With reference to homeostasis and the respiratory system, explain why Sarah is short of breath.

QUESTION 1: 250 words

Sarah (37 years old) has been feeling unwell for a couple of days. She has been taking 1g of paracetamol a couple of times a day. However she has been starting to feel worse. She is a smoker and is used to coughing, but it seems to be worse than usual, and her chest is feeling tight. She is also coughing up some sputum. She makes an appointment at her GP surgery to see the practice nurse.

The practice nurse notes that Sarah looks to be struggling with her breathing a little. Sarah has a productive cough, and the practice nurse takes a sputum sample.

The practice nurse takes observations from Sarah. They are as follows:

• Oxygen saturation - 94% on air
• Respiration rate – 24
• Pulse - 86 bpm
• Blood pressure - 125/85 mmHg
• Temperature - 38.5°c
• ACVPU - Alert.
• NEWS2 score is 4.

Question 1:

With reference to homeostasis and the respiratory system, explain why Sarah is short of breath.

QUESTION 2: 250 words

Asya (19 years old) was admitted for a review of her medication. She has a physical disability since she was involved in a road traffic collision 5 years ago. This means she needs some assistance with her personal care. After 24 hours as an in-patient she has a hospital acquired infection. Her family are not happy, as they feel that a couple of members of the ward team are not very diligent with washing their hands between helping patients.

Question 2:

With reference to contemporary UK evidence, explain why handwashing is the single most important clinical practice to reduce the risk of spreading disease.

QUESTION 3: 250 words

Arthur (68 years old) has had a vomiting bug for since yesterday afternoon. It is now the morning the day after he started. He still feels nauseas and has not managed to drink anything substantial since yesterday lunch time. He has now stopped vomiting. He thinks that he has not passed urine since last night and does not want to go now. He has a bad headache. He feels very thirsty, and his lips are dry.

He decides to try and pass urine and when he passes a small amount he notices that it is coloured quite a dark brown with a strong odour and stings upon voiding. When he stands he also feels very lightheaded and needs to sit down again straight away. He can feel his heart racing.

Question 3:

With reference to the renal system, explain what is happening physiologically in this scenario.

QUESTION 4: 250 words

Najma (41 years old) has had pain passing urine the last couple days. Today she has woken early and feels rotten. She has a high fever and is feeling shaky. Her husband persuades her to make an appointment with the practice nurse.

The practice nurse can see immediately that Najma is not well at all when she comes in the room. The practice nurse is very concerned and decides to take Najma’s observations, which are as follows:

• respiration rate of 25
• oxygen saturations of 93% on air
• blood pressure of 95/68mmHg
• pulse of 112 bpm
• temperature of 38.8 °c
• ACVPU scores Alert
• NEWS2 score of 8

The practice nurse refers to the sepsis guidelines. She begins oxygen therapy and calls an ambulance. Whilst she is waiting for the ambulance she takes a blood sample and puts an IV cannula in situ.

Question 4:

With reference to sepsis provide an explanation of the pathophysiology in this scenario.

QUESTION 5: 500 words

Donald (32 years old) has been passing blood in his stool on and off for a few weeks. He is persuaded to see the practice nurse. Upon history taking he shares that his father died of bowel cancer, and that his brother also had successful treatment for bowel cancer a couple of years ago. Donald is referred for urgent investigation. He asks the nurse if he is likely to have bowel cancer as inherited from his father. The practice nurse reassures Donald and explains that at this stage she is not able to answer that clearly, but with some investigations they will understand more and be able to support Donald.

Question 5:

With reference to genomics and pathophysiology of cancer provide an exploration of this scenario.

QUESTION 6a: 500 words

Hafsa (71 years old) has been diagnosed with Parkinson’s for 3 years. She has a meeting with the Parkinson’s nurse specialist and feels that her symptoms have become much worse over the last 3 months. On examination she has increased rigidity and tremor. There is no evidence of infection. Previously symptoms have been manageable without medication. Hafsa has been prescribed Sinemet+ 25/100mg one tablet at 8am and 8pm.

Question 6a:

With reference to pathophysiology and pharmacology provide an exploration of this scenario.

QUESTION 6b: 500 words

Kat is a 68-year-old woman who was diagnosed with Alzheimer’s disease 12 months ago. Over the last 6 weeks her daughter has reported to you that her symptoms seem to be getting much worse. She has more noticeable short term memory problems and her daughter reports that she seems more aggressive at times and more confused which has led to some difficulties in maintaining her own safety. Daphne has also been complaining of headaches and periods of feeling dizzy. Daphne was prescribed Memantine 5mg OD originally, and this had been increased to 10mg OD 4 weeks ago by the GP.

Question 6b:

With reference to pathophysiology and pharmacology provide an exploration of this scenario.