The rationale for Part B of this assignment is to test Learning Outcomes 1, 2 and 4 of the module and your ability to prepare authoritatively using reasoned argument which demonstrates an appropriate depth and breadth of knowledge. The marking grid, in your module study will help you to do this.
For this essay, you will choose one out of the two scenarios, described below. You will then answer one of the problems about your chosen scenario.
Your essay should include:
• An introduction which includes the areas you are going to focus on and why.
• An analysis of your chosen topic, considering the best available evidence. You need to analyse the literature and relate the clinical management not only to pathophysiology but also to the evidence base and clinical practice.
• An appropriate depth and breadth of knowledge and relate this knowledge to practice. You should refer to the marking grid in your module study guide.
• A conclusion which should provide a summary of the main points from your essay.
• A reference list. This should accurately follow UWL guidelines on using the Harvard Referencing System.
Results for the 1st attempt will be published following ratification by the Assessment Board.
Formative assessment
In preparation for the written assessment you will be required to submit an essay plan as a formative assessment. The submission date for this piece of work is Friday 10th February 2012. You will receive written feedback from your group tutor on your essay plan within ten working days.
Formative Template
Student Number:
Date:
problem:
Introduction
Indicate the focus of your essay and the issues that you intend to discuss
Content of main body
Outline relevant physiology
Identify treatment and care to be discussed
Include rationale for treatment and care
Identify any relevant ethical issues to be discussed
Conclusion
Summarise main issues and any recommendations for practice based upon insights gained.
References
Identify how key sources are to be utilized in your work
Scenario 1
David Jones was referred by his GP to A&E complaining of shortness of breath, sweating and mild chest pain. David was fine up until 2 weeks ago, when he hurt his leg and has not been able to get around very much. David's spirometry test showed a forced expiratory volume in one seconds (FEV1) / forced vital capacity of 60%. His exercise tolerance is normally 800m on flat ground. However, he now becomes breathless walking to the bathroom, his cough is productive and his phlegm is green. He feels that his salbutamol inhaler is no longer of benefit. David is a former smoker (over 15 years) but gave up approximately 6 years ago after diagnosis of COPD.
David was assessed on arrival at the A&E, he was found to have a respiration rate of 32/minute, a pulse rate of 98 /minute, widespread expiratory wheezes, and a peak flow of 100 L/minute. BP=150/90. The temperature was 37.2 o C, SpO2 89% and a GCS score of 15. Blood gas on admission, breathing air showed a PO2 of 8.1 kPa, PCO2 of 7.9kPa and pH 7.31. David was treated with 28% oxygen, nebulised bronchodilator, ipratropium bromide and intravenous prednisolone.
After 3 hours in the A&E David's condition deteriorated with PAR score of 5. He was reviewed by outreach team. He was in respiratory distress and was transferred to HDU for further management accompanied by the A&E nurse Helen and her niece.
Answer one of the following problems:
problem1
David was admitted to A&E with exacerbation on COPD.
With reference to altered physiology discuss the management of David in A&E for the first two hours.