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HNN751 Advanced Physiology And Patient Assessment

tag 0 Download 8 Pages / 1,837 Words tag 06-07-2021


Question 1.

Mr Simpson is hypotensive, tachycardic and tachypnoeic most likely due to dehydration. With reference specifically to Mr Simpson’s history and presentation, explain the physiological causes of hypotension, tachycardia and tachypnoea. Your answer does not require potential diagnoses; but rather a focus on the causes and emergence of these findings specifically drawing on determinants of cardiac output and compensatory mechanisms.

Mr Simpson, aged 68 years, was playing golf with his friends when he reported feeling dizzy. He had been playing for several hours on a 37 o

It is the fourth consecutive day with temperatures over 35o

His skin is flushed, he is agitated and drowsy. Mr Simpson has a pasthistory of an anterior myocardial infarction, hypertension, and a recent echocardiogram confirmeda left ventricular ejection fraction of 26%. His usual medications are: metoprolol 25 mg bd, ramipril5mg mane, atorvastatin 40 mg nocte, and aspirin 100 mg mane. It is unclear whether Mr Simpson is fully compliant with his medication regime.

You are the critical care nursing student responsible for this gentleman’s care. Your initial assessment findings are:

  • respiratory rate: 28 breaths per minute
  • blood pressure: 89/44 mmHg
  • pulse: 107 bpm (regular)
  • SpO2: 93% on room air
  • temperature: 37.4 degrees Celsius
  • GCS score: 15
  • reports pain score of 0

Question 2.

Mr Simpson requires intravenous fluids to restore his circulating blood volume. A central venous catheter (CVC) has been inserted. Hartmann’s solution, 0.9% Normal saline, 5% Dextrose, or Packed Cells are the fluid replacement options discussed. Based on research evidence, explain why or why not each of these options should be infused.

Question 3.

Select eight specific nursing/collaborative assessments the registered nurse should perform and monitor toevaluate the reestablishment of normal fluid and electrolyte homeostasis for this patient. For each assessment, provide the physiological rationale for performing/monitoring each assessment/parameter.

Question 4.

Provide an overall interpretation of Mr Simpson’s arterial blood gas results and provide a physiological explanation for any deviations noted for each parameter.

  • pH 7.30
  • PaCO2 30 mmHg
  • PaO2 83 mmHg
  • SaO2 94%
  • HCO3 20 mmol/L
  • Lactate 3.2 mmol/L

Question 5.

Suggest four possible reasons for this rhythm in this patient. Provide a physiological rationale for each. On assessment of Mr Simpson’s heart rate, an irregular rhythm is noted.

Question 6.

Mr Simpson undergoes a portable chest X-ray. Describe and rationalise four (4) factors or issues that should be evaluated by the nurse to assess the quality of a chest x-ray prior to performing an analysis of a chest xray.

Question 7:

“The notion that adverse events are sudden, unexpected and occur without warning has now been challenged and there is evidence that, for the majority of patients who suffer an in-hospital adverse event, the event is preceded by a period of physiological abnormality, whereby the patient exhibits clearly abnormal physiological signs.” (Considine & Botti, 2004, p. 23).

Medical emergency team (MET) activations are made for hypotension. Abnormal arterial systolic blood pressure measurements are strongly predictive of adverse hospital outcomes such as unexpected death, cardiac arrest, unplanned ICU admission and medical emergency team activations.

With reference to literature, critically discuss the importance of accurate blood pressure measurement; recognition, documentation and escalation of care for hypotension; and the sensitivity of hypotension as a predictor of critical illness. Primary sources from 1990 onwards are acceptable for this question. Full referencing is mandatory for this question.

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