Case Studies
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 ‐2

And 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.

•Identify two other stressors that Betty is experiencing based on her signs and symptoms
•Explain the mechanisms for how these stressors, both individually and collectively, induce a short-term or prolonged response to stress.
Part C (500 words)

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 America

The assignment needs to focus on stress response and be quite specific in regards to types of pain and neurohormonal responses.