conduct a comprehensive A to E assessment (Airway, Breathing, Circulation, Disability, Exposure) for a patient with an embolic stroke.
• Identify and interpret diagnostic results to inform clinical decision-making.
• Implement evidence-based, high-priority nursing interventions.
• Administer prescribed therapies and medications safely.

Key Pointers to be Covered:

1. A to E Assessment

   • Evaluate airway patency, respiratory status, cardiovascular stability, neurological function, and overall exposure of the patient.
   • Integrate vital signs to guide priority interventions.

2. High-Priority Nursing Interventions

   • Identify four critical interventions for embolic stroke management and explain rationales.

3. Medication Management

   • Select three medications (from IV Alteplase, Heparin, Metoprolol, Pantoprazole).
   • Discuss nursing considerations, including assessment before administration, administration guidelines, and potential side effects.

4. Evidence-Based Practice

   • Support all recommendations with current, evidence-based literature.

Mentor-Guided Approach

Step 1: Understanding the Case

• The Academic mentor first helped the student review the patient scenario: Mrs Teresita Manalo, experiencing embolic stroke with decreased consciousness, slurred speech, and left-sided weakness.
• The mentor emphasized identifying priority assessment areas using the A to E approach.

Step 2: A to E Assessment Guidance

• The mentor guided the student to systematically assess:
  • Airway: Check for obstruction, gag reflex, oxygen saturation.
  • Breathing: Respiratory rate, effort, auscultation, oxygen therapy needs.
  • Circulation: Heart rate, blood pressure, perfusion, IV access.
  • Disability: Neurological assessment, Glasgow Coma Scale (GCS), speech, pupil response, limb strength.
  • Exposure: Full physical assessment to detect other injuries or complications.
• Integration of vital signs into clinical reasoning was highlighted to prioritize interventions.

Step 3: High-Priority Nursing Interventions

• The mentor worked with the student to identify four critical interventions, such as:
  • Maintaining airway patency and oxygenation.
  • Administering thrombolytic therapy within recommended time window.
  • Monitoring neurological status and vital signs closely.
  • Preventing complications such as aspiration or DVT.
• Rationales were developed using evidence-based stroke management guidelines.

Step 4: Medication Management

• The student selected IV Alteplase, Heparin IV infusion, and Metoprolol.
• Mentor instructed on structuring medication considerations:
  • Assessment: Pre-administration checks (vitals, labs, contraindications).
  • Administration: Correct route, dose, timing, and monitoring during infusion.
  • Side Effects: Identification of potential adverse effects and management strategies.

Step 5: Evidence-Based Support

• Mentor emphasized sourcing peer-reviewed journals and clinical guidelines to support each intervention and medication discussion.
• Focus was on linking evidence to clinical decision-making and patient safety.

Outcome Achieved

• Comprehensive A to E assessment clearly outlined and linked to Mrs Manalo’s vital signs and neurological status.
• High-priority interventions were logically prioritized with evidence-based rationales.
• Medication considerations for selected therapies were detailed with assessment, administration, and side effects.
• The assignment demonstrated integration of theory, clinical practice, and evidence-based decision-making, achieving all learning objectives:
  • Competent patient assessment.
  • Prioritization of interventions.
  • Safe medication administration.
  • Clinical reasoning and application of evidence-based nursing practice.

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