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Nursing & Medication Management and Graduate Attributes Knowledge, communication, problem solving Directions.

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Appendix A Case Study Mrs. Amelia Middleton is a 68 year old retired receptionist who is bought in by ambulance to the Emergency Department (ED) of her local hospital. Her son Paul is with her. Paul had called the ambulance service earlier stating that his mother woke this morning complaining of a headache and is now unable to lift her right arm and has been having difficulty speaking. On examination Mrs. Middleton has a BP of 200/110, Pulse 78 and irregular, Respiratory Rate 16, SpO2 98%, Glasgow coma scale 12, & Temp 36.8. Her blood sugar level is 4.8. She also has ...

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Appendix A Case Study Mrs. Amelia Middleton is a 68 year old retired receptionist who is bought in by ambulance to the Emergency Department (ED) of her local hospital. Her son Paul is with her. Paul had called the ambulance service earlier stating that his mother woke this morning complaining of a headache and is now unable to lift her right arm and has been having difficulty speaking. On examination Mrs. Middleton has a BP of 200/110, Pulse 78 and irregular, Respiratory Rate 16, SpO2 98%, Glasgow coma scale 12, & Temp 36.8. Her blood sugar level is 4.8. She also has paralysis of the right arm and face and loss of sensation to touch on the right side of her face and right arm. She appears to understand what is being said to her but cannot respond verbally. Mrs. Middleton’s history includes depression and lower gastro-intestinal bleeding associated with haemorrhoids. She has no known allergies. Mrs. Middleton was an only child, her father died of an anterior myocardial infarct at age 57 and her mother died of breast cancer at the age of 72. Mrs. Middleton currently lives with her son, due to the recent death of her husband, Geoff. They are in the process of trying to sell the family home. She has three other children, all of whom live interstate. Amelia Middleton’s current medications are: Sertraline 100mg mane Rectinol HC topically as required At the time of arrival Mrs. Middleton had a provisional diagnosis of CVA. Mrs. Middleton was ordered a CT scan which was conducted 6 hours after her arrival to ED, the results excluded the presence of a hemorrhagic CVA but indicated ischemic CVA. A 12 lead ECG was also conducted on arrival and Mrs. Middleton was found to be in atrial fibrillation. Directions In this case study you will need to explore the pathophysiology, nursing management and medication management of the case and demonstrate your understanding in the answers you provide to the following questions. Your answers should be informed by your reading of current research and literature. 1) What is the pathophysiology associated with hemorrhagic and ischemic CVA and discuss the precipitating factors for each? 2) How would you manage the nursing care of Mrs. Middleton in the first 24 hours? Justify your answer. 3) Is thrombolysis indicated for Mrs. Middleton? Discuss the use of thrombolytic agents for stroke patients and provide a rationale for your answer in this case. 4) The doctor is considering prescribing aspirin, carvedilol and atorvastatin for Mrs. Middleton following her CVA. Do you agree with his decision? Outline your understanding of these drugs and any benefits or risks associated with their use in this case. 5) What is the significance of atrial fibrillation in this case and discuss possible pharmacological interventions that may be considered for Mrs. Middleton. Appendix B Helpful Hints for Assessment 1 – Case Study · This assessment is to be presented in an essay format, and therefore we require you to write a very brief introduction and conclusion (at most one or two sentences). Do not rewrite the case study in your introduction. · Please respond to the questions in a logical format. You may use a heading at the start of each new question. · Dot points are not acceptable. · References must be current, preferably from the past five years. Your reading should demonstrate wide reading from a variety of sources, such as texts, journals and clinical practice guidelines. · Consider the quality rather than the quantity of the references you use. Wikipedia and the Better Health Channel are not acceptable references. At this point in your BN we expect you to engage with the practice literature. · You may use tables, however they must be included as an appendix and the information must pertain and be integrated into the body of your paper that is, not simply added on to the end. · You may use pictures and diagrams but they must be used to support your paper and be integrated. They must be clearly labeled and referenced. · Spelling and grammar are very important, try to have another person read your paper prior to submission. · Requests for extension must be in accordance with the SNM Assessment Policy (please see the SNM webpage) they won’t be accepted if requested within 24 hours of the due date. · You will submit your paper online and receive you grade a feedback online Recommended reading Brotto,V and Rafferty, K.2012, Clinical dosage calculations for Australia and New Zealand Crisp, J & Taylor, C (eds) 2012, Potter and Perry’s fundamentals of nursing Australian Edition, 4th edn, Elsevier Mosby, Sydney. Levett-Jones, T (ed) 2013, Clinical Reasoning: Learning to think like a nurse. Pearson, NSW. Tiziani, A 2010, Havard’s nursing guide to drugs, 8th edn, Churchill Livingstone, Sydney. Tollefson, J 2010, Clinical psychomotor skills: Assessment tools for nursing students, 4th edn, Cengage Learning, Melbourne

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Nursing Management is a guidance function of decision-making and governance and in organizations that employ nurses. It integrates all the management processes, such as, planning, organizing, staffing, directing and controlling. One of the most significant steps in treating certain phobias is medication management. In various states, the medications are permitted to be only prescribed by medical doctors. Even though this changes gradually, the assistants of the physicians and the clinical nurse specialists could provide prescription under the physician’s unswerving supervision.

            Firstly they ensuring that the member's physician is aware of or involved in the case after that they facilitating the flow of information between the hospital and Group Health, Assisting hospital discharge planners, Confirming coverage through Review Services or Customer Service, Facilitating the use of Group Health or contracted providers, Answering member questions about coordination of care, Facilitating high-quality, cost-effective use of medically appropriate resources, Initiating and participating in patient-care conferences and utilization review committees, educating internal and external staff about case management and care coordination & lastly they orienting new contracted providers to Group Health. In the given case of Mrs. Amelia Middleton, we will try to explore the pathophysiology, nursing management and medication management in the situation.

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