A case study report requires students to analyse a case, in order to address specific aspects of the case through responses to focused questions that are relevant to a unit of study¹.

This assessment is relevant to two subjects and is divided into two parts:

• NSG2204 Professional Studies 4: Indigenous Culture and Health (Part A), and
• NSG2201 Nursing 4: Nursing Care B (Part B)

Instructions for completing the Case Study Report

You are required to carefully read through the Case Study attached to complete Part A and Part B questions relating to the case study and relevant to each unit of study.

Part A must be submitted with its own coversheet and reference list for NSG2204

Part B must be submitted with its own coversheet and reference list for NSG2201.

Each ‘Part’ is then individually assessed by the relevant subject coordinators.

Part A for NSG2204

• Weighting = 40%
• Word limit = 1500 words
• Due = Week 11 – 2000 hrs, Sunday 17^th October, 2021

Part B for NSG2201

• Weighting = 35%
• Word limit = 1500 words
• Due = Week 11 – 2000hrs, Sunday 17^th October, 2021

NOTE: If you are studying one subject only, you will only be required to submit the part of the case study report that relates to that one subject. For example, for NSG2204 you only complete Part A. For NSG2201 you only complete Part B

¹ Western Sydney University Library (2016) ‘Case Study Purpose’ https://westernsydney.edu.au/studysmart

BACKGROUND HISTORY

Arnhem land is an area of approximately 100,000 square kms in the north-eastern corner of the Northern Territory (NT) in Australia. It is home to the Yolngu people; the Indigenous custodians of the land who have lived there for at least 40,000 years and continue to engage in many traditional cultural practices^2,3..

However, the health of the Yolngu and other Aboriginal people in this region is generally poor, with people experiencing a high burden of preventable ‘lifestyle’ diseases that are clearly linked to poverty, poor infrastructure and disadvantage^4,5_. Babies from this region are often born underweight; children are at risk of infectious diseases, pneumonia, otitis media, skin diseases such as scabies and Rheumatic Heart Disease; and adults are at risk of chronic conditions such as diabetes and cardiac disease^6,7.

Mae Roberts is a 45 year old Yolngu woman from Yirrkala in East Arnhem. Yirrkala is a small, very remote town 900kms east of Darwin; where 13 clan groups speak different dialects of local language and live between Yirrkala and the surrounding homelands⁸. According to the 2016 census, the population is 809 people who are mostly Aboriginal and/or Torres Strait Islanders (83.1%) and mostly young with a median age of 26 years⁹. Low educational attainment and high unemployment are common, and most people live in family groups with children, in houses with an average of 6.6 people¹⁰.

Mae Roberts grew up in a traditional household in Yirrkala; living in a two-bedroom house with her mother, two aunties, an uncle and four siblings. Mae speaks and understands a little bit of English, but her native language is Yolŋu Matha. Mae’s mother was a stolen generation child who was taken from her home in Yirrkala at the age of 7 to work on a mission in Milingimbi some 1,434km away from Yirrkala. As a consequence, Mae’s mother was often sad, drank too much and sometimes wouldn’t leave the house for days. Mae doesn’t remember anything about her father.

Mae recalls always having a sore throat and itchy skin sores most of her childhood and remembers a number of horrible experiences where she was given very painful injections into her bottom. Her Aunty took her for these injections as it was too upsetting for her mother, but Mae remembers screaming and running away from the nurse because the injections hurt so much. Mae experienced terrible treatment from health providers when she was a child, as they either blamed her mother or Mae herself for not coming to the clinic for ‘them injections’ and said it was their fault for ‘livin all together in that dirty house’. Mae and her family rarely understood what was expected of them given the language barrier, but they did understand that they were treated poorly and never really understood much about ‘her sickness’. Mae remembers feeling terrified of ‘that nurse’ and her family feeling sad and angry for those ‘hurting injections’, which they told

Mae she could stop having. Mae now lives in Yirrkala with two sisters, her brother, two of her siblings and four of her grandchildren (10 people in the home).

CURRENT MEDICAL HISTORY

Mae has felt quite unwell lately, finding it harder and harder to get her ‘wind’, especially when she’s trying to ‘do things’ (dyspnoea worse on exertion). She has told her family that she is tired all the time with ‘short wind’, has ‘racing one’ in her chest and feels ‘a dizzy one’ in her head (extreme fatigue, palpitations and light-headedness). Mae has such ‘short wind’ and ‘racing one’ in her chest that she has to sit down most of the time.

Mae sees the doctor at the local medical service who examines her, does an ECG and explains she needs to see a cardiologist urgently and needs to fly down to Royal Adelaide Hospital. Mae is alarmed (as is her family) as Adelaide is 3,332 km from Yirrkala, and ‘a long, long way off country’ as Mae says. Mae has never been ‘off country’ or away from family for any length of time, and is terrified about going to hospital so far away. After much discussion Mae understands she is very unwell and the doctor organises to access funding for her sister to fly with her. Mae’s sister asks other family to ‘look after the kids’ because she and Mae usually care for the four grandchildren. Mae’s doctor commences her on Penicillin and tells her that this is to ‘prevent any further damage to her heart’.

Mae’s provisional diagnosis is Mitral valve stenosis, secondary to Rheumatic Heart Disease.

PAST MEDICAL HISTORY

• Acute Rheumatic Fever (ARF) at 6 years old post Group A streptococcal throat infection
• Chronic tonsillitis as a child and adolescent
• Hypertension
• Hypercholesterolemia
• Rheumatic Heart Disease (diagnosed 2011)
• Multigravida (2 live births)

FAMILY MEDICAL HISTORY

Coronary Heart Disease, Alcoholism, Depression, Type 2 Diabetes Mellitus (T2DM) (Mother died at 44 years from cardiac failure?); Father unknown;

CURRENT MEDICATIONS

• Ramipril 10mg/day
• Pravastatin 40mg/nocte
• Panadol 1g/PRN
• Benzathine Benzylpenicillin G (BPG or Bicillin) injection every 3-4 weeks

PART A FOR SUBMISSION TO NSG2204

CASE STUDY REPORT INSTRUCTIONS

Please read the case study carefully, so you have the context for Mae’s health condition and impending admission to hospital.

• Please address Questions 1 – 4 below in 1,500 words +/- 10%
• Use headings to make it clear which question you are addressing. Note: headings are NOT counted in the word count
• Beside each question is a guide to the word limit to help you structure your report. This is a guide only, so you may be under or over the suggested word count, as long as you answer each of the questions sufficiently to meet the rubric criteria and do not exceed the 1,500 word +/- 10%
• Each response must be referenced appropriately with relevant and recent literature and a reference list with at least 10 references must be included with your submission.
• Please make sure that you proof read your work for spelling, grammar and syntax prior to submission and include a coversheet (submit the coversheet separately)
• You must use APA 7^th referencing style for this submission.

CONSIDERATIONS AND PREPARATION FOR HOSPITAL ADMISSION AND DISCHARGE

Please respond to ALL the following questions described under EACH HEADING. Utilise relevant, peer- reviewed, evidence-based literature to support ALL responses

REFLECT: Epidemiology of Rheumatic Heart Disease

Refer to current health data about Rheumatic Heart Disease (RHD) in Australia to identify the prevalence and pattern of disease in Indigenous people. Critically analyse how this relates to Mae in relation to her risk factors and the social determinants that have impacted on her health to contribute to the development of RHD.                                                                                                                                                                 (500 words)

REFLECT AND RESPECT: Prevention and barriers experienced by the patient

Acute Rheumatic Fever with progression to Rheumatic Heart Disease is preventable. Explore some of the barriers Mae experienced to treatment and management for this condition.                                                                                                                                                                 (300 words)

COMMUNICATION AND ADVOCACY: Cultural Safety

Critically analyse the implications for Mae travelling to Adelaide so far off country and being away from her family and community. How might this affect her? How can health care staff advocate for Mae whilst she is in hospital to ensure she understands what is going on and feels culturally safe?                                                                                                                                                                 (350 words)

SAFETY AND QUALITY; COMMUNCIATION AND ADVOCACY: Collaborating for safe, quality care

A new medication regime and cardiac rehabilitation might be ordered for Mae for when she leaves hospital. Describe how health providers in Yirrkala might collaborate with other health and community service providers to ensure Mae can improve her health. Include how Mae be supported to take her medication safely and regularly.                                                                                                                                                                 (350 words)

CASE STUDY REPORT INSTRUCTIONS

Please read the case study carefully, so you have the background information regarding Mae’s health and current medical condition.

• Please complete Questions 1, 2 & 3 of this part of the assessment by referring to the case scenario.
• Once complete, submit PART B of this case study report into the allocated ‘Written Assessment task 2” drop-box on the NSG2201 Brightspace page
• You have been allocated 1500 words +/- 10% for PART B (approximately 500 words for each question).

Assessment Submission Instructions

• Please complete and submit a coversheet (located in the ‘Assessment’ section of Brightspace for NSG2201). Submit coversheet separately (to your Assignment) into the allocated ‘Written

Assignment 1’ drop box, so that it is not included in your Similarity Index

• Your writing must be consistent with academic writing. Please do not use dot points, however subheadings for each question are allowed.

• Ensure you edit your work to avoid errors in syntax, grammar and/or spelling

• A minimum of 10 evidence-based peer-reviewed references must be used for this task. Home – Nursing – LibGuides at Holmesglen

• Please ensure you use APA 7th referencing style (utilise Library referencing resources if you are unsure). Home – APA 7th Referencing Guide – LibGuides at Holmesglen

Additional information obtained on admission to hospital

Mae is given a provisional diagnosis of Mitral valve stenosis, secondary to Rheumatic Heart Disease.

On Examination

• Mae appears anxious.
• RR – 22bpm
• HR – 110 (regular)
• BP – 110/64
• Temp – 36.9
• O2 Sats – 94% RA

Investigations/Diagnostic tests

Pathology

• FBE (Hb – 13.2 g/dL, Hct 0.40, WBC count – 5 x 109/L, Plts – 250 x 109 /L)
• UEC’s (K = 3.5, Mg =0.85 mmol/L; Urea and Creatinine within normal parameters)
• LFT’s (within normal parameters)

Echocardiogram – severe mitral regurgitation; enlargement of left atria

ECG – sinus tachycardia (105bpm)

Please respond to ALL of the following questions. Utilise relevant, peer-reviewed, evidence-based literature to support your responses

QUESTIONS:

1.      Pathophysiology of Diagnosis

Describe the pathophysiology of Rheumatic heart disease and discuss how Mae’s past history of Rheumatic fever (as a child), may have progressed to this current diagnosis of mitral valve stenosis. What do the results of the above investigations tell you about her current presentation and prognosis?

2.      Focused Physical assessments and Medications.

Please note that this question consists of two sections (Assessment & Medications)

a)  Assessment

Identify two relevant focused systems assessments that you would perform on Mae and provide a rationale for your choices. Describe TWO abnormal findings you may note on performing these focused systems assessments (please include TWO abnormal findings per body system).

b)  Medications

Mae has been prescribed two new Medications (Digoxin and Carvedilol) by the Cardiologist. Discuss the action, indication and common side effects of each of these medications; and identify the nursing considerations involved in their administration.

3.      Complications and Clinical deterioration

Identify and discuss TWO potential complications associated with Mae’s diagnosis. What are THREE clinical cues (signs and symptoms) that would indicate deterioration in Mae’s condition.

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