{"id":67766,"date":"2020-11-03T06:37:00","date_gmt":"2020-11-03T06:37:00","guid":{"rendered":"https:\/\/www.essaybishops.com\/dissertations\/?p=67766"},"modified":"2025-11-03T06:42:30","modified_gmt":"2025-11-03T06:42:30","slug":"nursing-interventions-for-acute-heart-failure-exacerbation-in-elderly-patients","status":"publish","type":"post","link":"https:\/\/www.homeworkacetutors.com\/assessments\/nursing-interventions-for-acute-heart-failure-exacerbation-in-elderly-patients\/","title":{"rendered":"Nursing Interventions for Acute Heart Failure Exacerbation in Elderly Patients"},"content":{"rendered":"

Assessment Task 3: Extended Clinical Reasoning Case Study \u2013 Medical-Surgical Nursing<\/h3>\n

Unit Code:<\/strong> NRSG378 Unit Title:<\/strong> Principles of Nursing: Extended Clinical Reasoning Assessment Type:<\/strong> Individual Written Case Study Word Limit:<\/strong> 2,000 words (\u00b110%) Weighting:<\/strong> 50% Due Date:<\/strong> Wednesday, 4 June 2025, 2:00 pm AEST via Turnitin on LEO Learning Outcomes Assessed:<\/strong> LO1: Critically analyse complex clinical scenarios using extended reasoning frameworks; LO2: Integrate pathophysiological, pharmacological, and psychosocial data into care planning; LO3: Prioritise ethical and evidence-based interventions for acutely unwell patients; LO4: Evaluate care outcomes and reflect on professional development; LO5: Demonstrate person-centred communication in multidisciplinary contexts.<\/p>\n

Task Overview<\/h4>\n

Apply the Clinical Reasoning Cycle (Levett-Jones, 2018) to an acute medical-surgical case involving decompensated heart failure. Demonstrate extended reasoning by linking assessment data to pathophysiology, prioritising three nursing issues, and justifying interventions with ethical, legal, and evidence-based rationale. This task builds on prior units, focusing on the holistic impact of acute illness. Select if aligned with your placement; consult LIC if unallocated by Week 5. Avoid repeating prior cases.<\/p>\n

Case Scenario: Mr. Reginald Harris \u2013 Acute Exacerbation of Congestive Heart Failure<\/h4>\n

Mr. Reginald Harris, 72-year-old widower, admitted to the medical ward via ED with acute decompensated heart failure (CHF). Presented with 48-hour history of increasing dyspnoea on minimal exertion, orthopnoea, and bilateral leg swelling after non-compliance with fluid restriction and missing diuretic doses. Lives alone; limited mobility due to osteoarthritis.<\/p>\n

Past Medical History:<\/strong> Diagnosed CHF (ejection fraction 35%) five years ago; hypertension; type 2 diabetes (HbA1c 8.2%); ex-smoker (30 pack-years); BMI 28. Takes frusemide 40mg BD, ramipril 5mg daily, metoprolol 50mg BD, metformin 1g BD. Recent weight gain 4kg in one week.<\/p>\n

Current Presentation (Day 1 Admission):<\/strong> Short of breath at rest, anxious, reports “can’t catch breath.”<\/p>\n

Assessment Findings:<\/strong><\/p>\n

    \n
  • Vital signs: Temp 37.2\u00b0C, RR 28\/min (laboured), HR 110 bpm (irregular), SpO2 88% on 6L\/min O2 via mask, BP 160\/95 mmHg, Pain 4\/10 (chest tightness), GCS 15\/15.<\/li>\n
  • Physical: Pale, cool peripheries; bilateral crackles to mid-lung fields; 3+ pitting oedema to knees; JVP elevated 5cm; weight 85kg (baseline 81kg); dry mouth, urine output 20mL\/hr via IDC.<\/li>\n<\/ul>\n

    Investigations:<\/strong> BNP 1,200 pg\/mL (elevated); Na 128 mmol\/L, K 3.2 mmol\/L; ECG: AF with rate 110; CXR: pulmonary oedema; Echo: EF 32%.<\/p>\n

    Nursing Notes:<\/strong> IV cannula 20G left forearm; NBM for 4 hours pending GTN infusion; family visited, concerned about discharge planning; non-compliant with low-sodium diet per wife.<\/p>\n

    You are the Registered Nurse coordinating care.<\/p>\n

    Task Requirements<\/h4>\n

    Use the Clinical Reasoning Cycle (Levett-Jones, 2018) to structure analysis. Process cues from scenario, prioritise issues, set goals, implement\/evaluate interventions, and reflect. Incorporate multidisciplinary aspects (e.g., cardiology input) and address social determinants (e.g., isolation).<\/p>\n

    Required Sections:<\/strong><\/p>\n

      \n
    1. Introduction (200 words):<\/strong> Introduce scenario, framework, and overview of key issues (e.g., fluid overload, electrolyte imbalance, anxiety).<\/li>\n
    2. Consider the Patient’s Situation (250 words):<\/strong> Detail history, admission context, and biopsychosocial factors (e.g., non-adherence, grief).<\/li>\n
    3. Collect, Process, and Present Cues (300 words):<\/strong> Organise subjective\/objective data; highlight abnormalities (e.g., hyponatraemia, AF). Link to pathophysiology.<\/li>\n
    4. Process Information and Identify Three Nursing Issues (350 words):<\/strong> Prioritise based on ABCs\/Maslow (e.g., impaired gas exchange, excess fluid volume, ineffective health management); justify with NMBA competencies.<\/li>\n
    5. Establish Goals (200 words):<\/strong> Develop SMART goals for each issue (e.g., SpO2 >92% within 6 hours).<\/li>\n
    6. Take Action \u2013 Nursing Interventions (500 words):<\/strong> Detail 2\u20133 evidence-based strategies per issue (e.g., oxygen titration, fluid monitoring, education); rationalise priority, link to data\/history, address ethical\/legal elements (e.g., capacity for consent).<\/li>\n
    7. Evaluate Outcomes (100 words):<\/strong> Assess intervention impact; propose adjustments.<\/li>\n
    8. Reflect on the Process (100 words):<\/strong> Analyse reasoning gaps; discuss learning for future practice.<\/li>\n<\/ol>\n

      Use 12+ peer-reviewed sources (2019\u20132025); Harvard referencing. Ensure person-centred language.<\/p>\n

      Rubric Criteria<\/h4>\n
      \n
      \n
      <\/div>\n<\/div>\n
      \n
      <\/div>\n\n\n\n\n\n\n\n\n\n
      Criterion<\/th>\nHigh Distinction (85\u2013100%)<\/th>\nDistinction (75\u201384%)<\/th>\nCredit (65\u201374%)<\/th>\nPass (50\u201364%)<\/th>\nFail (<50%)<\/th>\n<\/tr>\n<\/thead>\n
      Extended CRC Application<\/strong> (30%)<\/td>\nSeamless integration; deep pathophysiological\/psychosocial links.<\/td>\nStrong framework use; minor linkages.<\/td>\nAdequate structure; some depth.<\/td>\nBasic cycle; fragmented.<\/td>\nFramework misused.<\/td>\n<\/tr>\n
      Issue Prioritisation<\/strong> (20%)<\/td>\nThree issues expertly prioritised with robust evidence.<\/td>\nClear priorities; solid rationale.<\/td>\nIssues relevant; partial evidence.<\/td>\nIssues identified; weak links.<\/td>\nIssues irrelevant.<\/td>\n<\/tr>\n
      Interventions & Rationale<\/strong> (25%)<\/td>\nInnovative, ethical interventions; data-driven justification.<\/td>\nEvidence-based; good links.<\/td>\nRelevant actions; descriptive.<\/td>\nBasic interventions; limited rationale.<\/td>\nUnsafe or unsupported.<\/td>\n<\/tr>\n
      Evaluation & Reflection<\/strong> (15%)<\/td>\nInsightful outcomes analysis; profound practice implications.<\/td>\nSound evaluation; reflective.<\/td>\nBasic evaluation; surface reflection.<\/td>\nMinimal analysis.<\/td>\nAbsent.<\/td>\n<\/tr>\n
      Scholarship & Structure<\/strong> (10%)<\/td>\nExemplary writing; flawless Harvard.<\/td>\nCoherent; few errors.<\/td>\nClear; some issues.<\/td>\nReadable; errors.<\/td>\nDisorganised; poor sources.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
      <\/div>\n<\/div>\n<\/div>\n

      Submission Instructions<\/h4>\n

      Label: “StudentID_NRSG378_Ass3_CaseStudy.docx”. Upload to LEO Turnitin. Late: 10%\/day. Integrity: <15% similarity. Extensions: 48 hours prior with evidence. Q&A recording on LEO Week 9.<\/p>\n

      Learning Materials\/Resources<\/h3>\n

      Longhini, J., Gauthier, K., Konradsen, H., Palese, A., Kabir, Z. N. and Waldr\u00e9us, N. (2025) The effectiveness of nursing interventions to improve self-care for patients with heart failure at home: a systematic review and meta-analysis. BMC Nursing<\/em>, 24(286). doi:10.1186\/s12912-025-02867-7.<\/p>\n

      Yu, S., Wei, D. and Shi, N. (2023) Comprehensive nursing intervention improves quality of life and reduces hospitalization time and expense in elderly patients with severe heart failure undergoing rh-BNP treatment. American Journal of Translational Research<\/em>, 15(8), pp.5239\u20135248.<\/p>\n

      Ord\u00f3\u00f1ez-Piedra, J., Ponce-Bland\u00f3n, J. A., Robles-Romero, J. M., G\u00f3mez-Salgado, J., Jim\u00e9nez-Pic\u00f3n, N. and Romero-Mart\u00edn, M. (2021) Effectiveness of the Advanced Practice Nursing interventions in the patient with heart failure: a systematic review. Nursing Open<\/em>, 8(4), pp.1879\u20131891. doi:10.1002\/nop2.847.<\/p>\n

      Marques, C. R. d. G. et al. (2022) Educational nursing intervention in reducing hospital readmission and the mortality of patients with heart failure: a systematic review and meta-analysis. Journal of Cardiovascular Development and Disease<\/em>, 9(12), p.420. doi:10.3390\/jcdd9120420.<\/p>\n","protected":false},"excerpt":{"rendered":"

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