Author: Anonymous

LONG SCENARIO QUESTION ONLY ANSWER ONE QUESTION. Each questi…

LONG SCENARIO QUESTION ONLY ANSWER ONE QUESTION. Each question will have 4 corresponding questions – 10 marks per question. If you answer both questions in error, only the first question will be marked.   SCENARIO 1 Eddie is a 75-year-old retired shipyard worker. He was diagnosed with chronic obstructive pulmonary disease (COPD) 5 years ago and, until 6 months ago, was stable under the care of his GP on inhalers only. Over the last 6 months, Eddie has noticed a marked decline in his exercise tolerance and is increasingly breathless when undertaking day-to-day activities. During this period, he has had two hospital admissions, with infective exacerbations of his COPD requiring nebulisers, oxygen and antibiotics.  In addition to his COPD, Eddie has hypertension and high cholesterol. Socially, Eddie lives alone in a second-floor rented council flat. He is widowed and has a nephew who helps with shopping, but he has little time to offer more support. Eddie can still manage his personal care but is finding cooking and cleaning difficult, eating convenience, easy to prepare food. He used to meet up with friends a couple of times a week for a pint at his local pub, but has stopped doing this as he can no longer manage to get there, choosing to drink at home instead. Making matters worse, the flat lift is frequently out of order, making him feel trapped. Eddie has started to be wakeful at night, thinking about the future.   QUESTIONS FOR SCENARIO 1 Describe the pathophysiological changes that occur in COPD, and identify Eddie’s risk factors.(10 marks) Identify the common symptoms of COPD, and explain why oxygen therapy should be used with caution in patients with advanced COPD?. (10 marks) Taking a holistic approach, discuss Eddie’s potential biopsychosocial care needs and how these may be supported/ addressed? (10 marks) What strategies could help reduce Eddie’s risk of future COPD exacerbations? (10 marks)    SCENARIO 2 Rashid is a 65-year-old service user who is open to a community mental health team. He has a diagnosis of schizophrenia and is currently prescribed Risperidone. Rashid has been struggling to manage his mental health symptoms and has some difficulties adhering to his treatment regimen due to forgetfulness and disorganisation. Rashid often misses his oral treatment, which can lead to fluctuations in his psychotic symptoms and increase his risk of relapse. Rashid also has a diagnosis of hypertension, and there is a history of cardiovascular problems in his family. Unfortunately, Rashid has also missed many physical health monitoring checks at his GP practice due to poor engagement. His latest blood pressure reading is 160/94, and the GP is keen to commence him on an ACE inhibitor (Lisinopril 5mg) Rashid has a history of smoking and tends to consume a diet high in processed foods. He is overweight and leads a sedentary lifestyle  with an irregular sleep pattern. Rashid lives alone and describes himself as lonely and often overwhelmed and stressed due to an ongoing dispute with a neighbour about noise levels at night. He is feeling really upset about his social situation and wants to relocate to live closer to his family.    QUESTIONS FOR SCENARIO 2 1) Describe the pathophysiology of hypertension and identify potential long-term complications of hypertension. (10 marks) 2) What investigations would you recommend before Rashid commences on antihypertensive medication, and what side effects would you be observing for? (10 marks) 3) As a nurse, how would you support Rashid to achieve treatment compliance?  (10 marks) 4) Identify Rashid’s psychosocial care needs and how you, as the nurse, can support him? (10 marks)