Case Study Report: Co-morbidities

Assessment item 2
Case Study Report Part A:Co-morbidities
Value: 50%
Due date: 18-Aug-2017
Return date: 08-Sep-2017
Length: 2000 Words
Submission method options
EASTS (online)
Task
The written assessment tasks for this subject require you to submit a Case Study Report in which you
explore the potential impact of chronic and complex conditions on the patient.
In addition to a brief introduction and conclusion, PART A of your report should include:
A discussion of the pathophysiology and related clinical manifestations of COPD and Hypertension
Explain the concepts of co-morbidity, chronicity and complexity
A discussion of the chronicity and complexity of the patient\’s condition, including the identification
of two interactions between the patient\’s arthritis, COPD and hypertension and a discussion of how
these conditions will impact the patient and her family. You will need to consider the pathophysiology,
clinical manifestations and the medications the patient is taking in this part of the report.
Your report must adhere to academic writing conventions. Sub-headings may be used, but dot points
and tables should not be included in this part of the assessment item.
You should support your discussion with a MINIMUM 10 recent (less than 7 years old) and credible
sources. Credible sources include, peer reviewed journal articles, text-books, evidence summaries,
best practice guidelines, government documents, health facility clinical guidelines and
policies/procedures and websites containing content aimed at health professionals. Please note that
lecture slides will not be considered to be credible sources for this assessment task.
Assignment Task
Case Study for Part A
Angela is a 69 year old lady who was born in England and moved to Australia when she was 14 with
her family. She is married and lives with her 74 year old husband, and has three daughters who live
close by, and has seven grandchildren that she helps care for when her daughters work.
Angela has a 24 pack per year history of smoking and has been diagnosed with Chronic Obstructive
Pulmonary Disease, with an FEV1/FVC ratio of 52%. She quit smoking 6 years ago, but her husband
continues to smoke. Her inhalers for COPD include Symbicort 400/12mcg (Budesonide and
Eformetorol) and Spiriva 18mcg (tiotropium Bromide). She uses salbutamol via inhaler as required.
Angela worked as a cleaner for many years and has some arthritic changes related to the wear and tear
secondary to this work. She takes paracetamol only to manage this. Angela is compliant with all
medications and efforts to manage her COPD and arthritis.
On a routine visit with her GP, Angela was noted to be hypertensive with a BP of 164/96. She has
been commenced on an angiotensin converting enzyme inhibitor, perindopril arginine, 2.5mg daily, to
be reviewed in 4 weeks. Her weight has increased from 64kg to 72kg in the 3 months since her last
review and she reports increased discomfort when mobilising, particularly from her spine. This is
limiting her ability to exercise and she is now finding she is increasingly breathless when walking any
distance, and is finding caring for the grandchildren more difficult.
Rationale
It is known that chronic disease is the leading cause of death across the world (Johnson & Chang,
2014). Nurses need to be able to provide care to all health consumers, with a significant role in
assessing a person, planning care, communicating with colleagues and ensuring that the holistic needs
are met and evaluated. The ongoing nature of the conditions can result in longer term debilitating
outcomes if not addressed appropriately. Children, young people, adults and older adults all
experience the full range of health issues yet manage them differently.
This assessment task addresses the following subject learning outcomes:
Plan nursing care for patients with complex co-morbidities demonstrating rationale for how
one affects the other (NMBA 1.1, 1.2, 1.4, 1.6, 4.1,4.2,4.3,4.4, 5.1,5.2,5.3, 5.4, 5.5, 6.1,
7.1,7.2, 7.3).
Plan nursing care of a patient with a co-morbidity in consultation with individuals/groups
significant others and the interdisciplinary health care team in the clinical setting (NMBA
2.6,2.8, 3.6, 6.3).
Explain and describe common physiological, mental health and developmental chronic
conditions (NMBA 1.1, 1.2)
Marking criteria
NRS223 Assessment Item 2 Marking Criteria 201660 Student Name:
Criteria HD DI CR PS FL Mark
Discusses the
Pathophysiology
of Chronic and
Complex
Conditions and
their Related
Clinical
Manifestations
(25 marks)
There is a detailed, succinct and accurate
discussion of the disruptions to normal
physiological processes that underlie
each condition, with consistently clear
links to all of the clinical manifestations.
All clinical manifestations are clearly
linked to underlying pathophysiology
21.5-25 marks
There is a clear,more
detailed and accurate
discussion of the
disruptions to normal
physiological processes
that underlie each
condition.
The main, and some
additional clinical
manifestations of each
condition have been
identified and most have
been clearly linked to the
related underlying
pathophysiology
19-21 marks
There is a basic and
accurate explanation of
the disruptions to the
normal physiological
processes that underlie
each condition.
The main clinical
manifestations of each
condition have been
identified and some have
been linked to the related
underlying
pathophysiology.
16.5-18.5 marks
There is a basic explanation of
the disruptions to normal
physiological processes that
underlie each condition.
The main clinical
manifestations of each
condition have been identified,
but most have not been linked
to the related underlying
pathophysiology.
12.5-16 marks
There is no,
minimal or a very
superficial
discussion of the
disruptions to
physiological
processes that
occur in each
condition
and/or
The discussion
contains several
inaccuracies
and/or
The main clinical
manifestations of
each condition
have not been
identified.
0-12 marks
Explains the
Concepts of
The definitions of each of the key terms
have been integrated into a detailed,
succinct and accurate discussion of the
chronicity and complexity of the
Each of the key terms
has been defined and
then clearly linked to a
detailed and accurate
discussion of the
chronicity and
Each of the key terms has
been defined and then
loosely linked to a
general but accurate
discussion of the
There is a basic definition of
each the key terms, with a
limited explanation of the
chronicity and complexity of
the patient\’s condition.
The key terms
have not been
defined and/or
there is minimal or
no discussion of
the chronicity and
Charles Sturt University Subject Outline
NRS223 201760 B D-8 June 2017-Version 1 Page 13 of 30
Criteria HD DI CR PS FL Mark
Co-morbidity,
Chronicity and
Complexity
(15 marks)
patient\’s condition.
13-15
marks
complexity of the
patient\’s condition.
11.5-12.5 marks
chronicity and complexity
of the patient\’s condition.
10-11 marks
7.5- 9.5 marks
complexity of the
patient\’s condition.
0-7 marks
Discusses the
Impact of
Chronic and
Complex
Conditions on
the Patient
(30 marks)
There is a comprehensive, accurate and
integrated discussion of two ways in
which the conditions may impact on
each other and the possible effects of the
conditions on the patient in the case
study, with substantial links made to the
previously discussed pathophysiology
and clinical manifestations.
25.5-30 marks
Two ways in which the
conditions may impact
on each other been
identified and a detailed
explanation provided.
The likely effects of the
conditions on the patient
in the case study have
been discussed, with
mostly clear links made
to the previously
discussed
pathophysiology and
clinical manifestations.
22.5-25 marks
Two ways in which the
conditions may impact on
each other have been
identified and clearly
explained.
The most likely effects of
the conditions on the
patient in the case study
have been clearly
explained, with some
links made to the
previously discussed
pathophysiology and
clinical manifestations.
19.5-22 marks
Two ways in which the
conditions may impact on each
other have been identified and
a basic explanation provided.
Some of the most likely effects
of the conditions have been
identified and a basic
explanation provided, but with
limited reference to the patient
in the case study and/or the
previously discussed
pathophysiology and clinical
manifestations.
15-19 marks
Less than 2 ways
in which the
conditions may
impact each other
have been
identified and/or
explained
and/or
There is a very
limited/superficial
discussion of the
combined impact
of the conditions
on the patient.
and/or
Multiple
unsupported
assumptions or
generalisations
have been made
about the
combined impact
of the conditions
on the patient
Use of Evidence
to Support the
Discussion
An extensive range of highly relevant
and current sources have been located,
evaluated and synthesised to
A range of relevant
sources and current
sources have been
located, evaluated and
A range of relevant and
current sources have been
located, evaluated and
Information from the minimum
number of required sources has
been located and incorporated
Less than the
required number
of appropriate
Charles Sturt University Subject Outline
NRS223 201760 B D-8 June 2017-Version 1 Page 14 of 30
Criteria HD DI CR PS FL Mark
(10 marks)
substantially support the discussion
throughout the paper
8.5-10 marks
synthesised to support
the discussion
throughout the paper
7.5-8 marks
incorporated to mostly
support the discussion
6.5-7 marks
to provide some support for the
discussion
5-6 marks
sources have been
used to support
the discussion
0-4.5 marks
Academic
Writing and
Presentation
(10 marks)
The report is logically and succinctly
structured according to academic writing
conventions.
The content is presented in such a
manner that it creates a cohesive,
coherent and analytical report.
There is use of formal academic
language throughout, including the
accurate use of nursing terminology.
The content consistently adheres to
grammatical conventions. There are no
spelling mistakes or errors in
punctuation.
8.5-10 marks
The report is logically
structured according
to academic
writing conventions.
The content is presented
in such a manner that it
creates a cohesive and
coherent piece of work.
There is use of formal
language throughout,
including the accurate
use of nursing
terminology.
The content mainly
adheres to grammatical
conventions. There are
only a few minor
spelling mistakes or
errors in punctuation.
7.5-8 marks
The report is generally
well structured according
to academic writing
conventions.
The content is structured
in such a manner that it
creates a mostly logical
and coherent piece of
work.
There is use of formal
language throughout,
including accurate use of
some nursing
terminology.
The content generally
adheres to grammatical
conventions, with some
minor spelling mistakes
and errors in punctuation
6.5-7 marks
The report is partially
organised into loosely linked
and basic paragraphs.
There is occasional use of
informal language and/or the
use of nursing terminology
requires improvement.
The content mostly adheres to
grammatical conventions,
though there are some spelling
mistakes and errors in
punctuation evident.
5-6 marks
The report does
not adhere to
academic writing
conventions and is
disjointed and/or
poorly organised.
There is frequent
use of informal
language and/or
nursing
terminology is
either not used or
incorrectly
applied.
There are multiple
spelling mistakes
and errors in
punctuation.
0-4.5 marks
All sources are explicitly acknowledged
All sources are explicitly
acknowledged in-text.
The majority of sources
used have been explicitly
acknowledged.
Some sources have not been
explicitly acknowledged in the
report.
Multiple sources
not acknowledged
or no in-text
referencing
included
and/or
APA referencing
Charles Sturt University Subject Outline
NRS223 201760 B D-8 June 2017-Version 1 Page 15 of 30
Criteria HD DI CR PS FL Mark
Referencing
(10 marks)
in-text.
APA guidelines for in-text referencing
and the reference list are consistently
adhered to.
All sources cited-in text match those
cited in the reference list.
8.5-10
APA guidelines for
in-text referencing and
the reference list are
mostly adhered to, with
1 or 2 minor errors.
All sources cited-in text
match those cited in the
reference list
7.5-8
APA guidelines for
in-text referencing and
the reference list are
mostly adhered to, with
some minor errors.
All sources cited-in text
match those cited in the
reference list.
6.5-7
There has been attempt to
adhere to APA guidelines for
in-text referencing and the
reference list, but errors are
evident.
There are 1-or two
inconsistencies between the
in-text the sources cited in text
and those cited in the reference
list.
5-6
guidelines have
not been adhered
to in-text or in the
reference list
and/or
There are multiple
inconsistencies
between the
sources cited
in-text and those
cited in the
reference list.
0-4.5
Final Mark /100: Converted Mark / 50
Comments
Charles Sturt University Subject Outline
NRS223 201760 B D-8 June 2017-Version 1 Page 16 of 30
Presentation
Please ensure that your submitted report meets the presentation requirements below:
3 cm margins
Work must be double spaced
Font must be 12pt, unless otherwise indicated
Number all pages
Include your name and student number in the header or footer of every page
All assignments should include a title page which includes – student name & number, subject code and
name, lecturer, assessment title, due date and date of submission.
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