You are a Graduate Nurse commencing your afternoon shift in a busy Emergency Department.
Your patient has been stepped down from the resuscitation bay to your monitored cubicle. The ISBAR
handover highlights:
• Identify: Robert is a 78-year-old male who presented to the Emergency Department 2 hours
ago. His wife Agnes is present with him at the bedside.
• Situation: after waking this morning with left upper and lower limb moderate weakness, left
side facial droop and aphasia. His wife noted his symptoms and called an ambulance. His CT
Brain confirms signs of a cerebrovascular accident (stroke), however because no time of
onset can be identified he is not a candidate for thrombolytic management.
• Background: Previous ST- elevation Myocardial Infarction (STEMI) 5 yrs ago with associated
Left Ventricular Failure (LVF), hypertension and hypercholesterolaemia. Managed with
medications: Aspirin, Furosemide, Enalapril, and Bisoprolol. He has nil known allergies.
• Assessments: Pathology has been sent for initial Urea & Electrolytes, Glucose, Full Blood
Examination, coagulation studies, cardiac markers, and C-Reactive Protein (CRP) and results
are normal so far. Initial ECG reveals Robert’s cardiac rhythm is Atrial Fibrillation, which is
new for him. Of interest, his vital signs indicate a moderate hypertension 165/96 and altered
conscious state GCS currently 12. He has two intravenous cannulas inserted to his left and
right cubital fossa.
• Review: Robert is awaiting a formal medical admission to stabilise his risk factors for further
cerebral vascular accident and commence rehabilitation.
Question 1: Using your existing knowledge of Cerebrovascular Accident (CVA), identify and
describe the pathophysiology of the most likely type of CVA Robert has presented with. In your
response include a definition, causes, clinical manifestations, and typical initial management. Ensure
you link this discussion to Robert’s presentation and history. (approx. 400 words)
You check on Robert to undertake routine post CVA assessments and note the following:
• Altered conscious state, GCS 10
• Temperature: 35.1 and cool on palpation
• Pulse: 65 bpm and irregular
• Blood Pressure: 196 / 120 mmHg
• Respiration: 14 bpm
• SpO2: 96% on room air
• Pain scale using Baker Wong pain scale indicates no pain.
Question 2: Discuss TWO specific nursing assessments that should be PRIORITY for Robert’s
deterioration (excluding vital signs). For EACH nursing assessment, ensure your discussion
includes a description of the undertaking of each assessment in the context of Robert’s condition AND
clear rationale as to why these assessments would be priority. (approx. 400 words).
…During your assessment, Robert starts to seize. You grab some gloves and observe no immediate
danger, Robert provides no pain response so you press the emergency call bell and lay the bed flat,
awaiting the assistance of other staff.
Question 3: Discuss THREE specific nursing interventions that YOU as a Graduate Nurse could
initiate to initially support Robert’s airway and ventilation. For EACH intervention, ensure your
discussion includes link to evidence-based practice AND provides rationale as to how it would improve
the physiological outcomes of Robert’s condition. (approx. 400 words)
*Nursing interventions would include nursing activities or actions that the nurse could initiate in
response to nursing assessment findings. Note: please be aware of the difference between an
assessment and an intervention.
The resuscitation team arrives and provides supportive care, and after 5 minutes a stat order of
Lorazepam 8mg Intravenously is prescribed.
Question 4: Describe the mode of action, indications, nursing administration, adverse effects,
and contraindications of Lorazepam within the context of administration in Robert’s
deterioration episode (approx. 300 words).
Question 5: Discuss THREE nursing evaluations that you would complete following the
administration of Lorazepam. For EACH evaluation, provide a brief rationale as to how each
evaluation will assist in preventing the further clinical deterioration of Robert considering his
management so far. (approx. 300 words).
Question 6: Despite the stress of observing Robert’s seizure, Agnes wishes to remain close by. Your
department works hard to ensure patient and family centred care is at the centre of care they provide.
Discuss how family centred care can be provided to Agnes during such a stressful event.
(approx. 200 words).
A minimum of 15 references must be used for the essay. These should be no more than
7 years old unless of historical significance and/or of specific relevance to the topic
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