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Case study: Betty Betty an 80‐year‐old lives alone in her own home. She is active, attending the local senior citizens club. She receives meals‐on‐wheels and has assistance with her house keeping once a week. She has been unwell for a few days experiencing decreased appetite and episodes of angina that have responded to sublingual ANGININE. Betty has a history of angina, peripheral vascular disease and congestive heart failure. Her regular medications include an ACE inhibitor, selective beta blocker and digoxin. Betty’s family doctor referred her to hospital with dehydration. It is also noted she has cellulitis to her left leg. She was admitted to the medical ward. On day three Betty experiences shortness of breath with some chest pain that is not relieved by ANGININE. Clinical examination reveals acute pulmonary oedema. Clinical assessment reveals: Temperature 37.9 degrees Celsius RR 36 breaths/minute HR 120 beats/minute BP 180/110 mmHg SpO2 88% Urine output < 30 mL/hour (<0.5mL/kg/hr) Bilateral peripheral pitting oedema, with cellulitis left lower leg Chest auscultation reveals crackles and she is coughing pink frothy sputum Management includes: Bilevel noninvasive ventilation at 60% oxygen, Rate 16 breaths/minute IPAP 10 cm H2O, EPAP 5 cm H2O ECG and cardiac monitoring IV normal saline decreased to 42 mL/hour IV FRUSEMIDE Subcutaneous CLEXANE Indwelling catheter CXR reveals atelectasis and pulmonary oedema Betty is transferred to the HDU First ABG ABG after 30 minutes pH 7.3 7.3 PaO 60 mmHg 100 mmHg PaCO 55 mmHg 50 mmHg HCO 24 mmol/L 24 mmol/L Base excess ‐2 ‐2And here is the essay questions, needs to be attended in 3 parts:Assessment 2: Short answer essay – Betty 1500 words +/- 10% Weighting 30% The purpose of this assessment is to enable you to demonstrate your knowledge of the neurohormonal basis of the stress response through application to a case study.These short answer questions incorporate the case study of Betty and your responses must relate to the clinical manifestations identified for this patient. Please note: nursing care and management are not the focus of this assessment.You must complete all three parts.Click here to open the case study.Part A (500 words)Betty is exhibiting signs and symptoms of a number of acute and chronic stressors. Pain is one of the most significant stressors and poses major challenges for nurses.Betty is experiencing multiple types of pain.•List the potential causes of Betty’s pain and identify the types (or mechanisms) associated with each cause •Explain the physiological processes by which Betty’s pain will act as a stressor •Describe the likely outcome if Betty’s pain remains unrelieved. Part B (500 words)As well as pain, Betty is also experiencing multiple other stressors.Various factors, including the medications she is taking, will modify Betty’s response to stressors.•List the medications Betty is taking that would influence her body’s ability to mount a stress response. •Explain the mechanism of action and potential impact of these medications on the stress response. Include in your answer the physiological impact of Betty’s ACE inhibitor and beta blocker medications providing evidence of this from the clinical data.The prescribed text book for the subject is Marieb, E, N and Hoehn, K, N 2014, Human anatomy and Physiology, 9th edn, Pearson Education Limited, United states of AmericaThe assignment needs to focus on stress response and be quite specific in regards to types of pain and neurohormonal responses.

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