Posted: April 3rd, 2015
physiology & development
Assessment 2: Short Essays
See case study information for Mary Smith, parts A & B.
Word count – 2000 words +/- 10%
The purpose of this assessment is to demonstrate your understanding of the materials presented in Sections 2 and 3 of your Study guide through your ability to analyse a case study and then construct a short essay in response to two direct questions on specific topics.
Question 1 (1000 words)
Section 2 of your Learning Guide is concerned with homeostasis. After you have worked through this section of your study guide, turn to page 4-53 where you will find a case study about three-year-old Mary Smith (Case study 2). Consider the neuroendocrine responses that have been activated in Mary’s acute presentation and how they work to restore homeostasis.
In your answer;
•provide an interpretation of Mary’s clinical presentation with clear links to the underlying pathophysiology
•explain the role of the sympathetic nervous system in the neuroendocrine response to Mary’s stressors
•explain how this response has affected Mary’s presenting signs and symptoms.
Use current literature to support your explanation.
Question 2 (500 words)
Mary’s case study continues on page 9-28. Interpret Mary’s progressing case information, making comment on her current blood pressure reading. Briefly describe how each of the following hormones affect her blood pressure:
•Adrenaline and noradrenaline
Question 3 (500 words)
It is reasonable to assume that Mary has an increased metabolic demand in response to her illness. You will notice that she has a fever and a history of recent vomiting thus not taking any oral nutrients. After reading Section 3 of your Learning Guide, describe how Mary’s increased metabolic requirements are met using her nutrient stores? What is the role of Cortisol?
The Marking Rubric for Short Essay will be used to mark this assessment
Case study A
Mrs Smith and her three-year-old daughter Mary, present at 1800 hours to the local emergency department. Mary has recently been diagnosed with acute lymphoblastic leukaemia and has completed her consolidation chemotherapy cycle two weeks ago. She still has her central venous catheter in-situ. Today she has been unwell with a fever (38.9ºC), she had a moist cough, had vomited all her lunch and was complaining of abdominal pain. Her mother also stated she had become lethargic during the afternoon, which was the main reason she had brought her to be reviewed by the hospital staff. She had last passed urine at 1100 hours.
On assessment the nurse noted the following observations:
Mary lay quietly on the bed, and was very compliant.
She had a moist cough and moderate retractions.
Mary’s vital signs were recorded as;
T 39ºC per auxilla
RR 40 breaths/min
HR 100 beats/min
SaO2 91% in room air
On auscultation: air entry R<L, mod wheeze R lung fields.
Case study B (continued)
Remember three-year-old Mary from Section 4, with acute lymphoblastic leukaemia, who had just finished her consolidation chemotherapy cycle (reread Case study 2 from Section 4 [4-53] to refresh your memory)?
In the ED Mary was commenced on oxygen via face mask at six litres per minute, a peripheral cannula was inserted and blood was taken for full blood count and cultures. Maintenance fluids were commenced and Mary was taken for a chest x-ray.
After the chest x-ray Mary’s skin colour looked pale. Her limbs were cool and mottled, with a capillary refill time greater than three seconds. She was irritable, difficult to rouse and having difficulty following directions.
Vital signs recorded at this time were;
HR – 160 beats/minute
RR – 46 breaths/minute
T – 39.5ºC per axilla
BP – 88/50
It was also noted that Mary had still not passed any urine since admission and it was now 1900 hours (Mum last reported Mary passing urine at 1100 hours).
Bloods and chest x-ray were reported on urgently. The full blood count showed a marked neutropaenia and chest x-ray confirmed the presence of a right lower lobe consolidation. IV antibiotics were commenced and Mary’s oncologist was paged for further consultation.
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