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PARA2000 Pathophysiology 1 – Cardiovascular Assignment: Case Study Analysis
Evaluate the case below and choose two (2) potential differential diagnoses that relate to PARA2000 topic content.
The case study will provide you with an opportunity to discuss:
•    •? Key clinical signs of the case
•    •? Differential diagnoses and their rationales
•    •? The pathophysiology of those diagnoses
•    •? Current management practices
•    •? A critique on the evidence supporting the management practices
You are required to demonstrate a thorough understanding of the pathophysiology and provide rationales for your alternative diagnoses and interventions.
It is expected that you research the condition from both text books and current literature. At least five journal articles are expected to be part of your literature search (Less than 10 years old). The goal is to provide up to date evidence based practice for the management of the patient’s condition.
Higher grades will be awarded for evidence of extensive use of literature and a critical evaluation of the care provided for the patient.
2500 word limit
Case Scenario
Situation: You have been called to the office of a 57 year old woman, Lily, who experienced an episode of syncope.
Background: The patient has a history of has been complaining of feeling increasingly unwell for the last 24 hours with pain in her chest. She has been bruising easily over the last 3 months and is currently being investigated by her GP.
PMHx: Angina diagnosed 2 years ago, angioplasty (successful), HT, Asthma, GORD,
Med’n: Atenolol, GTN spray, transiderm-nitro patch, atorvastatin, salbutamol inhaler, symbicort inhaler, omeprazole, aspirin, paracetamol PRN,
Allergies: Morphine
Comm. Diseases – Nil Known, up to date with vaccinations
Social Hx: Lives with partner
Family Hx: Father died of heart disease, mother died of breast cancer Alcohol: Social
Smoking: stopped 10 years ago (30/day)
Assessment: When you arrive you find the patient looking distressed.
PARA2000 Pathophysiology 1 – Cardiovascul Vital signs: BP 90/60, PR 105, RR 28, SpO2 96%, T35.1°C,
Appearance: Pale, cool, clammy, distressed
You are expected to:
•    •? outline your potential diagnosis and defend your diagnosis from
pathophysiology.
•    •? provide an ECG appropriate to your diagnosis and explain why.
•    •? outline the paramedic management of your patient, including the vital
signs and defend how these align for your potential diagnosis against the A&P. Please see example for further clarification. (You may outline treatment up to the first 24 hours in hospital)

Assignment tips for PARA2000
[these are your notes which will be converted into prose for this assignment]
Potential diagnosis     Pathophysiology Underlying Diagnosis     Paramedic clinical practice interventions     Critique of interventions from literature
Potential Cardiac arrest from lethal arrhythmia due to low potassium K+     The heart relies on its internal pacemaker (SA node) and superconductive pathway to generate and disseminate cardiac action potentials. These action potentials cause the contraction of cardiac muscle tissues and the effective propulsion of blood throughout the body. Abnormal conduction of the action potential may cause ineffectual cardiac muscle function and thus catastrophic heat failure. The sodium potassium exchange across the cardiac cell membrane required to get an action potential and contraction of the cardiac muscle. (Reference)     Cardiac monitoring
•    •? Attach defibrillation monitor
& encourage early defibrillation should defibable arrhythmia occur
•    •? Continuous Monitoring of patients cardiac rhythm,
•    •? 1/24 vital signs eg BP. P RR SaO2 checks
•    •? Regular checks and management of electrolyte balances
•    •? 12 lead ECG
•    •? CPR & Medication
management of arrhythmia
•    •? (Referenced)     Critique each of the clinical practice intervention, defending is validity or not from the current literature linking this to the underlying pathophysiology of the potential diagnosis identified. (Referenced)
* Attachment and monitoring of the defibrillator of the cardiac patient during transport allows for the early defibrillation. Early defibrillation has increased success at reverting lethal arrhythmias and preventing death in a cardiac arrest (Ref1, Ref 2, Ref 3,…….)………
Paramedic
Introduction (the introduction may be brief but should cover major concepts)
[all in prose, sort of like an essay introduction]
Introduce the patient…. [it is okay if this part isn’t much different from others’ introduction of the patient, consider SBAR format]
The issues that will be discussed are………. They have been chosen because…….
Differential diagnosis [2 potential diagnoses]
[XXXXXXXXXXX] You will be not be graded on achieving my expected final diagnosis but on your ability to relate the signs and symptoms to a disease process and then on your suggested management and critique of the management that is defended from literature.
[make sure that you include the pathophysiology behind the diagnosis] XXXXXX (Reference).
Paramedic Intervention and Rationale
[What paramedic interventions/treatment are you doing and why are you doing them] The interventions that will address the issue of potential arrhythmias are as follows.
————————————————————————————————————————–
Working example of transferring bullet points into sentences
1.    Attach defibrillation monitor & encourage early defibrillation should defibable arrhythmia occur
2.    Continuous Monitoring of patients cardiac rhythm,
3.    1/24 vital signs eg BP. P RR SaO2 checks
4.    Regular checks and management of electrolyte balances
5.    12 lead ECG
6.    CPR & Medication management of arrhythmia
(Referenced)
————————————————————————————————————————–
[Intervention 1 in prose format, you will need to be more comprehensive in your assignment]
Attachment and monitoring of the defibrillator of the cardiac patient during transport allows for the early defibrillation and reverting of cardiac arrhythmias. Early defibrillation has been shown to have increased success at reverting lethal arrhythmias and preventing death in a cardiac arrest (Ref1, Ref 2, Ref 3,…….)………
The interventions need to be critiqued from literature as to how they will be treating, monitoring or managing the diagnosis they have chosen. This will include their paramedic guidelines. The assignment is designed to help them understand their practice and be able to critique what they do in a constructive format. They are allowed to discuss management into the hospital for the 1st 24 hours to assist them with the assignment and understanding the disease process.
Conclusion (sort of like an essay conclusion)
We’ve discussed ….
We’ve identified potential diagnoses such as….
These potential diagnoses should be addressed by the paramedic interventions as described. [This is purely optional: acknowledge that it is not comprehensive if you like, BRIEFLY
mentioning some examples of what you might have looked at.]
Good writing is concise yet still easy to read and cover all of the content required.

Student:
Case study Assignment
Assessable items     Comments     Max Grade     Your Grade
CONTENT         70
•    •? Introduces the assignment with a brief synopsis of the case and outline the writer intent
•    •? Accurately identifies the key diagnostic signs and relates these signs to a set of plausible differential diagnoses
•    •? Provides a plausible rationale for including each differential diagnosis
•    •? Selects no more than two (2) most likely diagnoses and comprehensively describes pathophysiology/pathology involved and underlying mechanisms responsible for each of the differential diagnoses
•    •? Accurately describes current management practices and/or therapies and provides an informed discussion of their benefits and limitations (from literature)
•    •? Identifies correct ECG and discusses why it appears in the diagnosis chosen
•    •? Identifies areas of current research and how outcomes are likely to aid the development of new therapies, prevention or management practices, detection methods etc (can be focussed on a specific aspect or generalistic)
•    •? Critically reviews information and correctly identifies knowledge gaps or areas of debate (can be focussed around a specific clinical aspect of the condition)
•    •? Provides a succinct summary section highlighting 2-3 key points as primary conclusions (based on evidence presented)
•    •? Higher marks will be awarded for a comprehensive exploration of the topic, with consistently sound critical evaluation of concepts and personal synthesis of issues.
STRUCTURE         10
•    •? Develops a sound and informative table of contents
•    •? Main points clearly identified, discussed in a logical and
sequential manner and directly related to the table of
contents
•    •? Paragraphs and sentences are well structured and linked
in terms of context and information content. Appropriate sentence length used with clear concept development and supporting detail provided with minimal repetition
•    •? Clear development of themes and/or discussion “arguments” based on critical review of the literature
•    •? Diagrams and figures used effectively to support text
PRESENTATION         5
•    •? Well set out; clear, easy to read style.
•    •? Grammatical and spelling accuracy.
•    •? Within 10% of word limit         2 2 1
EVIDENCE OF RESEARCH     15
•    •? Researched material is well synthesised into content, cited correctly and accurate details provided in a reference list conforming to Author-Date (Harvard or APA 5th) System.
•    •? Limited use of text books, with only peer reviewed sources used (no web sites)
•    •? Extensive use of primary references supporting critical evaluation of concepts and personal synthesis of issues, areas of debate
•    •? Clear distillation of referenced material into own words, NO evidence of plagiarism         5
2 5 3
OVERALL GRADE     100
PARA2000
Additional Comments
Case study Assignment
PARA2000

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