Patient scenario 3 Daku (he/him) is a 59-year-old Aboriginal man with a past medical history of rheumatic fever, hypertension, type-2 diabetes mellitus, benign prostatic hyperplasia

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Failure to submit an assignment by the agreed deadline will result in a penalty of the deduction of 10% of the total marks allocated to the assessment component for each day that the assignment is late. Assignment submitted later than 5 working days after the due date will not be marked and will receive no marks.
Other possible penalties
Any piece of work which exceeds the stipulated word limit by more than 10% will result in the deduction of 5% of the total marks allocated for the assessment for each 10% over the word limit. The maximum penalty that a student can receive is 50% of the student’s mark for that piece of work. The Board of Examiners may offer supplementary assessment to a student in special circumstances.
Purpose of the task
The purpose of this task is to critically analyse the patient scenario in the context of pharmacology and apply the principles of the Quality Use of Medicines to develop an education session that covers medication management aspect for the patient, family member or the carer. In critical analysis of the patient scenario, you will apply scientific judgement, and contemporary evidence from a range of sources to underpin the use of pharmacological therapies and management of medication regimes. You are expected to integrate evidence from a variety of information sources including the peer-reviewed literature, clinical practice guidelines and the Australian Quality Use of Medicines Framework.
This task will expand your knowledge of medications regarding the basic principles of pharmacology, including pharmacodynamics and pharmacokinetics and will assist you in developing an education session that covers medication management aspect for the patient, family member or the carer. This task should be written in an essay-like format with full sentences, paragraphs, and references.
Task description
Choose one of the following patient scenarios. This task should be written in an essay-like format with full sentences, paragraphs, and references. Students should use the marking rubric provided in Assessment module on LMS to facilitate and assist in the preparation and development of their assessment task.
Criteria
A complete response will include a clear introduction, essay body divided into sections, and a conclusion.
• Introduction sets the context and diverse perspectives. It outlines the findings of the patient scenario and clearly and succinctly describes the structure and purpose of the assignment focusing on the pharmacology, Quality Use of Medicines (QUM) Framework, education, and medication management.
• Body critically analyses the patient scenario in relation to pharmacology and the QUM Framework. Applies the principles of the QUM to develop an education session that covers medication management aspect for the patient. Utilises the relevant evidence to the patient scenario, applies theoretical perspectives to practice and makes clear recommendations for further research. Examines the patient scenario findings in a unified and structured manner and considers the quality of the evidence and similarity of patients studied compared to the patient scenario given. The body needs to be divided into sections with headings and subheadings where appropriate. The ideas expressed in the body of the assignment should follow a logical progression. A structured approach using subheadings for the areas discussed can be helpful for the author (to order your thoughts) and for the reader (they serve as signposts for the direction of the content). A logical, rational argument also depends on appropriate sentence and paragraph construction. Paraphrase previous work wherever possible rather than using direct quotes. However, direct quotes can be used to emphasise key issues. Avoid long quotes as they interrupt the flow of your discussion.
• Conclusion provides a comprehensive summary of the patient scenario, reiterates the paper’s main findings and outlines limitations.
• Use double spacing and avoid single or triple spacing between paragraphs.
• Use a minimum of eight different references (peer-review articles, text-books, clinical guidelines, policies, professional websites) in APA 7th referencing style.
*** Please refer to the subject guide for additional information that you may find useful.
Academic Integrity
All assessments are reviewed for potential breaches of the University of Melbourne’s academic integrity policy https://academicintegrity.unimelb.edu.au/plagiarism-investigation-and-penalties including breaches such as plagiarism, collusion, and the unapproved use of artificial intelligence. Turnitin is software utilised by the University of Melbourne to assist with the identification of plagiarism, collusion and the use of artificial intelligence https://lms.unimelb.edu.au/learning-technologies/turnitin.
All claims and opinions should be supported by available evidence.
• Content should be paraphrased and cited correctly using APA 7th referencing style.
• If content is presented verbatim, without paraphrasing, then the content needs to be presented as a quote (noting we prefer to paraphrase rather than quote).
• The work should be original. This means that the content of the assessment should not be plagiarising your own work from previous assessments for any University. Additionally, the work should not be developed or written in collusion with another student or person other than the student who is submitting it as their work.
Artificial Intelligence
Students are NOT permitted to use artificial intelligence (AI) to (a) generate content OR (b) edit content for this assessment. That means, students are not permitted to use any AI sources (e.g., ChatGPT) to generate answers to questions, nor are students permitted to use AI (i.e., Quillbot, Wordtuner etc) to edit their own responses to enhance written expression.
The University permits students to use Grammarly. As Grammarly is AI, the use of Grammarly use can trigger Turnitin’s artificial intelligence score. As such, if using Grammarly, please ensure you:
• use Grammarly as a prompt only. That is, if Grammarly suggests an edit to a section of your text, look at why Grammarly is recommending the correction (e.g., the sentence is very long), but do not accept, use, or copy and paste Grammarly’s edit into your assessment. Instead, ensure you think of how to revise the text to make the correction and complete the revision yourself. This will ensure the revision is your work and not generated by AI.
• maintain a version of your assessment before and after you use Grammarly.
More generally, students are advised to:
• maintain several versions of their assessment including digital and paper notes, downloads of articles, and copies of assessment drafts throughout the entire conceptual development of an assessment.
• do not delete any content associated with an assessment or its development.
• write the assessment in English and do not use a translator for passages of text (single word translations is accepted).
Please note that if the use of Artificial Intelligence is suspected, you may be asked to provide drafts or notes of early versions of your assessment https://academicintegrity.unimelb.edu.au/plagiarism-and-collusion/artificial-intelligence-tools-and-technologies/advice-for-students-regarding-turnitin-and-ai-writing-detection.

Patient scenario 1
Kosala (he/him), a 6-year-old male of Sri Lankan background weighing 24 kg was brought to the Emergency Department (ED) by his parents. He lives at home with both parents and has a younger sibling, Asheni (3 years old). Kosala was brought to the ED as his parents were concerned about his increasing symptoms of breathlessness, vomiting and right sided chest discomfort. Kosala has had a 3-day history of cough, mild runny nose, and fevers. He saw his General Practitioner (GP) two (2) days ago and was diagnosed with a generalised respiratory infection and sent home with clinical advice to maintain fluids, simple analgesia/antipyretics as required and rest. Kosala tested negative to 3 consecutive daily COVID-19 rapid antigen tests and was negative to COVID-19 PCR. Kosala was diagnosed with epilepsy when he was 4 years old and since then he is on oral levetiracetam, twice daily that has provided good seizure control. He also has a history of a previous right wrist fracture 2 years ago after falling off a monkey bar and his immunisations are up to date, including COVID vaccines. Kosala has a documented history of penicillin allergy.
On initial assessment in the ED, Kosala was tachypnoeic with a rate of 47 breaths per minute, with consolidation over the right lower lobe, severe use of accessory muscles and an initial oxygen saturation (SpO2) of 85% on room air. Kosala had an initial heart rate of 182 beats per minute, temperature of 39.5°C, dry mucous membranes, skin pallor and he looked unwell. After initial resuscitation and treatment, which included high flow nasal prongs, insertion of an IV cannula and antiemetic and analgesia administration, Kosala continues to require low flow oxygen support and has difficulty tolerating oral intake due to nausea and vomiting. Therefore, the decision is made to admit Kosala to the inpatient paediatric ward with a diagnosis of pneumonia, with ongoing intravenous fluids and oxygen therapy.
Kosala’s medications are listed below:
• Keppra (levetiracetam) 480 mg oral solution, BD
• Zithromax (azithromycin) 240 mg IV, daily
• Panadol (paracetamol) 360 mg orally or IV, 6 hourly, PRN
• Nurofen (ibuprofen) 240 mg orally, 8 hourly, PRN
• Zofran (ondansetron) 4 mg wafter, 8 hourly, PRN
Kosala’s parents are now referred for education in relation to Kosala’s pharmacological therapy initiated at the hospital.

Patient scenario 2
Bella (she/her) is a 55-year-old primary school teacher of Maltese background with a past medical history of social anxiety disorder, hypertension, and osteoarthritis. Her medications include Zoloft (sertraline 50 mg orally, mane), Olsetan (olmesartan medoxomil 20 mg orally, once daily), Panadol Osteo (paracetamol 665 mg-controlled release orally, two tablets BD), and Nurofen (ibuprofen 200 mg orally, TDS PRN). Bella is overweight (BMI = 29.5) and has a history of smoking one pack of cigarettes per day for 25 years (31 pack years). She had elevated blood sugar and cholesterol levels 12 months ago but did not follow up with a clinical diagnostic work-up. Until recently, Bella has felt fine. Today, she presents to the general practitioner (GP), Dr. Wong, complaining that her left foot has been weak and numb for nearly two weeks, and that the foot is difficult to flex. Furthermore, she reports that she has been very thirsty lately and gets up more often at night to urinate.
Bella’s physical examination including random plasma glucose level revealed the following: blood pressure of 165/105 mmHg, pulse rate of 98 bpm, and random plasma glucose of 13.8 mmol/L. Dr. Wong suspects type 2-diabetes, and orders additional tests that need to be done after an overnight fast. Some of Bella’s results of additional tests are presented in the table below.

Blood test results Urinalysis
BGL: 9.2 mmol/L Ketones: negative
HbA1c = 7.7 Protein: negative
Total cholesterol: 7.1 mmol/L Glucose: positive
HDL: 1.2 mmol/L Microscopy: negative for microbes, red blood cells and white blood cells.
LDL: 4.9 mmol/L
Dr. Wong initiates pharmacological therapy consisting of Caduet (amlodipine 10 mg and atorvastatin 20 mg orally, once daily), Diabex XR (metformin 500 mg-controlled release orally, once daily) and cessation of olmesartan medoxomil. Bella is now referred for education in relation to her medication management.

Patient scenario 3
Daku (he/him) is a 59-year-old Aboriginal man with a past medical history of rheumatic fever, hypertension, type-2 diabetes mellitus, benign prostatic hyperplasia (BPH) and major depression. His medications include Prexum Combi (perindopril arginine 2.5 mg + indapamide hemihydrate 625 mcg orally, mane), Janumet (sitagliptin 50 mg and metformin 500 mg orally, BD), Duodart (dutasteride 500 mcg and tamsulosin 400 mcg-controlled release orally, once daily) and Mirtazon (mirtazapine 30 mg orally, nocte).
Daku is very thin, smokes heavily since his teenage years and is a regular drinker, having 3-4 standard drinks daily. After returning from a week-long fishing trip in Northern Territory three days ago, Daku has been feeling unwell. This morning he presents to his general practitioner (GP) clinic with an acute onset of abdominal cramps, chills, watery diarrhoea, and emesis over the last eight (8) hours. Daku appears to be dehydrated and his physical examination revealed a temperature of 38.9°C, a blood pressure of 170/100 mmHg, pulse rate of 110 bpm, and pale skin with cool extremities. His GP suspects a gastroenteritis, and orders differential blood cell count and stool specimen culture test. At the same time, Daku’s dose of mirtazapine is increased to 45 mg at night. Daku is now referred for education in relation to his medication management.

Patient scenario 4
Sally (she/they), a 35-year-old woman, was pregnant with her first child. Sally is a primary school teacher with a past medical history of type-1 diabetes mellitus, asthma, and depression. Their medications are as follows: combination insulin therapy (NovoRapid, Actrapid and Protaphane), Symbicort 200/6 Turbuhaler (budesonide 200 mcg + formoterol 6 mcg/dose, 1 puff twice a day), and Zoloft (sertraline 50 mg, once daily). The pregnancy was uneventful until 35 weeks of gestation when Sally experienced three bouts of hyperglycaemia in a week. She increased her NovoRapid and Actrapid dose however her random blood glucose level (BGL) was still fluctuating between 13-17 mmmol/L.
Last night, Sally presented to the emergency department of the tertiary hospital and was admitted to the maternity unit. Soon after admission, Sally went into labour, 4 weeks before her due date. Sally received an epidural anaesthetic, Xylocaine with Adrenaline [300 mg of lidocaine 1% (15–30 mL) with adrenaline 5 micrograms/mL] midway through her 10-hour labour and delivered a 2.5 kg baby girl, 36 weeks gestation, with Apgar score of 81 and 95 minutes. The baby received skin-to-skin cuddle and breast contact for 10 minutes. As per standard protocol for Infants of Diabetic Mothers (IDM), the midwife performed a true blood glucose (TBG) measurement within one hour of birth. The result was 1.8 mmol/L. Neonatal Team was contacted and baby was transferred to Special Care Nursery where an IV was inserted and baby received a bolus dose of 10% dextrose (2 ml/kg) followed by an IV infusion of 10% dextrose at 60 ml/kg/day. Sally was encouraged to express her breasts 3 hourly. On day 2, baby had three (3) consecutive TBG’s > 2.6 mmol/L and had commenced 3 hourly breast feeds followed by EBM/Formula top-up via nasogastric tube at 40 mL/kg/day. IV infusion was weaned to 40 mL/kg/day with total fluid intake of 80 mL/kg/day. Sally is now referred for education in relation to her medication management as well as education regarding hypoglycaemia and treatment of her baby daughter.
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