RMIT University

School of Health and Biomedical Sciences

MEDS 2148 Clinical Presentations across the Lifespan

Case Study
Mrs Dorothy (Dotty) Beecham is 74 years old, and has been visiting the RMIT University clinic for 2
years to seek treatment of her Osteoarthritis. She was recently discharged from her local hospital after
suffering from community-acquired pneumonia (CAP) and Deep Vein Thrombosis (DVT). Mrs Beechams
current medical history includes Chronic Obstructive Pulmonary Disease (COPD), Myocardial infarction
2012, osteoarthritis (poor mobility and awaiting a Total Knee replacement), hypertension,
hypercholesterolaemia, type 2 diabetes mellitus, varicose veins and 4 episodes of DVT in the last 2
years. Mrs Beecham states that she has been smoking upto 5 cigarettes/day since 2012 and prior to
this 20 per day for 25 years despite knowing about her emphysema, heart disease and risks for further
DVTs. Her alcohol intake is limited to the1 small glass of port per day. Mrs Beecham is a retired
machinist, who lives alone since her husbands death 2 months ago. Her two children live in Qld and visit
infrequently. She has one sister Ruby who assists with her housework.
Mrs Beechams observations on arrival to the clinic are:
Temperature: 35.9C
Pulse: 92 beats per minute
Respirations: 28 breaths per minute
BP: 135/75 mmHg
Weight: 85 kg
Height: 174 cm
Random blood glucose 9.6 mmol/L
The following Blood tests were taken on her recent admission to hospital and were included in the
discharge summary to the local General practitioner:
Clinical Examination
Fasting Glucose
Cholesterol
Triglycerides
HDL
LDL
Thyroxine
Sodium:
Potassium:
Chloride:
Bicarbonate:
Creatinine:

Result
7.8
7.1
3.2
0.79
5.3
55
136
4.1
97
27
78

Units
mmol/L
mmol/L
g/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
umol/L

Reference Range
(3.96.4)
(desired < 5.2)
(0.41.5)
(0.802.05)
(1.554.65)
(58154)
(135-145)
(3.5-5)
(95-105)
(22-31)
(60-110)

Haemoglobin:
Haematocrit
GlycosylatedHaemoglobin
Red blood cell count
Haematocrit
Mean corpuscular volume (MCV):
Mean corpuscular hemoglobin (MCH):
MCH concentration (MCHC):

12
38
5
3.5
38
91
29
34

g/dL
%
%
x 1012/L
%
fL
pg
g/dL

(12-15 women)
(36%-47% women)
(4%-6%)
(3.8-4.8 for adult females)
(36-46 % for adult females).
(80-100)
(27-32)
(32-36)

White blood cells (WBC)

Neutrophils:
Lymphocytes:
Monocytes:
Eosinophils:
Platelets:

13
7.9
3.8
0.8
0.4
235

x 109/L
x 109/L
x 109/L
x 109/L
< 0.5 x 109/L
x 109/L

(4-11)
(2-8)
(1-4)
(0.0-1.0)
(150-450)
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Creatine kinase:
Creatine kinase MB (CKMB):
Troponin

32
0
0

U/L
ng/mL
ng/mL:

C-reactive protein:
D-dimer:

9.2
126

< 5 mg/L
< 500 ng/mL

(25-200)
(0-4)
(0-0.4)

Her arterial blood gas results on admission were as follows:

Result
Normal ranges
pH: 7.27
pH: 7.35-7.45
PCO2: 56 mmHg
Partial pressure of carbon dioxide (pCO2): 35-45 mm Hg
PO2: 70 mmHg
Partial pressure of oxygen (pO2): 75-100 mm Hg
HCO3: 25 mmol/L
Bicarbonate (HCO3): 22-26 mmol/L
SaO2: 89%
Oxygen saturation: 96%-100%
Medication regimen for Mrs Beecham:
As per usual at home medication regime:
Salbutamol 5 mg nebule by nebuliser 3-4 hourly PRN
Fluticasone 250 mcg / salmeterol 50 mcg (Seretide) 2 inhalations by inhaler (MDI) bd
Tiotropium 1 capsule (18 mcg) daily by Handihaler
Lisinopril 5 mg per orally daily
Gliclazide (Diamicron MR) 30 mg mane per orally
Metformin (Diabex XR) 500 mg mane per orally
Frusemide 40 mg mane per orally
Simvastatin 40 mg nocte per orally
Oxycodone Hydrochloride controlled release 10 mg per orally daily when required.
Warfarin 3mg daily varied accrding to weekly INR results
Aspirin 100mg daily

Document: 316647152.doc
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Case Study Written Assignment

Mrs Beecham has a history of deep vein thrombosis and will continue to be at risk on discharge.
Using current literature, discuss the aged related physiological and psychosocial factors that
contribute to this risk. Explain the current therapeutic regime put into place by her medical team
that will reduce this risk as well as any additional risks associated with manual therapy, and
what benefits evidence based adjunctive therapies Mrs Beecham might receive at the RMIT
University clinic. Include in the text of the body of a letter to her GP informing her of the care
she is receiving at the RMIT University clinic.

Submission Due Date of Written Assignment:

The word count for this written assignment will be 1500-2000 words.
You will be expected to use research or evidence-based journal articles (a minimum of
five), textbooks and appropriate authoritative web sites (not Better Health Channel,
Virtual Hospital, etc.), and all references used are to be no older than five years.
All referencing is to be formatted intext and final list using the VANCOUVER/APA
referencing style.
You are required to submit an electronic copy of your completed Case Study Assignment
through the Assignment Folder in the course Blackboard site which will be submitted via
Turn it in.
Please use the template provided which provides a Title page, with your first and last
given names clearly written, along with course/program details and the chosen topic as
well as a comprehensive version of the marking matrix.
A Table of Contents is required if headings are used in your assignment.
Assignments are not to be emailed to the Course Coordinator, or submitted by hard
copy; unless prior arrangement and approval has been given to do so.
An electronic copy of your assignment must be retained by you until after your final
course grade has been processed by the University, and this copy must be available on
request if resubmission is required.

Document: 316647152.doc
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Student Identification:
Criteria for Marking
Style &
Presentation
Adheres to style
requirements;
including use of
assignment
guidelines; such as
word limit, doublespacing, use of
header & footer, page
numbers, and size-12
font

Weight

Spelling, grammar
and paragraph
structure meets
academic standards

Topic is introduced
clearly and succinctly

Conclusion provides
a concise summary
of main points
covered

Self Assess

Fail Comments

Pass Comments

Credit Comments

Distinction Comments

High Distinction
Comments

Please rank
what you
perceive
your
performance
to be

You have not adhered

to the style
requirements in
accordance with the
assignment guidelines;
with one or more of the
following: no double
spacing; incorrect font
size, word limit not
adhered to; no cover
sheet; no title page; no
page numbers; no use
of headings. [0-0.9]
Many spelling and
punctuation errors.
Errors may include
unclear sentence
structure, no use of
meaningful paragraphs
to allow logical flow of
content, poor use of
professional language,
and no definition of
terms. You need to
consult with the Study
and Learning Centre for
assistance with writing
skills; before
completing any further
academic writing
assessments. [0-0.75]
Your introduction is
either absent or too
brief, and doesnt state
what the topic is or
what you intend to
cover in your
submission. [[0-0.75]
No conclusion is
evident.
You have not
summarised the main
components of your
paper. [0-0.75]]

You have adhered to the style

requirements at a basic level
although you have not followed
the guidelines fully; with one or
more of the following: no page
numbers, no or inadequate /
incorrect use of headings, no
double spacing, font size not
readable, and word limit not
adhered to. [1.0-1.25]

You have met the assignment

guidelines satisfactorily,
although you have not followed
two or more of the required
criteria.
[1.25-1.5]

The majority of style

requirements have been
adhered to, although
there are still some minor
formatting errors.
[1.5-1.75]

All style requirements and

assignment guidelines
adhered to.
[1.75-2.0]

There are a number of spelling

and grammatical errors
throughout, which detract from
your content and flow of ideas.
Errors may include inadequate
definition of terms, limited use
of professional language,
paragraphs not structured
correctly, and too much use of
point form in your responses.
You need to review correct
paragraph structure. [1.0-1.25]]

Your submission reads well,

though there is not a logical
flow of ideas. Problems may
include some sentences being
a bit confusing and/or rambling;
good use professional
language, but missing some
definition of terms; and
paragraphs missing a key idea
or focus, to enable a flow of
information. [1.25-1.5]

You have generally met

the academic standards
for writing, with few
spelling and punctuation
errors evident.
Your paragraph structure
is good, with good use of
professional language.
You still need to
consistently define terms.
[1.5-1.75]

Excellent paragraph
structure.
Professional language
used throughout, with
well-defined terms. [1.752.0]

Your introduction is only a

restatement of what the case
study is about, and doesnt
adequately state how you are
going to set out your response
to the question. [1.0-1.25]

You introduce the case study

well, making clear links to the
topic question. You have not
stated clearly enough how you
intend to set out your response.
[1.25-1.5]

Your general introduction

is good, with a clear
summary of the key
points to be covered.
[1.5-1.75]]

You provide an excellent

introduction to your
submission, and clearly
explain how you intend to
answer the topic
question. [1.75-2.0]

Concluding comments are too

brief, and do not summarise the
main components of your paper
adequately. [1.0-1.25]

You sum up the major focus of

the case study satisfactorily,
but need to also contextualise
the key points of your
responses. [1.25-1.5]

You summarise the main

components of your
responses, but need to
link them more
consistently to your
discussion. [1.5-1.75]

Your conclusion provides

a high quality summary of
the major points covered
in your responses. [1.752.0]

Content
Document: 316647152.doc
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Criteria for Marking

Weight

Provides a
comprehensive
response to the
criteria of the
question

15

Effectively links
evidence-based
information to the
case study data

References
Utilises relevant and
contemporary
references in
response

Intext referencing
used throughout.
Referencing
formatted in
accordance with
VANCOUVER/APA
requirements

Total Marks
awarded
Additional
comments:

35

Self Assess

Fail Comments

Pass Comments

Credit Comments

Distinction Comments

The question is
inadequately answered.
You have not provided
rationales for the points
that you identify. Your
response is too general
and not focused on the
topic. [0-7.4]
Poor use of evidence to
support your response.
Your lack of supporting
evidence indicates
inadequate research into
the topic question. [02.75] ]

Your response to the question

is answered to a adequate level
only, and require more detail
and also to be applied more
specifically to the topic. [7.58.9]

Your answer is satisfactorily

researched, and addresses the
key criteria. You focussed on
only one or two key points only,
limiting your response to the
question. [9.-10.4]

You have answered the

question well, and in
appropriate detail. You
could have provided
more detail in some
areas. [10.5-11.9]

Your use of evidence-based

information is limited to basic
references only, and reflects
inadequate research. [3.0-4.0]

The references used provide

adequate evidence for your
response, but you have not
searched widely enough in some
areas. . [4.25-4.75]

You provide good

evidence for most of
your rationales; although
you need to be more
consistent with your
level of research. [5.05.75]

You effectively linked

quality research based
evidence to justify each of
your rationales. [5.75-6.0]

No or inadequate
references cited
throughout your paper.
References used are not
contemporary or
reflective of current
practice. Many of your
references are older
than 5 years. Many of
your references are
web-based and are not
peer reviewed. [0-0.75]
Formatting of intext
references incorrect and
not according to
VANCOUVER/APA
requirements. Reference
list is incomplete and is
not formatted according
to VANCOUVER/APA
requirements. Your
reference list does not
meet the referencing
requirements of the
Discipline of Nursing &
Midwifery. [0-2]
0-17.5

You have met the reference

requirements at a basic level
only. Some references used
are older than 5 years. You
have overused non peerreviewed and web-based
information, which does not
lend credibility to your
responses. [1.0-1.25]

References used reflect

adequate research into the topic,
although your selection indicates
a need to use more evidencebased peer reviewed journals,
and/or seek assistance with
database/information retrieval.
[1.25-1.5]

You have provided a

relevant list of
references; though you
still need to ensure that
the majority of
references used are
contemporary and peer
reviewed. [1.5-1.75]

You have provided an

excellent list of references;
with the majority of
references contemporary
and peer reviewed. [1.752.0]

You have not been consistent

in your citation of references
throughout this paper.
You have not formatted your
intext referencing according to
VANCOUVER/APA.
Your reference list is not
formatted correctly, and you
must review the
VANCOUVER/APA guidelines.
[2.0-2.3]

Intext referencing is used

throughout, but is inconsistent.
This may include a need to
review the use of quotes and
paraphrasing intext, or incorrect
use of et al.
Your reference list does not
adhere completely to
VANCOUVER/APA
requirements.
[2.4-2.75]

Your use of intext

referencing is good, and
generally consistent.
Reference list indicates
good use of
VANCOUVER/APA
guidelines for most
reference citations.
Please read comments
made throughout where
improvements can be
made. [2.8-3]

Your intext referencing and

final reference list
demonstrate a high level of
consistency and are
formatted correctly and
according to
VANCOUVER/APA
guidelines.
[3-4]

17.3 -20.9

21-24

24.5-27.5

28-35

It is recommended that
you review the available
resources on
referencing. You have
not demonstrated
adequate analysis of the
topic. You must go to the
Study and Learning

Your response is generally

adequate, but there are still a
number of areas that can be
improved upon. Review the
comments throughout, and
also review the available
resources on referencing. To
improve your mark in future,

You have presented a

satisfactory analysis of the topic.
You are let down at times by
your referencing inconsistencies
and your underutilisation of key
references on this topic.
Please read the comments
made throughout your paper;

You have presented a

good analysis of the
topic overall; though
there are still some
areas where
improvement can be
made. You are advised
to read the comments

Your submission is clearly

structured and well
organised. All referencing
is consistent with
guidelines. You have
answered the topic
question thoroughly, and
provided a clear

Document: 316647152.doc
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High Distinction
Comments
You have
comprehensively
answered the question to
a high standard of detail.
[12-15]

Criteria for Marking

Weight

Self Assess

Lecturer:
Additional Comments:

Fail Comments

Pass Comments

Credit Comments

Centre for assistance

before submitting any
written work. You must
also take note of any
guidelines and marking
criteria as part of your
assignment preparation.

you are advised to seek

assistance with the Study and
Learning Centre before
submitting any written work.

and consider them before

submitting any written work in
the future.

Date:

Document: 316647152.doc
Page 6 of 6

Distinction Comments
made throughout the
paper. Good job.

High Distinction
Comments
understanding of academic
research requirements.
Well done.