Stress Management

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Question 1
Mr. Jones, aged 70 years, has a history of Left Ventricular Failure and has been admitted to a medical admissions unit with dyspnoea and is found to be tachycardic. He is accompanied by his wife. a) Discuss the immediate care that would be given by the multidisciplinary team to aid Mr Jones dyspnoea. (12Marks)

Feedback Question 1a:
Those who did well: demonstrated a clear understanding of the anatomy and physiology of the heart and the pathophysiology of LVF, discussing compensatory mechanisms, the development of pulmonary oedema and how this related to his clinical symptoms of dyspnoea and the involvement of the MDT. Those who did not do the question well: showed a lack of understanding of the anatomy and physiology of the heart and /or did not discuss correctly and with detail, the pathophysiology of LVF and the development of dyspnoea and tachycardia. It is advisable for students to revise the normal anatomy and physiology and pathophysiology relating to the development of LVF and dyspnoea caused by the presence of pulmonary oedema and show a clear understanding of the signs and symptoms a patient might present with.

b) His wife has handed over his medications bought in from home. These include furosemide (diuretic), enalapril (ace-inhibitor) and carvedilol (beta-blocker). With reference to the pathophysiology of left ventricular failure, explain the reason these drugs are prescribed. (6marks)

Feedback Question 1b:
Those who did well demonstrated understanding of the actions of each of the drugs and related this effectively to the pathophysiology. In so doing were able to clearly and concisely explain why these drugs were prescribed and how patients benefitted from the drug actions Those who did not do well demonstrated either a lack of knowledge or superficial awareness of the drugs in question. Knowledge of the rationale for prescribing these drugs was poorly explained and in many instances the question was avoided.

Mr. Jones’s condition begins to deteriorate and the multidisciplinary team discuss his management c) Explore one ethical issue which the team may discuss in relation to Mr. Jones’s care. (7 marks) Feedback Question 1c:

Those who did well: discussed appropriate considerations surrounding the chosen ethical decision. They showed understanding of the ethical principles behind their discussion (i.e. Autonomy, non-maleficence/ beneficence, justice, respect) and referred to relevant guidelines for example, Decisions relating to cardiopulmonary resuscitation (BMA; Resuscitation Council; RCN, 2007) Those who did not attempt the question well: did not explore the ethical decision effectively and made unethical assumptions, often in relation to the patient’s age and diagnosis. They were not clear on best practice or did not use ethical principles or guidance to rationalise their discussion.

Question 2
Maria Dolan is a 28 year old lawyer who has been transferred to your ward for Renal Replacement Therapy. Her original admission to the Emergency Department was for a crush injury in which her right leg was under a considerable weight for several hours. a)Clearly explain why a patient with a crush injury is at risk of developing acute renal failure. (10 Marks)

Feedback Question 2a:
Those who did well: demonstrated a clear understanding of compartment syndrome and rhabdomyolysis. Discussed anaerobic respiration/lactic acidosis, water & electrolyte imbalance and nephrotoxins as reasons for renal failure and demonstrated knowledge of the pathophysiological processes that led to this failure. Those who did not attempt the question well showed a lack of understanding of the pathophysiological...
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