NRSG265 Principles of Nursing: Medical, Assessment 1 Project

Unit Context and Purpose

Australian Catholic University delivers NRSG265 Principles of Nursing: Medical as a 10 credit point second year unit inside the Bachelor of Nursing, and Assessment 1 for NRSG265 is a Project worth 50 per cent of the unit grade, built as a narrated PowerPoint presentation supported by an educational infographic poster and a full script. The task sits in Semester 2 with a mid-September due date at 14:00 AEST and follows a semester of case based tutorials on endocrine, respiratory, cardiac, neurological and renal alterations. Students work from one supplied case study and teach a graduate registered nurse or enrolled nurse audience what the disease does to the body, what one medicine does to the disease, and what to do when the person deteriorates. A project completed well reads like a staff education resource. A project completed poorly reads like a student summary of a textbook chapter, and markers can tell the difference inside a minute.

Assessment Snapshot

Assessment Task

Select one supplied case study and build a teaching resource for nurses. Three components carry the mark: a narrated PowerPoint that explains epidemiology, pathophysiology, clinical manifestations and pharmacology; an infographic poster presenting a nursing care plan for one acute exacerbation; and a written script that carries the spoken word and the reference list. Clinical reasoning must be visible, since the rubric rewards the moments where you link a mechanism to an assessment finding to a nursing action.

Case Study for This Study Period

Mr Colin Richards is a 46 year old Aboriginal man living in a regional town four hours by road from the nearest tertiary cardiac service. He reports recurrent episodes of tonsillitis and strep throat during childhood with limited access to timely antibiotic treatment. Over the past five months he has noticed increasing fatigue, breathlessness on exertion and episodes of palpitations. Bilateral ankle swelling and reduced exercise tolerance have developed in the past three weeks. He travels long distances for specialist appointments and has said he worries about being separated from family and Country if admitted. Previous hospital experiences left him feeling unheard, which has made him reluctant to engage with ongoing treatment. Cardiac examination reveals a systolic murmur, and echocardiography confirms significant valvular damage with reduced cardiac function consistent with rheumatic heart disease. He becomes acutely unwell with decompensated heart failure and rapid atrial fibrillation during the presentation, which supplies the acute exacerbation for your care plan.

Component A: Narrated PowerPoint

Record ten minutes of narration across ten content slides, excluding the title slide and the reference slide. Open with the disease and why it matters to Australian nursing, then move through the mechanism, the clinical picture, the medicine and the deterioration. Slides carry headings and visuals, not paragraphs. Your face must stay visible throughout the recording, so plan the camera position and the lighting before you rehearse.

Component B: Educational Infographic Poster

Build the poster on the provided infographic template. Identify two acute issues arising from the exacerbation, state a measurable nursing goal for each, and list evidence based interventions that a nurse on the next shift could act on. Keep it readable at a glance, since the marker will view it as a poster rather than as a document. Interventions that only restate medical orders will not satisfy the criterion, because the criterion asks what nursing contributes.

Component C: Written Script

Submit the full spoken script with in-text citations and a reference list on a new page. No word limit applies to the script, although ten minutes of speech runs about 1,300 to 1,500 words and a script far outside that range signals a timing problem. Attach the public Studio link to the same word document.

Slide and Minute Allocation

1. Title slide with the case, the disease and your name, excluded from the ten.
2. Epidemiology, one minute. Australian incidence and prevalence data, the populations most affected, and two implications for nursing practice.
3. Pathophysiology step one, two minutes. The trigger, the immune mechanism and the tissue injury, shown as a labelled flowchart.
4. Pathophysiology step two, two minutes. Valve damage, haemodynamic consequences and the path to heart failure.
5. Clinical manifestations, one minute. Each sign mapped to the mechanism that produces it.
6. Pharmacology, one and a half minutes. Drug class, mechanism of action, indication, adverse effects and nursing considerations tied to this patient.
7. Impact of the chronic illness, one minute. Physical, psychological, social, cultural and financial consequences, with the travel and separation burden named.
8. Long term management and health promotion, one minute. Secondary prophylaxis, anticoagulation, activity, dental care and self management support.
9. Nursing care plan poster walkthrough, one minute. Two acute issues, goals and interventions.
10. Justification of the care plan, thirty seconds. Why those interventions and what evidence supports them.
11. Cultural safety and closing message, omitted from the timing if you run long.

Marking Rubric

The weighting above follows the published rubric structure for this assessment, with criterion percentages distributed across the six published domains. Confirm the current semester weightings in Appendix A of the NRSG265 unit outline before release, since the wording of the criteria shifts between teaching periods even when the domains remain the same.

Academic Integrity and Generative AI

Declaration of any generative AI use belongs on the cover page, with the tool, the purpose and the extent described in plain terms. Fabricated references, invented statistics and narration read verbatim from AI output breach the ACU Academic Integrity Policy, and markers check epidemiology figures against the cited sources. Audio must be your own voice, since the criterion on oral communication assesses your delivery rather than the quality of a synthesised voice.

References and Learning Materials

Australian Institute of Health and Welfare. (2024). Acute rheumatic fever and rheumatic heart disease in Australia 2024. https://www.aihw.gov.au/reports/indigenous-australians/arf-rhd/contents/summary

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health, 18, 174. https://doi.org/10.1186/s12939-019-1082-3

Levett-Jones, T. (Ed.). (2023). Clinical reasoning: Learning to think like a nurse (3rd ed.). Pearson Australia.

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Ralph, A. P., Noonan, S., Wade, V., & Currie, B. J. (2021). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. Medical Journal of Australia, 214(5), 220-227. https://doi.org/10.5694/mja2.50851

RHDAustralia. (2022). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 ed.). Menzies School of Health Research. https://www.rhdaustralia.org.au/resources/2020-guideline-prevention-diagnosis-and-management-acute-rheumatic-fever-and-rheumatic

Sample Answer: Opening Script on Epidemiology

Good morning. My resource teaches graduate nurses how to plan care for a man living with rheumatic heart disease in a regional Australian town, and the epidemiology explains why this disease still reaches a hospital ward in 2026. Acute rheumatic fever and rheumatic heart disease are preventable conditions that concentrate almost entirely among Aboriginal and Torres Strait Islander peoples, and the national picture is stark. Jurisdictional registers held records for 11,794 people, and 9,496 of them, or 81 per cent, were Aboriginal and Torres Strait Islander people, which means this is not a rare curiosity for Australian nurses but a core equity problem in cardiac care (Australian Institute of Health and Welfare, 2024). Case notification also clusters in the 5 to 14 year age band, so most people on those registers acquired the disease in childhood and carry it into adult services. Travel distance shapes outcomes as much as pathology does, because specialist echocardiography and anticoagulation monitoring sit in metropolitan centres while the highest prevalence sits in regional and remote communities. Nurses meet the consequence of that geography when a patient weighs a four hour drive against a follow up appointment. Recognition matters for a second reason, since a sore throat in a high risk child warrants empirical antibiotics rather than watchful waiting, and nurses in primary care and emergency settings make that call first (Ralph et al., 2021). Epidemiology therefore frames the rest of this resource. The mechanism explains the damage, and the data explains who carries it.

Sample Answer: Care Plan Justification on Fluid Overload

Acute decompensated heart failure with fluid overload is my first acute issue, and the goal is a net negative fluid balance of 1,000 to 1,500 millilitres over 24 hours with a return to the patient’s documented dry weight and no increase in breathlessness at rest. Daily weight before breakfast in the same clothing, strict intake and output charting, a documented fluid restriction, and hourly urine output assessment together turn that goal into something the next shift can measure. Positioning upright, supplemental oxygen titrated to the prescribed target and a scheduled nursing review of electrolytes after diuresis address the respiratory consequence while the fluid comes off. My second acute issue is rapid atrial fibrillation with thromboembolic risk, and the goal is a controlled ventricular rate with no neurological deterioration. Continuous or scheduled rhythm monitoring, hourly observation of rate and rhythm, neurological observations using a validated tool, and prompt escalation for new confusion or unilateral weakness are the nursing actions that make a difference. Justification rests on the rhythm disturbance being driven by atrial distension from chronic volume and pressure loading, which is why treating congestion reduces recurrence. Rapid atrial fibrillation in rheumatic heart disease also raises stroke risk substantially, since atrial dilation promotes stasis and thrombus formation in the left atrium. Cultural safety rather than cultural competency reframes the third layer of this plan, because this patient has already told us he felt unheard (Curtis et al., 2019). Naming his fear about separation from Country in handover, offering family involvement in discharge planning and arranging telehealth echocardiography follow up all reduce the chance that the same pattern repeats.

Secondary Prophylaxis Is Where Marks Sit

The long term management slide decides whether a project reads as nursing or as a disease summary, and secondary prophylaxis carries most of that weight. Benzathine benzylpenicillin G delivered every 21 or 28 days prevents recurrent acute rheumatic fever and slows valve damage progression, with the interval and duration set by the severity of cardiac involvement and the time since the last episode. Timing failures matter more than drug choices in practice, since a dose delivered at week five of a four week regimen leaves a window for reinfection. Australian guideline evidence points to delivery of injections, pain management for intramuscular administration and register based recall as the practical levers that keep adherence intact (Ralph et al., 2021). Nursing action here includes shaping the appointment around the patient’s travel constraints rather than the clinic’s roster. Warner conditions, community transport and coordinated dosing around family commitments all count as clinical interventions when the alternative is a missed dose. Adding a short discussion of the pain and fear associated with repeated intramuscular injections gives the slide clinical credibility, because the guideline treats injection experience as a determinant of adherence rather than as a comfort issue.

Ten Slides Into Ten Minutes

Students lose marks on timing more often than on content, and the cause is almost always a pathophysiology script written for a reader rather than for a listener. A rehearsed pace of 130 to 150 words per minute gives roughly 1,300 to 1,500 words of usable speech, which is far less than most drafts. The 2020 guideline supplies enough pathophysiology detail to fill an hour, so selection becomes the skill being assessed. Four moves keep the project inside the limit:

1. Write the pathophysiology as a chain of five sentences, then cut to the three that a nurse can act on.
2. Put the detail in the labelled diagram and speak to the diagram, rather than duplicating it in narration.
3. Reserve a fixed block for the care plan, since that criterion carries the heaviest weighting and cannot be improvised.
4. Record once without slides to check timing, then add visuals to the audio that already fits.

Common misconceptions narrow to two. Some students read that valve damage is irreversible and skip prevention, which leaves out the entire secondary prophylaxis argument. Others treat the poster as a decorative slide rather than as the submitted artefact, which costs them the digital communication marks and usually the care plan marks with it.

Poster Design That Survives a Small Screen

Markers open the poster on a laptop, often after a long day, and a dense A3 layout collapses into grey text at that size. Building the infographic around two clearly separated columns, one per acute issue, with a goal band across the top of each, gives the eye a route through the content. Colour coding assists comprehension when it maps to a clinical idea, such as one colour for assessment, another for intervention and a third for escalation, rather than when it decorates. Font size matters more than font choice, and 14 point at poster scale is the realistic floor. Each intervention needs a verb, a measurement and a timeframe, because “monitor observations” tells the reader nothing while “record heart rate and rhythm hourly, escalate above 120 beats per minute” tells the next shift exactly what to do. Nursing identity comes through in the ratio of independent nursing interventions to delegated medical tasks, so count that ratio before submitting. Referencing the figure at the point of use, in a small footer citation, satisfies APA 7th without crowding the layout.

Closing Note on the Project

The strongest projects I have marked started with the patient rather than with the disease. Reading the case study twice, once for the pathology and once for what the person said about his life, changes what goes on the poster. Rehearsal fixes most of the delivery marks for free, and a kitchen timer is a better planning tool than a word processor counter. Fifteen current sources sounds generous until the pathophysiology and care plan compete for them, so allocate them early and keep the guideline alongside the journal articles. Cultural safety earns marks only where it changes a decision, which means a transport plan and a handover sentence rather than a paragraph of general principle. Timing the recording against the slide allocation leaves room to breathe, and the ten minute limit rewards the presenter who stops early.

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Rheumatic Heart Disease: Pathophysiology, Pharmacological Management and Nursing Care During Acute Deterioration

Institution: Australian Catholic University
School: School of Nursing, Midwifery and Paramedicine
Unit: NRSG265 Principles of Nursing: Medical
Assessment: Assessment 1, Project
Case study: Mr Colin Richards, 46 years
Presentation audience: Graduate registered nurses and enrolled nurses
Referencing: APA 7th edition

Narrated Presentation Script

Slide 1: Title

Rheumatic Heart Disease: From Childhood Streptococcal Infection to Acute Cardiac Deterioration

Subtitle: Pathophysiology, pharmacology and evidence-based nursing management.

Slide 2: Epidemiology and Implications for Australian Nursing

Rheumatic heart disease (RHD) remains a preventable but serious health problem in Australia, with Aboriginal and Torres Strait Islander peoples experiencing a disproportionate burden. The Australian Institute of Health and Welfare (AIHW, 2025) recorded 11,794 people with RHD and/or a history of acute rheumatic fever (ARF) on jurisdictional registers at the end of 2024. Aboriginal and Torres Strait Islander people accounted for 81% of these records. During 2024, First Nations people represented 93% of recorded ARF diagnoses, with an incidence of 51.8 cases per 100,000 compared with 2.7 per 100,000 across the Australian population.

The figures have direct implications for nursing practice. Nurses need to recognise the significance of recurrent streptococcal infections, particularly in communities with a high risk of ARF, and support early assessment and treatment. Continuity of care also matters. Regional and remote patients may travel considerable distances for echocardiography, specialist appointments and medication monitoring. Colin’s four-hour journey to the nearest tertiary cardiac service illustrates how geographical barriers can affect access to treatment and follow-up. National hospital data recorded 6,300 ARF or RHD hospitalisations in 2023–24 and 376 deaths in 2024, confirming the continuing consequences of these conditions (AIHW, 2026).

Slide 3: Pathophysiology I: Streptococcal Infection and the Immune Response

Rheumatic heart disease develops following an abnormal immune response to infection with group A Streptococcus, commonly associated with throat or skin infections. Acute rheumatic fever occurs when the immune system responds to the bacterial infection and mistakenly recognises certain human proteins as similar to streptococcal antigens. Researchers describe this process as molecular mimicry. Antibodies and T lymphocytes that respond to the infection may also attack the body’s own tissues, including structures within the heart (Yeow et al., 2026).

Cardiac inflammation during ARF can affect the heart valves and other cardiac tissues. The resulting injury may involve the endocardium, myocardium and pericardium. The valves are particularly vulnerable because inflammation can damage their endothelial surfaces and initiate changes in the surrounding connective tissue. Recurrent attacks increase the likelihood of progressive injury, although a severe initial episode can also cause substantial damage. Colin’s history of repeated tonsillitis and untreated streptococcal throat infections provides a clinically plausible explanation for his later cardiac disease, although his history alone cannot establish the precise timing of the original damage (Noonan et al., 2026; Menzies School of Health Research, 2025).

Suggested visual flowchart:

Group A Streptococcus infection → Abnormal immune response → Molecular mimicry → Cardiac inflammation and valvulitis → Permanent valve tissue injury → Rheumatic heart disease.

Slide 4: Pathophysiology II: Valve Damage and Development of Heart Failure

Persistent inflammation and healing gradually alter the structure of affected heart valves. Fibrosis, thickening, calcification, restricted leaflet movement and changes to the supporting chordae can produce valve stenosis, regurgitation or a combination of both. Stenosis obstructs forward blood flow, whereas regurgitation allows blood to move backwards through an incompletely closing valve. Either condition increases the workload placed on the heart. The exact valve involved and the severity of its impairment require echocardiographic assessment; Colin’s case does not specify the anatomical valve lesion (Yeow et al., 2026).

The heart initially compensates for the increased workload through changes in chamber size, wall thickness and contraction. Over time, however, persistent pressure and volume stress can impair ventricular function. Reduced cardiac output limits oxygen delivery to tissues, producing fatigue and reduced exercise tolerance. Increased pressure in the pulmonary circulation can cause breathlessness and pulmonary congestion, while systemic venous congestion contributes to peripheral oedema, particularly around the ankles. Colin’s reduced cardiac function, exertional breathlessness and bilateral ankle swelling are consistent with these haemodynamic changes.

Atrial fibrillation further aggravates the problem. Structural changes and increased atrial pressure can promote electrical instability, resulting in an irregular atrial rhythm. Rapid ventricular responses shorten the time available for ventricular filling and can reduce cardiac output. The combined effects of valvular dysfunction, impaired ventricular performance and rapid atrial fibrillation can therefore precipitate acute decompensated heart failure (Noonan et al., 2026; Menzies School of Health Research, 2025).

Slide 5: Clinical Manifestations and Their Physiological Causes

Colin’s symptoms reflect different consequences of impaired cardiac function. Increasing fatigue and reduced exercise tolerance suggest inadequate cardiac output during physical activity. Breathlessness occurs as elevated cardiac filling pressures increase pulmonary venous pressure and may produce pulmonary congestion. Bilateral ankle swelling indicates increased systemic venous pressure and fluid accumulation in peripheral tissues. Palpitations reflect the rapid and irregular electrical activity associated with atrial fibrillation.

The systolic murmur indicates abnormal blood flow across a cardiac valve, although auscultation alone cannot establish the precise lesion. Echocardiography provides the necessary information about valve structure, blood flow and ventricular performance. Nursing assessment should therefore combine respiratory observations, oxygen saturation, blood pressure, peripheral perfusion, fluid status and electrocardiographic findings. A change in any of these findings may indicate worsening cardiac function and require prompt clinical escalation (Noonan et al., 2026).

Slide 6: Pharmacology: Loop Diuretics and Furosemide

Intravenous furosemide, a loop diuretic, is an important medicine for treating fluid overload during acute decompensated heart failure. It acts on the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle. Blocking this transporter reduces sodium and chloride reabsorption, increasing the excretion of water and electrolytes through urine. The resulting reduction in circulating fluid volume helps lower cardiac filling pressures and relieve pulmonary and peripheral congestion (Heidenreich et al., 2022).

Furosemide is appropriate when a patient presents with clinical evidence of fluid retention. In Colin’s case, breathlessness and bilateral ankle oedema suggest congestion, although the treating team must confirm his haemodynamic status and prescribe the appropriate dose. Intravenous administration allows treatment when rapid diuresis is required. The medicine relieves congestion, but it does not repair damaged valves or directly correct atrial fibrillation. Acute heart failure guidelines therefore emphasise assessment of congestion, perfusion and response to diuretic treatment (McDonagh et al., 2023).

Nurses must monitor blood pressure, urine output, daily weight, fluid balance, renal function and serum electrolytes. Furosemide can cause dehydration, hypotension, hyponatraemia, hypokalaemia and hypomagnesaemia. These electrolyte disturbances are particularly important in Colin’s case because low potassium and magnesium levels can increase the risk of cardiac arrhythmias. Ototoxicity may also occur, particularly with high or rapidly administered intravenous doses. Monitoring after administration helps nurses identify adverse effects and report an inadequate response or excessive fluid loss. Oxygen should be administered when hypoxaemia or another clinical indication warrants it, rather than automatically for every patient with heart failure (Heidenreich et al., 2022; McDonagh et al., 2023).

Slide 7: Physical, Psychological, Social and Financial Effects of Chronic RHD

Living with RHD can affect several aspects of a person’s life. Physically, progressive valve damage may reduce exercise capacity, interfere with employment and increase the likelihood of hospital admission or cardiac surgery. Persistent breathlessness and palpitations can also create anxiety, particularly when symptoms worsen unexpectedly. Colin has expressed concern about leaving his family and Country during hospital admission, indicating that treatment decisions carry personal and cultural consequences.

Regional specialist care can create additional travel, accommodation and employment costs. Long journeys may also make regular appointments and medication monitoring difficult to maintain. His previous experience of feeling unheard may reduce trust in hospital services and contribute to reluctance to seek further treatment. The National Aboriginal and Torres Strait Islander Health Plan identifies culturally safe, accessible and responsive healthcare as an important part of improving health outcomes (Department of Health, 2021). Nurses should therefore consider the practical and personal effects of chronic illness alongside the clinical findings.

Slide 8: Long-Term Management and Health Promotion

Long-term management must address the underlying valve disease and prevent further episodes of ARF. Secondary antibiotic prophylaxis with intramuscular benzathine benzylpenicillin G is a central preventive measure for eligible patients. Administration generally occurs every 28 days, although some patients require a 21-day schedule according to their clinical risk and specialist treatment plan. Regular administration reduces the likelihood of recurrent ARF, which can cause further valve injury. The 2025 Australian guideline recommends ongoing assessment and specialist review when determining the appropriate duration of prophylaxis (Menzies School of Health Research, 2025).

Adherence presents a significant challenge. Only 32.4% of First Nations people prescribed three- or four-weekly benzathine benzylpenicillin in Queensland, Western Australia, South Australia and the Northern Territory received at least 80% of their prescribed doses in 2024 (AIHW, 2025). Nurses can support adherence through register-based follow-up, clear education, appropriate pain-management strategies and coordination with local health services. Evidence from Australian clinical services also supports community-based administration and collaborative follow-up arrangements (Liaw et al., 2022; Tarca et al., 2024).

Colin’s atrial fibrillation also requires assessment of thromboembolic risk and an appropriate anticoagulation plan. The exact choice of anticoagulant depends on echocardiographic findings. Patients with moderate-to-severe rheumatic mitral stenosis or a mechanical heart valve generally require a vitamin K antagonist such as warfarin rather than a direct oral anticoagulant (Joglar et al., 2023; Van Gelder et al., 2024). Further care includes individualised activity advice, oral and dental health, review of symptoms, medication education and specialist monitoring.

Slide 9: Nursing Care Plan and Poster Walkthrough

The infographic presents two immediate nursing priorities. The first is acute decompensated heart failure with fluid overload. The nursing goal is to improve breathlessness, maintain oxygen saturation within the prescribed target and achieve an appropriate fluid balance without compromising renal function or blood pressure. Interventions include respiratory assessment, upright positioning, prescribed oxygen when indicated, strict intake and output monitoring, daily weights and observation of the response to prescribed intravenous furosemide.

The second priority is rapid atrial fibrillation with reduced cardiac output and thromboembolic risk. The goal is to achieve the prescribed ventricular rate target while maintaining adequate perfusion and avoiding new neurological complications. Nursing actions include ECG monitoring, regular assessment of heart rate and blood pressure, review of symptoms and neurological observations. Nurses must also monitor relevant electrolytes, administer prescribed medicines and escalate deterioration promptly. The poster identifies specific warning signs requiring urgent review rather than relying on routine observation alone.

Slide 10: Evidence and Justification of the Nursing Interventions

The selected interventions address the physiological causes of Colin’s deterioration. Fluid assessment and diuretic monitoring help evaluate whether treatment reduces congestion without causing hypotension, electrolyte disturbance or renal impairment. ECG monitoring allows early recognition of persistent rapid atrial fibrillation, while neurological observations help identify possible embolic complications. Anticoagulation decisions require particular care in rheumatic valve disease. The INVICTUS trial found that vitamin K antagonist treatment produced better cardiovascular outcomes than rivaroxaban in patients with RHD-associated atrial fibrillation who met the study’s inclusion criteria (Connolly et al., 2022). The plan therefore combines immediate stabilisation with measures that reduce further harm.

Slide 11: Cultural Safety and Closing Message

Cultural safety should influence how nurses communicate, make decisions and organise ongoing care. Colin has already described previous hospital experiences in which he felt unheard. Nurses should listen without judgment, explain treatment in accessible language and ask how he would like his family involved. An Aboriginal and Torres Strait Islander health practitioner or liaison officer may assist with communication and continuity of care, with Colin’s consent. The team should also explore transport arrangements, local community-controlled health services and telehealth follow-up to reduce unnecessary travel.

Culturally safe practice requires healthcare professionals to consider the patient’s experience of care rather than assume that professional intentions guarantee safety. Research on Australian hospital initiatives identifies the importance of patient perspectives in evaluating culturally safe services (Clough et al., 2025; Hiyare-Hewage et al., 2024). Colin’s care should respect his connection to Country and support shared decisions about treatment and admission. Effective nursing management of RHD requires early recognition of deterioration, accurate clinical assessment, safe pharmacological care, prevention of recurrent infection and respect for the patient’s priorities.

Educational Infographic Poster: Acute Nursing Care Plan

Poster title: Nursing Management of Acute Decompensated Heart Failure and Rapid Atrial Fibrillation in Rheumatic Heart Disease

Patient: Mr Colin Richards, 46 years
Clinical context: Significant rheumatic valve damage, reduced cardiac function, acute heart failure and rapid atrial fibrillation.

Acute Issue A: Decompensated Heart Failure and Fluid Overload

Problem: Impaired cardiac pumping function contributes to pulmonary and systemic congestion, breathlessness and peripheral oedema.

Measurable nursing goal: Within 24 hours, Colin will demonstrate reduced breathlessness at rest, maintain oxygen saturation within the prescribed target range and achieve the prescribed fluid-balance goal, with urine output of at least 0.5 mL/kg/hour unless an individualised clinical target applies.

Nursing interventions:

• Assess respiratory rate, oxygen saturation, work of breathing, lung sounds and level of breathlessness at regular intervals.
• Position Colin upright to support lung expansion and reduce respiratory discomfort.
• Administer oxygen only when indicated and titrate according to the prescribed target.
• Record fluid intake and output accurately, including urine output following intravenous diuretic treatment.
• Measure weight daily at the same time, using the same scales and similar clothing.
• Administer prescribed intravenous furosemide and assess its effect on urine output, oedema and breathing.
• Monitor blood pressure, renal function, potassium and magnesium to identify treatment-related complications.
• Apply prescribed fluid and dietary restrictions, taking account of the patient’s clinical condition.

Escalation indicators: Increasing breathlessness, worsening oxygen saturation, new or increasing crackles, hypotension, confusion, cool peripheries or urine output below 0.5 mL/kg/hour.

Acute Issue B: Rapid Atrial Fibrillation and Risk of Reduced Cardiac Output and Stroke

Problem: Rapid, irregular ventricular activity may reduce ventricular filling and cardiac output. RHD-associated atrial fibrillation also increases thromboembolic risk.

Measurable nursing goal: Within four hours, provided Colin remains haemodynamically stable, his resting ventricular rate will reach the prescribed target, generally below 110 beats per minute under a lenient rate-control approach, with adequate perfusion and no new neurological deficit.

Nursing interventions:

• Obtain a 12-lead ECG and maintain continuous cardiac monitoring when indicated.
• Assess heart rate, rhythm, blood pressure and symptoms frequently until the condition stabilises.
• Monitor for chest pain, dizziness, syncope, worsening breathlessness and signs of poor peripheral perfusion.
• Perform neurological observations and report facial drooping, unilateral weakness, speech changes or sudden confusion immediately.
• Review potassium, magnesium and renal function results, reporting clinically significant abnormalities.
• Administer prescribed rate-control and anticoagulant medicines, observing their therapeutic effects and adverse reactions.
• Confirm the echocardiographic valve findings and the prescribed anticoagulation plan. Moderate-to-severe mitral stenosis or a mechanical valve requires particular attention when selecting anticoagulation.
• Monitor for bleeding and assess INR when warfarin forms part of the treatment plan.

Escalation indicators: Persistent rapid ventricular rate, hypotension, chest pain, altered consciousness, worsening pulmonary oedema, syncope or signs of acute stroke. Haemodynamic instability requires immediate emergency escalation and urgent medical assessment for possible synchronised cardioversion.

Evidence base: Menzies School of Health Research (2025); Heidenreich et al. (2022); McDonagh et al. (2023); Joglar et al. (2023); Van Gelder et al. (2024).

References

APA 7th edition. All listed sources fall within the assessment’s five-year publication window, using the current date of November 2026.

Ambari, A. M., Radi, B., Dwiputra, B., Arityanti, D., Rikl, T., Inggriani, M. P., Qhabibi, F. R., Susilowati, E., Makes, I. K., Rudiktyo, E., Cramer, M. J., Doevendans, P., Setianto, B., & Santoso, A. (2024). Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: A systematic review and meta-analysis. Annals of Medicine and Surgery, 86(4), 2116–2123. https://doi.org/10.1097/MS9.0000000000001833

Australian Institute of Health and Welfare. (2025). Acute rheumatic fever and rheumatic heart disease in Australia 2024 (Catalogue No. CVD 100). Australian Government. https://www.aihw.gov.au/reports/indigenous-australians/arf-rhd/contents/summary

Australian Institute of Health and Welfare. (2026). Heart, stroke and vascular disease: Australian facts. Australian Government. https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/all-heart-stroke-and-vascular-disease/arf-and-rhd

Clough, B., Fraser, J., Flemington, T., & Power, T. (2025). Implementation and evaluation of cultural safety initiatives in Australian hospital settings: A scoping review. Journal of Transcultural Nursing, 36(3), 279–289. https://doi.org/10.1177/10436596241296818

Communicable Diseases Network Australia. (2023). Acute rheumatic fever and rheumatic heart disease: CDNA national guidelines for public health units. Australian Government Department of Health and Aged Care. https://www.cdc.gov.au/resources/publications/cdna-national-guidelines-arf-rhd

Connolly, S. J., Karthikeyan, G., Ntsekhe, M., Haileamlak, A., El Sayed, A., El Ghamrawy, A., Damasceno, A., Avezum, A., Dans, A. M. L., Gitura, B., Hu, D., Kamanzi, E. R., Maklady, F., Fana, G., Gonzalez-Hermosillo, J. A., Musuku, J., Kazmi, K., Zühlke, L., Gondwe, L., … Yusuf, S. (2022). Rivaroxaban in rheumatic heart disease-associated atrial fibrillation. New England Journal of Medicine, 387(11), 978–988. https://doi.org/10.1056/NEJMoa2209051

Department of Health. (2021). National Aboriginal and Torres Strait Islander Health Plan 2021–2031. Australian Government. https://www.health.gov.au/resources/publications/national-aboriginal-and-torres-strait-islander-health-plan-2021-2031

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895–e1032. https://doi.org/10.1161/CIR.0000000000001063

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