Case Study Assessment Task – Nursing Care for Acute Ischaemic Stroke

Assignment Brief: Case Study Assessment Task – Nursing Care for Acute Ischaemic Stroke (2025)

Course: Bachelor of Nursing (Year 2) Assessment Title: Acute Stroke Management: A Comprehensive Case Study Weighting: 40% Word Limit: 2,500 words (excluding references and appendices) Due Date: Friday, 14 November 2025, 5:00 PM AEDT Submission: Via LMS (Turnitin enabled)

Overview

This assessment task requires you to apply the nursing process (assessment, diagnosis, planning, implementation, and evaluation) to a simulated acute care scenario involving a patient with an ischaemic cerebrovascular accident (CVA). Drawing on evidence-based practice, you will address immediate nursing priorities, interdisciplinary collaboration, and patient-centred care considerations. The scenario is adapted from contemporary Australian clinical guidelines (e.g., Australian Stroke Foundation, 2024 updates) and incorporates cultural safety principles relevant to diverse populations in Australia.

Your response should integrate therapeutic communication, risk management, and holistic care, with a focus on the acute phase transitioning to rehabilitation. Use APA 7th edition for referencing. Support your answers with at least 8 credible sources, including peer-reviewed journals from 2019–2025.

Patient Scenario: Mr. Liam O’Reilly

Mr. Liam O’Reilly is a 51-year-old male (identifies as he/him) admitted to the acute stroke unit at Royal Melbourne Hospital following sudden onset of right-sided weakness, slurred speech, and confusion while at work. His colleague called emergency services after finding him slumped over his desk.

He has been diagnosed with a right-sided ischaemic CVA in the middle cerebral artery territory, confirmed by CT angiography. He was thrombolysed within 2.5 hours of symptom onset and commenced on dual antiplatelet therapy.

Family and Social History

• Born in Australia to Irish immigrant parents
• Catholic, speaks English only
• Lives with wife Sarah (48 years old) and three children: Emma (16), Jack (12), and Mia (8 years old)
• Works as a construction supervisor; supports extended family financially
• Recent stressors: Job redundancy fears due to industry slowdowns post-2024 economic shifts

Medical History

• Hypercholesterolaemia
• Obstructive sleep apnoea (uses CPAP at night)
• Gastro-oesophageal reflux disease (GORD)
• History of mild anxiety disorder
• Hearing impairment (right ear, uses hearing aid)
• No known allergies

Medication (Pre-Admission)

• Atorvastatin 40 mg daily
• Omeprazole 20 mg daily
• Lorazepam 0.5 mg as needed for anxiety

Admission Observations

• BP: 165/95 mmHg
• PR: 92 bpm, irregular
• RR: 20 breaths/min
• T: 37.2°C
• SpO2: 94% on room air
• BGL: 6.2 mmol/L
• Weight: 92 kg
• Height: 178 cm
• GCS: 13 (Eyes: 3, Verbal: 4 slurred, Motor: 6)
• Oriented to person and place, disoriented to time
• Left hemiparesis (arm and leg)
• PERLA (Pupils equal, reactive to light and accommodation)

Issues/Impacts of the CVA

• Moderate headache, rated 6/10
• 4 cm laceration on left forearm from fall at work
• Aphasia (expressive > receptive)
• Impaired swallowing (coughing on sips of water)
• Left-sided neglect
• Mild left facial droop
• Risk of aspiration due to reduced gag reflex

Initial Doctor’s Orders and Interventions

• Bed rest with head of bed elevated 30 degrees
• Hourly neurological observations for first 24 hours
• Nil by mouth (NBM) pending speech pathology swallow assessment
• Occupational therapy review for activities of daily living (ADLs)
• Full assistance with personal hygiene and mobility
• Indwelling urinary catheter (IDC) inserted
• Intravenous saline 0.9% at 100 mL/hr via left antecubital cannula
• Prophylactic low-molecular-weight heparin (subcutaneous)

Discharge Information Mr. O’Reilly is expected to remain in acute care for 10–14 days, followed by transfer to the Victorian Rehabilitation Centre for intensive therapy. The multidisciplinary team (including social work) has initiated contact with NDIS for home modifications and community nursing support post-discharge. Family education on telehealth monitoring apps for follow-up is planned.

Assessment Questions

Provide evidence-based responses to each question below, relating directly to Mr. O’Reilly’s scenario. Use subheadings for clarity and integrate cultural safety (e.g., respecting his Irish-Australian heritage and family roles).

1. Room Preparation for Admission Explain how you would prepare the hospital room for Mr. O’Reilly’s admission, considering his hemiparesis, aphasia, and risk of falls. Include at least four specific safety and comfort measures aligned with Australian Commission on Safety and Quality in Health Care standards (2025).
2. Initial Assessment Equipment List four pieces of equipment required to conduct a comprehensive admission assessment on Mr. O’Reilly, justifying each with reference to his clinical presentation (e.g., vital signs instability or neurological deficits).
3. Nursing Documentation Essentials Identify four key components of accurate nursing documentation (including electronic health record practices) in the context of acute stroke care. Explain their importance for Mr. O’Reilly’s multidisciplinary management.
4. Admission Anthropometrics Discuss the clinical rationale for measuring and recording Mr. O’Reilly’s weight and height on admission, linking to stroke-specific risks such as medication dosing and nutritional planning.
5. Clinical Handover You are providing a bedside handover to the incoming shift team using the ISBAR framework. Outline the key information you would include for each element in relation to Mr. O’Reilly:
   • I (Identify)
   • S (Situation)
   • B (Background)
   • A (Assessment)
   • R (Recommendation)
6. Pathophysiology of CVA Mr. O’Reilly has experienced an ischaemic CVA.
   • Explain the two primary types of CVA, including their anatomical locations, underlying causes, and differences in acute management.
   • Identify four clinical indications of a right-sided CVA as observed in Mr. O’Reilly.
7. Comorbidities and Holistic Impacts
   • List and briefly describe three comorbidities from Mr. O’Reilly’s history that may influence his stroke recovery.
   • At 51 years of age, discuss how anxiety disorders can impact individuals in middle adulthood, particularly in the context of sudden neurological events like stroke, including effects on family dynamics and rehabilitation adherence.
8. Nursing Care Plans The registered nurse has developed four priority nursing diagnoses based on the nursing process:
   • Impaired verbal communication related to aphasia
   • Risk for aspiration related to dysphagia
   • Acute pain related to headache and laceration
   • Impaired physical mobility related to left hemiparesis

   As an enrolled nurse contributing to the team, for each diagnosis, provide:

   • Two evidence-based nursing implementations (actions).
   • One rationale for each implementation (linked to stroke pathophysiology or guidelines).
   • One evaluation criterion for each implementation (measurable outcome).

Marking Criteria

• Content Knowledge (40%): Accurate application of stroke pathophysiology, nursing process, and evidence-based interventions.
• Critical Analysis (30%): Integration of scenario-specific details, cultural safety, and interdisciplinary links.
• Structure and Communication (15%): Logical flow, ISBAR clarity, professional language.
• Referencing and Presentation (15%): APA 7th compliance, 8+ sources (2019–2025), within word limit.

Academic Integrity: Plagiarism will result in zero marks. Use paraphrasing and cite all sources. Consult the university’s AI policy for tool use in drafting.

Support Resources:

• Australian Stroke Foundation Clinical Guidelines (2024)
• Nursing and Midwifery Board of Australia Code of Conduct (2023)

Suggested Peer-Reviewed References

These references align with key themes in the assignment (acute stroke management, nursing interventions, psychosocial impacts, and care planning) and are drawn from reputable databases like PubMed and Google Scholar (2019–2025).

Jiang, L., Cheng, L., Li, X., & Yan, J. (2022). What should nurses do on post-stroke depression? A global systematic assessment of clinical practice guidelines. BMJ Open, 12(11), Article e064069. https://doi.org/10.1136/bmjopen-2022-064069

Madu, C. S., & Ajibade, V. M. (2025). Acute stroke management and nursing intervention. Cureus, 17(6), Article e86820. https://doi.org/10.7759/cureus.86820

Nazari, A. M., Abbaszadeh, A., Kazemi, R., & Zandi, M. (2025). Design and validation of a comprehensive educational program for stroke nursing care: A mixed methods study. BMC Medical Education, 25, Article 1056. https://doi.org/10.1186/s12909-025-07623-8

Siewers, K., Svaerke, K., Rosenørn, A. E., & Christensen, H. (2025). Nutritional care in rehabilitation and acute care of stroke patients: A systematic review of clinical practice guidelines. Frontiers in Stroke, 4, Article 1558019. https://doi.org/10.3389/fstro.2025.1558019

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II;

Assignment Brief: Case Study Assessment Task – Nursing Care for Chronic Illness and Palliative Management (2025)

Course: Bachelor of Nursing (Year 3) Assessment Title: Palliative Approaches in Chronic Respiratory Disease: A Holistic Case Study Weighting: 35% Word Limit: 2,200 words (excluding references and appendices) Due Date: Monday, 17 November 2025, 11:59 PM AEDT Submission: Via University LMS (with plagiarism check)

Overview

This assessment requires you to demonstrate application of the nursing process in the context of chronic illness management with a palliative focus. You will analyze a case involving advanced chronic obstructive pulmonary disease (COPD), incorporating evidence-based palliative care principles, symptom management, and family-centered support. The scenario draws from updated Australian guidelines (e.g., Lung Foundation Australia, 2024; Palliative Care Australia, 2025 standards) and emphasizes cultural sensitivity for multicultural patients.

Responses should address ethical considerations, advance care planning, and interdisciplinary collaboration. Use APA 7th edition referencing with at least 7 credible sources (peer-reviewed, 2019–2025).

Patient Scenario: Mrs. Elena Rossi

Mrs. Elena Rossi is a 72-year-old female (identifies as she/her) admitted to the palliative care unit at St. Vincent’s Hospital for exacerbation of advanced COPD and symptom palliation. She was found at home by her daughter, struggling to breathe after a short walk to the kitchen. Emergency services noted severe dyspnea and initiated oxygen therapy en route.

She has been diagnosed with end-stage COPD (GOLD Stage IV), with recent complications including cor pulmonale. She is on palliative oxygen therapy and has expressed wishes for comfort-focused care via an advance care directive.

Family and Social History

• Born in Italy, migrated to Australia at age 25
• Catholic, speaks Italian and English (prefers Italian for emotional discussions)
• Widowed; lives alone in a suburban home but receives daily visits from daughter Maria (45 years old) and grandchildren Luca (18) and Sofia (14)
• Retired factory worker; strong family ties, values independence
• Recent stressors: Isolation due to mobility limitations and fear of burdening family

Medical History

• COPD (diagnosed 15 years ago, ex-smoker with 40 pack-year history)
• Chronic heart failure (secondary to COPD)
• Osteoporosis
• Anxiety disorder
• Vision impairment (wears bifocals)
• No allergies

Medication (Pre-Admission)

• Tiotropium inhaler 18 mcg daily
• Salbutamol inhaler as needed
• Furosemide 40 mg daily
• Sertraline 50 mg daily for anxiety
• Morphine sulfate (slow-release) 10 mg twice daily for dyspnea

Admission Observations

• BP: 140/85 mmHg
• PR: 102 bpm, irregular
• RR: 28 breaths/min, labored
• T: 37.0°C
• SpO2: 88% on 2L nasal prongs
• BGL: 5.8 mmol/L
• Weight: 52 kg
• Height: 158 cm
• GCS: 15 (alert, oriented)
• Dyspnea scale: 8/10 at rest
• PERRLA (Pupils equal, round, reactive to light and accommodation)

Issues/Impacts of Advanced COPD

• Severe shortness of breath, worsened by minimal exertion
• Chronic cough with minimal sputum
• Fatigue and muscle wasting
• Anxiety attacks related to breathlessness
• Right-sided heart strain (edema in ankles)
• Sleep disturbances due to nocturnal dyspnea
• Risk of hypercapnia with oxygen use
• Emotional distress about prognosis

Initial Doctor’s Orders and Interventions

• Low-flow oxygen (1-2L) titrated to SpO2 88-92%
• 4-hourly respiratory observations
• Oral intake as tolerated; dietitian review for nutritional support
• Social work review for family support
• Assistance with ADLs; bed rest with elevation
• IDC if urinary retention develops
• Subcutaneous morphine as needed for breakthrough dyspnea
• Advance care planning discussion

Discharge Information Mrs. Rossi is anticipated to stay in the palliative unit for 7-10 days for stabilization, then transition to community palliative care with home visits. The team has engaged Aged Care Assessment Team (ACAT) for potential residential aged care options. Family education on non-invasive ventilation alternatives and end-of-life signs is scheduled.

Assessment Questions

Respond to each question with evidence-based rationale, linking to Mrs. Rossi’s scenario. Incorporate cultural safety (e.g., respecting her Italian heritage and family involvement). Use subheadings.

1. Room Preparation for Admission Explain how you would prepare the palliative care room for Mrs. Rossi’s admission, focusing on dyspnea management, fall prevention, and comfort. Include four specific measures aligned with Palliative Care Australia standards (2025).
2. Initial Assessment Equipment List four pieces of equipment needed for Mrs. Rossi’s admission assessment, justifying each based on her COPD presentation (e.g., respiratory compromise or cardiac involvement).
3. Nursing Documentation Essentials Identify four components of effective nursing documentation in palliative care (including electronic records). Explain their role in ensuring continuity for Mrs. Rossi’s interdisciplinary team.
4. Admission Anthropometrics Discuss why measuring and recording Mrs. Rossi’s weight and height on admission is crucial, relating to chronic illness risks like malnutrition and medication adjustments.
5. Clinical Handover Provide a bedside handover to the next shift using ISBAR, tailored to Mrs. Rossi:
   • I (Identify)
   • S (Situation)
   • B (Background)
   • A (Assessment)
   • R (Recommendation)
6. Pathophysiology of Chronic Condition Mrs. Rossi has advanced COPD.
   • Explain the two main types of COPD (emphysema and chronic bronchitis), including causes, locations, and palliative implications.
   • Identify four clinical indications of end-stage COPD as seen in Mrs. Rossi.
7. Comorbidities and Holistic Impacts
   • List and describe three comorbidities from Mrs. Rossi’s history that complicate her palliative care.
   • At 72 years old, discuss how anxiety affects older adults with chronic illness, including impacts on family roles and adherence to palliative plans.
8. Nursing Care Plans The registered nurse has identified four priority nursing diagnoses:
   • Ineffective airway clearance related to chronic cough
   • Activity intolerance related to dyspnea
   • Chronic pain related to breathlessness
   • Anxiety related to prognosis

   As an enrolled nurse, for each diagnosis, provide:

   • Two evidence-based nursing implementations.
   • One rationale for each implementation (tied to COPD palliative guidelines).
   • One evaluation criterion for each implementation (measurable).

Marking Criteria

• Knowledge Application (35%): Accurate integration of palliative principles and chronic illness management.
• Analysis and Evidence (35%): Scenario linkage, cultural considerations, and peer-reviewed support.
• Structure (15%): Clear organization, ISBAR accuracy, professional tone.
• Referencing (15%): APA compliance, 7+ recent sources, word adherence.

Academic Integrity: Cite all ideas; plagiarism results in failure. Refer to AI usage policy.

Resources:

• Lung Foundation Australia COPD Guidelines (2024)
• NMBA Standards for Practice (2023)

Suggested Peer-Reviewed References

These references focus on palliative nursing in chronic COPD, sourced from PubMed and scholarly databases (2019–2025).

Houben, C. H. M., Spruit, M. A., Wouters, E. F. M., & Janssen, D. J. A. (2023). The effect of an integrated palliative care intervention on quality of life in patients with COPD: A randomized controlled trial. The Lancet Respiratory Medicine, 11(6), 515–523. https://doi.org/10.1016/S2213-2600(23)00045-7

Mechler, K., & Liantonio, J. (2019). Palliative care approach to chronic diseases: End stages of heart failure, chronic obstructive pulmonary disease, liver failure, and renal failure. Primary Care: Clinics in Office Practice, 46(3), 415–432. https://doi.org/10.1016/j.pop.2019.05.008

Miller, S., Higgins, E., Cain, J., Coyne, P., Peacock, R., Logan, A., Fasolino, T., & Lindell, K. (2024). Dyspnea and palliative care in advanced COPD: A rapid review. Journal of Hospice & Palliative Nursing, 26(4), 195–204. https://doi.org/10.1097/NJH.0000000000001042

Pascoe, A., Chen, X., & Smallwood, N. (2025). A narrative review of proactive palliative care models for people with COPD. Therapeutic Advances in Respiratory Disease, 19. https://doi.org/10.1177/17534666241310987

Scheerens, C., Chambaere, K., Pardon, K., Derom, E., Van Belle, S., Joos, G., Pype, P., & Cohen, J. (2019). Development of a complex intervention for early integration of palliative home care into standard care for end-stage COPD patients: A Phase 0-I study. PLoS ONE, 14(1), Article e0208932. https://doi.org/10.1371/journal.pone.0208932