Using Pathophysiology to Prioritize Patient Care -

NUR231 Assessment Task 2 – Written piece (30%)
Assessment Name Case study
Goal The goal of this task is to integrate and apply knowledge of
pathophysiology and safe administration of medication to a patient
scenario. This will also incorporate your creative and critical thinking in
the application to the patient scenario. You will consider the professional,
ethical and legal codes, and practice standards relevant to decision
making and safe medication practice.
Product Written Piece
Length 1500 words
Weighting 30%
Individual/Group Individual
Formative/Summative Summative
How will I be assessed 5-criterion grading scale using the rubric provided
Due Date: Friday of Week 6 (4 pm April 3, 2020)
Presentation
requirements
This assessment task must:
 Be a written academic response to the case scenario provided as
Task 2 on the NUR231 Blackboard.
 Use the template provided on Blackboard.
 Use Times New Roman font, size 12 with 1.5 line spacing
 Adhere to the word limit (+/-10%)
 Use Harvard referencing style
 Be submitted by the due date in an electronic format as a PDF
document via SafeAssign
What you need to do 1. Access the NUR231 2020 Task 2 case scenario template that
includes questions requiring a comprehensive written response.
2. Answer the questions clearly and precisely using academic
writing style except in question 8.
3. Support all responses with scholarly academic sources that are
cited using the Harvard referencing style in the text and
reference list.
4. Adhere to the recommended word limit (+/- 10%).
Suggested Format Use the template provided in the Task 2 folder in Blackboard
Respond to the questions on the template and within the word limit
Provide at least one reference for each question response
Provide detailed but succinct descriptions of the relevant
pathophysiology for each condition present in the case scenario.
Discuss the indications for the medications from the case and their
mechanism of action.
Prioritise the advice you would give in the case and relate it to
professional codes and standards.
Use evidence from scholarly health literature to support and justify your
discussions and interventions. (Intext references are included in the word
counts. The reference list is not included in the word count. The word
count leniency is +/- 10%)
Resources needed to
complete task
 Task 2 assessment guide
 Harvard Referencing Guide https://www.usc.edu.au/current-
students/student-support/academic-and-study-support/online-

study-resources/referencing-and-academic-integrity-guide/
harvard
 NMBA Registered Nurse Standards of Practice
 NMBA Midwife Standards for Practice
RUBRIC
Criteria High
Distinction
Distinction Credit Pass Fail
Application of
Nursing or
Midwifery codes
and standards to
underpin decision
making and safe
medication
practice (25%)
Exemplary
discussion of
the codes and
standards
demonstrating
insightful
interpretation
of them into
practice.
In-depth
discussion of
the codes
and
standards
demonstrati
ng accurate
knowledge
of them in
practice.
Comprehensiv
e discussion of
the codes and
standards
demonstrating
understanding
of them in
practice.
Description of
the codes and
standards
demonstrating
application of
them in
practice.
Limited evidence
of knowledge of
the codes and
standards
related to
practice. Codes
and standards
incorrectly
applied.
Application of
pathophysiolog
ical and
pharmacologic
al concepts to
the case study,
specific to safe
medication
administration
(20%)
Meaningful
synthesis of the
relevant
pathophysiolog
y related to the
case study.
Medication
safety
discussed in-
depth related
to the
pharmacologica
l concepts in
the case study.
Thoughtful and
informed
discussion of
the relevant
pathophysiolo
gy related to
the case study.
Medication
safety
comprehensiv
ely related to
the
pharmacologic
al concepts in
the case study.
Clear and
coherent
discussion of the
relevant
pathophysiology
related to the
case study.
Medication
safety
synthesised
related to the
pharmacological
concepts in the
case study.
Accurately
discusses some
of the relevant
pathophysiology
related to the
case study.
Medication
safety accurately
related to the
pharmacological
concepts in the
case study.
Incomplete or
superficial
discussion of the
relevant
pathophysiology
related to the case
study. Medication
safety inaccurately
related to the
pharmacological
concepts in the
case study.

Application of
pathophysiological
and
pharmacological
concepts to the
case study, specific
to person-centred
care (40%)
Detailed
analysis of case
scenario details.
Meaningful
application of
the professional
codes and
standards to
person-centred
care.
Demonstrates
insightful
conclusions
about client
needs.
Critical
analysis of
case scenario
details.
Comprehensiv
e application
of the
professional
codes and
standards to
person-
centred care.
Demonstrates
balanced
conclusions
about client
needs.
Logical links are
made regarding
the case scenario
details.
Complete
application of
the professional
codes and
standards to
person-centred
care.
Conclusions
made about
client needs are
appropriate.
Discussion of the
case scenario
details are
satisfactory.
Application of
the professional
codes and
standards to
person-centred
care are
satisfactory.
Relevant
conclusions are
made about
client needs.
A descriptive
account of the
case scenario
details with
limited or no
application of the
professional codes
and standards to
person-centred
care. Absence/
Inconsistent
conclusions
relevance to case
scenarios
Evidence-based
argument and
justification of
decisions,
coherent written
expression and
presentation (10%)
Exemplary
academic
communication.
All responses are
fully and clearly
supported by
several sources
of relevant
evidence
demonstrating
analysis.
Advanced
academic
communicatio
n. All
responses are
fully and
clearly
supported by
evidence,
demonstrating
synthesis.
Proficient
academic
communication.
Responses are
generally
supported by
appropriate
evidence with
some synthesis
cited.
Satisfactory
academic
communication
with minor
errors only.
Responses are
supported by
evidence;
however, critical
analysis of
evidence
needed
synthesis in the
responses.
Academic
communication
contains several
errors. Limited
evidence supports
the responses or
evidence from
sources is treated
uncritically.
Referencing style
conforms to
Harvard referencing
style used at USC
(5%)
Nine or more
appropriate
references cited
in the case
scenario
response. All
citations meet the
Harvard
referencing style
conventions. No
errors.
Eight or more
appropriate
references cited
in the case
scenario
response.
Consistent,
accurate and
complete
referencing
style with minor
errors.
Seven or more
appropriate
references cited
in the case
scenario
response.
Consistent and
complete
referencing style
with some errors.
Six or more
appropriate
references cited
in the case
scenario
response.
Generally
consistent in the
referencing
technique but
needs attention
to Harvard style
details.
Inadequate number
of scholarly
sources. Incorrect
referencing style
and technique.
Task 2 Case Scenario

Jolene is a 33-year-old woman living with her husband on a cattle farm in Dalby. She presents to the
Dalby emergency department complaining of a racing heart, palpitations, shortness of breath and a
headache. On examination Jolene has Tachycardia, Tachypnoea, Angina, Hypertension, anxiety and
tremor.
Q1. Explain these terms and provide examples of what observation data could be charted to
represent these signs and symptoms (200 words)
Answer-
A brief description of the provided terms are as follows-
Tachycardia- Tachycardia is a state of body, which is characterised by high level of heart beat per minute. It
beat even rises up to 100 beats per minutes. It is also termed as rhythmic disorder due to faulty regeneration
of the electrical signals that are produced from the upper chamber of the heart.
Tachypnoea- Tachypnoea is a condition of the body that indicates abnormal breathing symptoms which
comprises of rapid or shallow breathing sign. The condition of tachypnoea develops from chronic disease such
as asthma, anxiety, heart block, stroke and obesity (Park & Khattar 2019).
Angina- Angina can be regarded as a clinical symptom, which results in discomfort caused as a result of lack of
oxygen in the body especially in the heart muscles. The condition causes discomfort in the arms, back, jaw and
shoulders. It is also accompanied by painful feeling especially in the chest (Benjamin et al. 2017)
Hypertension- Hypertension is a condition that indicates high or elevated blood pressure in the body. The
situation results in elevated systolic pressure that rises up to 140mmHg or elevated diastolic pressure that
rises up to 90mmHg. High blood pressure has a risk of heart failure or stroke.
Anxiety- Anxiety is a psychological condition of the body that occurs due to nervousness, worry and
uneasiness along with fluctuating blood pressure. Anxiety occurs with severe sweating of the body (Stein &
Sareen 2015) .
Tremor- Tremor is a neurological disorder that happens in the body. The body involves and indicates the
involuntary rhythmic movement of the muscles (Agarwal & Biagioni 2019).
Observation data- Blood pressure- 175/95mmHg, Heart rate- 175bpm, Respiratory rate- 29bpm. The signs are
sweating, worriness and chest pain.
You are the emergency nurse.
Q2. What immediate action would you take to assess and monitor these signs and symptoms? (150
words)
Answer-
The nurse appointed in the emergency department must provide immediate treatment to
this patient to drop down the blood pressure level. The nurse can provide medicines such as beta-
blockers after doctors prescription or under the guidance of supervisor nurse as it drop the high
blood pressure level by blocking the action of sympathetic nervous system which in turn will lower
the heart rate (Rasmussen et al. 2020). The nurse must also assess the vital signs at a regular
interval. Continuous positive airway pressure can also be provided by the nurse to enhance the

functional capacity and thereby reducing the cardiac output (Javaheri, Gottlieb & Quan 2019). The
renal flow needs to be observed as well along with restriction in fluid intake. The nurse must also
focus upon reducing the anxiety symptom in the patient by providing a calm environment. The
tremor condition can be reduced by the drug named propranolol after giving instructions from the
practitioners. The nurse can also assist the patient in maintaining a proper body posture which will in
turn reduce the chance of asthma.
Jolene’s medical record discloses that she has had several earlier admission’s for asthma since she
was an adolescent.
Q3. Explain the pathophysiology of Asthma (300 words)
Jolene advises you that she usually takes Ventolin, Serevent and Atrovent.
Answer- Asthma is a condition of the body that results in chronic pulmonary disorder by developing
inflammation in the areas of respiratory tubes along with tightness and stiffness in the smooth
muscles present in the respiratory tubes. Asthma can be classified into two types allergic and non-
allergic (Mims 2015). Inflammation or bronchoconstriction is common in both the types, this
inflamed cells in the airways reacts with the particles of environment such as smokes, pollens
leading to narrowing of the passage of airways and resulting in excessive secretion of the mucus
from this cells leading to breathing difficulty (Chabra & Gupta 2019). Asthma is an autoimmune
condition of the body that develops due to the hypersensitivity type 1. The function of bronchus is
retained by the autonomic nervous system. The afferent nerves of the parasympathetic nervous
system gets stimulated by the external factors and carries the impulse in to the brain. The impulse is
actually received by the vagal centres of the brain which in turns carried in to the bronchial airways
by the vagal pathways. The bronchoconstriction is initiated by the acetylcholine secreted by the
efferent nerves. The acetylcholine forms inositol triphosphate which leads to the shortening of the
muscles in the lungs airways. The inhaled allergens results in the bronchial inflammation which is
kind of immune response. Interleukin 4 is released by the immune system which helps in the
differentiation of the helper T-cells. The condition is resolved by the antibodies produced in
response to the allergens. The cell-mediated immune system is caused due to inflammation of the
airways cells which actually proliferate and develops thicker mucus cells (Lambrecht & Hammad
2015). This condition results in bronchospasm. The stimuli can be of many types such as air
pollutions, food allergies, salicylate, industrial compounds, hormonal changes, obesity and
psychological stress. Asthma is a common problem among people with gastrointestinal disorder and
sleep disorder.
Q4. Provide the generic details of these medications and explain their indication and action (200
words)
On examination the other signs and symptoms that Jolene exhibits are excessive weight loss over
the past 3 months, occasional unexplained diarrhoea, thinning hair and brittle nails. You also notice a
small goitre. The provisional diagnosis from the emergency physician is Graves’ disease. Once

stabilised, Jolene is discharged to her GP for further treatment. A referral to an Endocrinologist is
completed.
Answer-
Albuterol is the generic name of the drug Ventolin which is also called as Salbutamol. This
drug belongs to the family of bronchodilators used in the treatment of asthma. It is generally orally.
The drug needs specific precaution while consuming as it cannot be used in the treatment of sudden
asthma attack. It must be stored in room temperature away from sunlight and moisture.
The drug Serevent belongs to the class of bronchodilatos also called as Salmeterol. Serevent
Diskus is the brand name of this drug. The drugs acts as a beta 2 adrenoreceptors agonist (Price et al.
2016). The drug enhances and smoothens the breathing condition by relaxing the muscle present
around the pathways of the lungs. It lowers the bronchospasm condition and used in the treatment
of sudden asthma attack.
Ipratropium is the generic name of the drug Atrovent. The drug belongs to the family of
bronchodilators and is also used in the treatment of asthma (Saab & Aboeed 2019).
Serevent relaxes the smooth muscles of the lungs airways and prevents the chronic
bronchitis. It is also a type of beta 2 agonist which acts by a initiating the action of complex cascade
mechanism of the body. The ventolin reduces the asthma by initiating the bronchodilation of the
lung airways and also activating the receptors of beta 2 adrenergic. Atrovent hinders the action of
cholinergic nerves and thus dilates the muscles.
Q5. What is Graves’ disease? (100 words)
Answer-
Graves’ disease can be defined as a condition of the body which results in overproduction of
the thyroid hormone. The production of hormone is regulated by the thyroid-stimulating hormone
receptors, which are triggered by the pituitary gland. The adenylate cyclase produce the two
hormone from the glands these are triiodothyronine and thyroxine. Graves’ disease is also regarded
as an autoimmune disease where the antibodies present in the body mimics the thyroid producing
hormones generating a false signal and thus over producing the both the hormones. It is regarded as
the hyperthyroidism condition of the body (Smith & Hegedus 2016). The symptoms if these
condition are loss of weight, irritability, heat sensitivity, enlargement of the thyroid gland, redness
of skin, rapid heartbeat and irregulation of menstrual cycle.
Q6. Describe antithyroid drug treatment for Graves’ disease (150 words)
The Endocrinologist prescribed an antithyroid medication regimen and included Beta-Blockers.
Answer-
The chief goal of the antithyroid drug is to switch the additional creation of thyroid
hormones. The most common drugs that are used in the handling of hyperthyroidism are
Methimazole and Propylthiouracil (DeGroot 2016). These two are administered orally and are used

in the inhibition of peroxidase enzyme and iodine which in turn stops the interaction of
thyroglobulins to produce triiodothyronine and thyroxine. The beta blockers are also used in the
treatment of graves disease. The drugs that belongs to this class are Lopressor, Toprol, Nadolol and
Atenolol. This drug does not stop or inhibits the production of hormone but helps in regulating the
metabolism of this hormones in the body (Jastrzebska 2015). The drugs are used in providing sudden
relief from few symptoms such as irritability, tremors, sweating, intolerance of heat, muscle
weakness and anxiety. The swelling of eyes can be reduced by the application of corticosteroids.
These are also used ionic inhibition such as thiocynate, perchlorates.
Q7. Explain the rationale for this combination of drug therapy and discuss the interactions with the
bronchodilators already used (200 words).
You are now the nurse at the GP clinic and Jolene discusses with you that she and her husband, Jack,
want to have a baby.
Answer-
The practitioner in this case advised the patient to consume a drug of combination therapy
like beta-blockers and anti-thyroid drugs for effective result. These both drugs regulates the
situation by two different mechanism which will be helpful in lowering the side effects of the drugs
along with providing optimal dosages required in treatment. The beta-blockers such as Lopressor,
Toprol, Nadolol and Atenolol regulates the function of the thyroid gland and inhibiting the capacity
to act in the body. It also helps in lowering the hyper-adrenergic condition. It is also used in lowering
the heartbeat and heart rate. The anti-thyroid such as methimazole and Propylthiouracil inhibits the
function of the peroxidase enzyme and also affects the conversion as well as the iodine contain of
the body resulting in the lower production of the thyroid hormones and recovering from the graves’
disease along with goitre (Liu et al. 2017). The combination therapy helps in controlling the
adrenergic responses along with hyperthyroidism. Beta- blockers can result in bronchospasm lowers
the effectiveness of bronchodilators. These drugs also reduces the response of the body towards the
bronchodilators and reduces the respiratory signs. The bronchodilators targets the beta-2 receptors
which is usually a G-protein receptors of the lungs airways thus relaxing the smooth muscles present
in that area thereby improving the breathing state. The non-selective beta-blockers acts in counter
position with the asthma causing bronchoconstriction due to the beta two receptors. The
bronchodilation can lead to many severe conditions like high pulse rate, tremor, anxiety,
tachycardia. The Propylthiouracil can be prescribed in pregnancy period to reduce the hyperthyroid
condition (Gupta & Rehman 2019).
Q8. How would you respond to Jolene? What advice would you give her about her existing condition
and drug therapy related to pregnancy? Write your response as if you were speaking to Jolene. That
is in clinical conversation language instead of academic language. Consider your professional codes
and standards when writing your response (200 words).
Answer-
The first step that I would be taking in addressing the patient (Jolene) is to provide
correct information about the disorder that she is suffering from. This will be advantageous in having
a better response towards the treatment she is provided as, the nurses are responsible for
maintaining the patient state and reducing the condition with the help of both pharmacological and

non-pharmacological interventions. According to NMBA standard 2- nurses are accountable for their
actions. In this case before forthcoming to the patient, the nurse must have a precise information
about the medications that are prescribed. Standard 3- states that effective communication
enhances the knowledge of the patient (Deveugele 2015) and it helps in decision making ability
(NMBA, 2016). Person centred care is also important in this respect which will increase the chance
the recovery by addressing the patients need. The diet plan that I will be planning along with the
supervisor will be based upon the vital signs and attention will be given in reducing the blood
pressure level and thyroid state. I will also advise the patient for maintaining a hygienic condition
which will in turn reduce the asthma condition. The thyroid drugs that can be given during
pregnancy are Propylthiouracil and Methimazole. I will try to promote the safe medication and
practice by giving appropriate knowledge about the drugs to the patient which is according to the
Standard 4 of NMBA (NMBA, 2016). The hypertension drug that can be used during pregnancy are
Methyldopa and Hydralazine, Ventolin is safe during pregnancy to control asthma. I would also keep
a regular observation of the vital signs and symptoms of the patient and report to higher authority in
case of any complications.

References
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Chabra, R. & Gupta, M., 2019. Allergic And Environmental Induced Asthma. In StatPearls [Internet].
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