Australian Catholic University · Faculty of Health Sciences · School of Nursing, Midwifery and Paramedicine
NRSG265 Assessment 1 Project: Narrated PowerPoint for an Adult with Rheumatic Heart Disease
A 10-minute narrated presentation, 10 content slides and a written script, weighted at 50 percent. This teaching brief reconstructs the Assessment 1 Project that Australian Catholic University runs in NRSG265 Principles of Nursing: Medical, with an original scenario in place of the login-gated case bank.
- NRSG265
- 202660
- Assessment 1 of 2
- 50 percent
- 10 slides
- 10 minutes
- APA 7
- 15 references
- Due 15 September 2026
Why this task, and what changed
Australian Catholic University assesses NRSG265 Principles of Nursing: Medical through an Assessment 1 Project that has run in the same architectural shape since at least 2020 while the delivery tool has moved twice. Public copies show a 50 percent weighting, a 10-minute presentation, a 10 slide ceiling excluding the reference list, and a script lodged with the Canvas submission. The 2020 copy required PowerPoint with nine content slides and one reference slide. The 2024 copy replaced PowerPoint with a Microsoft Sway website set at an equivalent of 2,000 words plus or minus ten percent, split into 1,200 to 1,300 written words and 700 to 800 words for the video component. The 2026 copy returns to a narrated PowerPoint built in Office 365 and uploaded to Studio, with a public link, a Word script and reference list, a due date of Tuesday 15 September 2026 at 14:00 AEST, a 50 percent weighting, and the explicit statement that the script carries no word limit.
| Version | Delivery tool | Length rule | Weighting | Due date |
|---|---|---|---|---|
| 2020, Semester 2 | PowerPoint, 10 slides with reference slide | 10 minute maximum | 50 percent | Friday 11 September 2020 |
| 2024, Semester 2 | Microsoft Sway website plus infographic | Equivalent to 2,000 words, plus or minus 10 percent | 50 percent | Wednesday 11 September 2024 |
| 2026, Semester 2 | Narrated PowerPoint, Studio link, Word script | 10 minutes, 10 content slides, no script word limit | 50 percent | Tuesday 15 September 2026, 14:00 AEST |
Assessment Details
| Institution | Australian Catholic University, Faculty of Health Sciences |
|---|---|
| School | School of Nursing, Midwifery and Paramedicine |
| Unit | NRSG265 Principles of Nursing: Medical, teaching period code 202660 |
| Assessment title | Assessment 1: Project |
| Weighting | 50 percent of the total unit mark |
| Length | 10 minute narrated PowerPoint, maximum 10 content slides excluding the title slide and the reference list, plus a Word script with the full reference list. No word limit applies to the script in 2026 |
| Due | Tuesday 15 September 2026 at 14:00 AEST |
| Submission | Studio public link for the narrated file, plus the Word script and reference list, through the Assessment module in Canvas |
| Audience | Graduate registered nurses or enrolled nurses using the resource to plan care |
| Referencing | APA 7th edition, with DOIs presented as working hyperlinks |
| Sources | Minimum 15 nursing-related sources, published in the last five years, with seminal works permitted by exception |
| Format | Page numbers required. Header blank. Footer reads Name, Student Number, AT1 NRSG265, 2026 Semester 2. Reference list on a new page, heading centred and bold in 14 point Calibri or Arial, hanging indent, double spacing |
| Late penalty | Five percent of available marks per day or part day from 14:01 on the due date, capped at 15 percent, with no marks after three calendar days unless an extension is approved |
| Learning outcomes | LO1, LO2, LO3 and LO4, covering pathophysiology and clinical manifestations, culturally safe evidence-based management, nursing models and clinical reasoning for care planning, and health education strategy |
| Generative AI | Permitted only as the current unit sheet allows. The published task materials name the script and the reference list as assessable authorship, so any drafting assistance must be declared as the unit requires |
Assumption statement: the 2026 public copy states the duration, slide ceiling, weighting, due date and reference rules. It does not publish a script word count, the current criterion weightings or the full case bank, so the health education marking weight below is a reasoned reconstruction rather than an official figure.
Ten Slides, One Argument
The slide ceiling is a grading constraint, not a formatting preference. Ten content slides means ten claims, and every slide must earn its place by answering a question the rubric asks. Use the map below as the default architecture, then adjust only where the chosen case demands it.
Teaching Case: Taleisha Cooper
Presenting situation. Taleisha Cooper is a 27-year-old Aboriginal woman who lives in a regional town in Central Queensland with her partner and two children, aged four years and seven months. She was diagnosed with rheumatic heart disease at 15 after two episodes of acute rheumatic fever and has been on three-weekly intramuscular benzathine benzylpenicillin G since then.
Current presentation. She presents to the emergency department with four weeks of worsening exertional breathlessness, two-pillow orthopnoea, bilateral ankle swelling and a non-productive cough. She reports sleeping in a recliner for the past five nights. Weight has risen 4 kg in twelve days against her recorded baseline. Observations show a respiratory rate of 26, oxygen saturation of 92 percent on room air, heart rate of 104 in atrial fibrillation, blood pressure of 104 over 68, and temperature of 36.8 degrees Celsius. Auscultation reveals bibasal crackles, a pansystolic murmur at the apex and a third heart sound.
Investigations. Transthoracic echocardiography shows severe mitral regurgitation with a left ventricular ejection fraction of 40 percent and moderate left atrial enlargement. Chest radiograph shows pulmonary congestion and small bilateral effusions. Serum sodium is 133, potassium 3.4, creatinine 112 micromoles per litre, and N-terminal pro B-type natriuretic peptide is markedly raised.
Social and cultural context. Taleisha missed four of her last eight prophylaxis doses. The nearest clinic that stocks the injection is 90 minutes away, appointments fall on the mornings she cares for her mother, and she describes one occasion when staff spoke about her in front of her without explanation. She is reluctant to be admitted because her baby is breastfeeding and her mother needs help at home. She asks whether the injections can be given closer to where she lives.
Current management. Intravenous frusemide with strict fluid balance, a fluid restriction of 1.5 litres per day, daily weights, telemetry, potassium replacement, dental review before discharge, and a planned return to secondary prophylaxis once the acute admission settles.
The case is fictional and built for teaching. Its clinical details follow the Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease, edition 3.3, so that the recommended prophylaxis schedule, dental screening and heart failure management are checkable against a real source.
What to Submit
Part A: narrated presentation
- Select one case only. Do not blend cases, because mixed cases produce contradictory pathophysiology and lose marks in the care plan.
- Complete the clinical reasoning cycle template supplied on Canvas before building slides. The template is the assessment spine, not an optional worksheet.
- Explain the pathophysiology as a causal sequence, so each clinical sign is traced back to a mechanism rather than listed beside it.
- Identify two acute issues only. State each as problem, cause and evidence, then attach one SMART goal per issue.
- Justify the care plan. Every intervention needs a reason drawn from a source, and the justification should explain why that intervention outranks another option.
- Discuss one medication in detail, covering class, mechanism, indication and nursing considerations linked to this patient.
- Design a health education strategy for this patient. Name the behaviour being taught, the teaching method, the check for understanding and the safety net if understanding fails.
- Demonstrate culturally safe practice across the plan rather than in a separate closing slide.
Part B: script and references
- Write the narration as a script you could read aloud, in sentences rather than bullet fragments.
- Keep the spoken script near 1,250 to 1,350 words so the recording fits the 10 minute ceiling at a normal speaking pace.
- Place in-text citations in the script where the claim sits, and match every citation to the reference list.
- Use at least 15 nursing-related sources, most published since 2021, and present each DOI as a working hyperlink.
- Include a reference slide inside the presentation as well as the list in the script. Duplication here is correct practice, not waste.
What markers penalise most
- Epidemiology reported without an implication for nursing practice.
- Goals that describe nursing tasks instead of patient outcomes.
- Medication sections that list side effects without linking them to the patient’s physiology.
- Cultural safety reduced to a sentence about respect for diversity.
- Slides carrying paragraphs of text while the narration repeats the same words.
Criterion-Referenced Rubric, 50 Marks
| Criterion | High distinction, 80 to 100 percent | Distinction, 70 to 79 | Credit, 60 to 69 | Pass, 50 to 59 | Fail, below 50 |
|---|---|---|---|---|---|
| 1. Epidemiology, 5 marks | Two or more current Australian and international figures, correctly attributed, with a clear implication for nursing this patient. | Accurate figures with an implication for practice. | Figures relevant but implication for nursing thin. | Figures present, mostly descriptive. | Epidemiology absent or inaccurate. |
| 2. Impact on the person, 5 marks | Physical, psychological, social, cultural and financial effects explained and connected to this patient’s circumstances. | Most domains addressed with clear links to the case. | Several domains named, links uneven. | Impact described in general terms. | Impact omitted or irrelevant. |
| 3. Pathophysiology, 8 marks | Causal chain from mechanism to each sign and symptom, with correct terminology and no unexplained leaps. | Accurate explanation with most signs traced to mechanism. | Explanation accurate but largely descriptive. | Fragmented facts with limited causation. | Pathophysiology inaccurate or absent. |
| 4. Medication, 6 marks | Class, mechanism, indication and nursing considerations all correct and tied to the patient’s pathophysiology and adherence pattern. | All elements present and accurate with minor gaps. | Elements present, nursing considerations generic. | Partial coverage, some errors. | Medication section absent or unsafe. |
| 5. Care plan and clinical reasoning, 12 marks | Two acute issues stated as problem, cause and evidence, with measurable SMART goals, prioritised interventions and a defensible justification. | Issues and goals sound, justification supported. | Care plan workable, goals partly measurable. | Issues listed without clear goals or justification. | No care plan, or unsafe priorities. |
| 6. Long-term management, 6 marks | Strategies address prophylaxis continuity, dental health, heart failure self-management and independence, with realistic service pathways. | Strategies relevant and mostly specific. | Strategies relevant but general. | Limited strategies, little tailoring. | Absent or unrelated to the case. |
| 7. Health education and cultural safety, 5 marks | Names the behaviour, method, teach-back check and safety net, and shows how power and access shape whether the teaching works. | Plan clear and culturally safe in practice. | Plan present, cultural safety partly applied. | Plan generic, cultural safety tokenistic. | No plan, or culturally unsafe framing. |
| 8. Presentation, digital literacy, APA 7, 3 marks | Slides support the narration, face and audio clear, timing inside 10 minutes, 15 or more current sources, faultless APA 7 and working links. | Clear delivery and accurate referencing. | Delivery acceptable, several referencing slips. | Cluttered slides or inconsistent referencing. | Unworkable file, broken link, or unusable references. |
Sample Answer and Reflection Help
Epidemiology as Argument
Epidemiology earns marks when a student turns a statistic into a nursing decision, and this case gives room for that move. At 31 December 2024, 7,510 Australians were recorded as living with rheumatic heart disease on jurisdictional registers, and 78 percent of them were First Nations people (Australian Institute of Health and Welfare, 2025). Prevalence among First Nations people peaks between 35 and 44 years, which places a 27-year-old with severe mitral regurgitation ahead of the usual curve rather than outside it. Age at diagnosis matters clinically as well as statistically, because repeated acute rheumatic fever in adolescence predicts earlier valve damage and a shorter window before surgical review. Reading national figures through the 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease gives the slide its clinical anchor, since the guideline sets the prophylaxis interval, the dental screening requirement and the surveillance expected after each episode (Ralph et al., 2021). Impact then becomes concrete rather than abstract: twelve injections a year, a ninety minute drive each way, a breastfeeding infant and a mother who needs help at home explain missed doses far better than the word non-compliance. Framing the burden through colonisation, housing and service access rather than personal choice keeps the analysis culturally safe and matches the evidence on where this disease concentrates.
Care Plans That Hold
The care plan section rewards specificity, and the clinical reasoning cycle supplies the structure markers look for. Two acute issues can carry the presentation if each is written as problem, cause and evidence: fluid volume excess related to severe mitral regurgitation, evidenced by orthopnoea, bibasal crackles and a 4 kg gain in twelve days; and activity intolerance related to reduced cardiac output, evidenced by breathlessness while dressing her children. SMART goals then attach to those statements, for instance a net fluid loss of 1 to 1.5 litres over 48 hours with daily weights taken before breakfast on the same scale, or a sitting oxygen saturation above 94 percent on room air without supplemental oxygen. Interventions follow from the goal instead of from habit, so fluid restriction, intravenous frusemide with potassium monitoring and a strict intake and output chart each answer a named target. Benzathine benzylpenicillin G belongs in the same discussion, because secondary prophylaxis prevents the next valve injury while the admission treats the current one, and the injection brings its own nursing considerations around cold chain, pain, anaphylaxis readiness and documented reaction history. Structured frameworks carry this reasoning, and a scoping review of teaching strategies of clinical reasoning in advanced nursing clinical practice confirms that explicit frameworks help students connect cues to action rather than recite observations (Giuffrida et al., 2023).
Cultural Safety Beyond Checklists
Cultural safety fails as an add-on paragraph, and the evidence explains why. Curtis et al. (2019) argue that cultural safety shifts attention from what a clinician knows about culture to the power relationships that decide whether a person experiences care as safe, which changes what a student writes about Taleisha’s hesitation. Her reluctance reads as reasonable once the history includes a consultation where staff discussed her in front of her, a clinic that runs on its own timetable, and travel that separates her from the people she cares for. A plan that names who can give the next injection locally, how the Aboriginal and Torres Strait Islander health worker stays involved, and what happens when a dose is delayed shows safety in practice rather than in sentiment. The RHD Endgame Strategy links clinical care to housing and environmental health, and the Australian guideline ties adherence to service design rather than to patient motivation. Citing the Nursing and Midwifery Board of Australia code alongside these sources makes clear that the expectation is regulatory, not aspirational.
Why SMART Goals Keep Failing
Specific, measurable, achievable, relevant and time-bound sounds simple until a draft meets a rubric line about evaluation. Most goals in marked work describe a nurse’s task rather than a patient outcome, so monitoring fluid balance becomes the goal and the evaluation step has nothing to measure. A goal belongs to the person and states what will be demonstrably different, by when, and against what baseline. Three failures recur across student submissions.
- Timeframes borrowed from the shift rather than from the physiology, such as a 24 hour target for a diuresis that needs 48 hours to be safe.
- Goals that restate the intervention, which makes the evaluation phase circular.
- No recorded baseline, so improvement cannot be shown even when the patient improves.
Each failure disappears with one edit, and the edit usually shortens the sentence. Reading each goal against the evaluation step of the cycle before recording catches the rest.
Teaching Back What Matters
A health education strategy earns marks when it names the behaviour, the method and the check. Asking a patient to weigh herself daily means little without a scale she can stand on safely, a time she will remember, and a rule for when to telephone. Teach-back converts the check into evidence, and trial evidence in chronic disease education reports better recall when patients explain the plan in their own words instead of repeating a handout (Choi & Choi, 2021). Written material should sit near a year 6 to 8 reading level, use pictures for the injection calendar, and be offered in the person’s first language where that language is not English. Digital options work only where a device and a reliable connection exist, so a printed card on the fridge may outperform an app in a regional town. Tying each education item to a measurable outcome, such as two consecutive doses received on schedule, keeps the strategy assessable rather than hopeful.
Closing Judgement on the Project
The project looks large until the sections are listed and counted, and then 10 slides and 10 minutes become a set of constraints that help. Most decisions come down to discipline: one case, two acute issues, one medication, and a plan a graduate nurse could follow at 3 am without asking a question. Current AIHW figures give the presentation its footing, and the national guideline supplies the clinical rules the care plan has to obey. Cultural safety then has to appear inside the plan itself, in who gives the injection and how the appointment is arranged, not in a closing line about respect. Rehearsing the narration out loud twice before recording exposes the slides carrying too much text, which is the mistake markers notice first in narrated work.
References and Learning Materials
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
Choi, S., & Choi, J. (2021). Effects of the teach-back method among cancer patients: A systematic review of the literature. Supportive Care in Cancer, 29(12), 7259-7268. https://doi.org/10.1007/s00520-021-06445-w
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
Giuffrida, S., Silano, V., Ramacciati, N., Prandi, C., Baldon, A., & Bianchi, M. (2023). Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review. Nurse Education in Practice, 67, 103548. https://doi.org/10.1016/j.nepr.2023.103548
Katzenellenbogen, J. M., Bond-Smith, D., Seth, R. J., Dempsey, K., Cannon, J., Stacey, I., Wade, V., de Klerk, N., Greenland, M., Sanfilippo, F. M., Brown, A., Carapetis, J. R., Wyber, R., Nedkoff, L., Hung, J., Bessarab, D., & Ralph, A. P. (2020). Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in Australia using linked data: The case for policy change. Journal of the American Heart Association, 9(19), e016851. https://doi.org/10.1161/JAHA.120.016851
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y.-S., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2010). The five rights of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically at risk patients. Nurse Education Today, 30(6), 515-520. https://doi.org/10.1016/j.nedt.2009.10.020
Menzies School of Health Research. (2025). Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd ed., version 3.3). RHDAustralia. https://rhdaustralia.org.au/arf-rhd-guidelines/
Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.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
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AUSTRALIAN CATHOLIC UNIVERSITY
NRSG265 PRINCIPLES OF NURSING: MEDICAL
Rheumatic Heart Disease
Clinical reasoning and culturally safe nursing care
Assessment 1 Project | Teaching case: Taleisha Cooper
Student name: [Insert]
Student number: [Insert]
Unit: NRSG265 | Teaching period: 202660
Assessment: Assessment 1 Project
Presentation format: 10 content slides | 10-minute narration
Narration: approximately 1,309 words, excluding slide headings and references
Use in accordance with the current Canvas assessment sheet and AI-use declaration requirements.
Presentation overview
The presentation uses the supplied fictional case of Taleisha Cooper. It prioritises two acute nursing problems, examines one medication in detail and carries cultural safety through assessment, treatment and discharge planning. The 2025 Australian ARF/RHD guideline recommends benzathine benzylpenicillin G every 28 days for most patients and reserves 21-day dosing for selected patients; Taleisha’s existing three-week schedule is therefore flagged for specialist confirmation rather than changed by the nurse.
Slide 1. Case and nursing role
Taleisha Cooper, 27 | Aboriginal woman | Central Queensland
RHD diagnosed at 15 after two ARF episodes
Prescribed three-weekly benzathine benzylpenicillin G
Now: exertional dyspnoea, orthopnoea, oedema, 4 kg weight gain
Echo: severe mitral regurgitation | LVEF 40% | left atrial enlargement
Nursing role: recognise decompensation, monitor treatment, coordinate safe discharge
Slide 2. Epidemiology: local burden, global impact
AUSTRALIA | 7,510 registered people with RHD in QLD, WA, SA and NT at 31 Dec 2024
78% (5,867) were First Nations people
GLOBAL | 2021 estimates: 3.85 million new RHD cases; 373,345 deaths
NURSING IMPLICATION | early recognition, reliable prophylaxis, accessible follow-up and continuity
Slide 3. Living with RHD: the person behind the diagnosis
PHYSICAL | breathlessness, fatigue, oedema, reduced capacity for daily care
PSYCHOLOGICAL | worry about admission, uncertainty, treatment fatigue
SOCIAL | breastfeeding infant, two children, care for her mother
ACCESS AND COST | clinic 90 minutes away; appointments conflict with caring duties
CULTURAL SAFETY | acknowledge previous disrespect; address service barriers, not blame
Slide 4. Pathophysiology: from valve damage to congestion
Repeated ARF → immune-mediated inflammation → permanent valve scarring
Mitral regurgitation → systolic backflow into left atrium → raised pulmonary venous pressure
Pulmonary fluid → crackles, cough, orthopnoea, effusions and SpO₂ 92%
LV volume load + LVEF 40% → impaired forward output and neurohormonal fluid retention
Left atrial enlargement → atrial fibrillation → reduced ventricular filling and cardiac reserve
Pansystolic murmur reflects regurgitation; S3 reflects rapid filling of a volume-loaded ventricle
Slide 5. Medication focus: intravenous frusemide
CLASS | loop diuretic
ACTION | blocks sodium-potassium-chloride reabsorption in the loop of Henle
PURPOSE | increases sodium and water excretion to reduce congestion and filling pressures
MONITOR | BP, symptoms, urine output, intake/output, same-time daily weight
CHECK | potassium, sodium, magnesium and renal function; replace potassium as prescribed
CASE RISKS | K⁺ 3.4 mmol/L, creatinine 112 μmol/L, BP 104/68 and AF
Slide 6. Clinical reasoning: situation and cues
SITUATION | probable acute decompensated heart failure associated with severe rheumatic MR
RESPIRATORY | RR 26, SpO₂ 92%, crackles, cough, orthopnoea, pulmonary congestion
CIRCULATORY | HR 104 in AF, BP 104/68, S3, apical pansystolic murmur, oedema
TRENDS / TESTS | +4 kg in 12 days; Na 133, K 3.4, creatinine 112, raised NT-proBNP
PRIORITY | ABC assessment, upright positioning, telemetry and prompt medical/cardiology review
Slide 7. Two acute priorities and SMART goals
PRIORITY 1 | excess fluid volume related to severe MR and impaired LV function
EVIDENCE | +4 kg/12 days, oedema, orthopnoea, crackles, congestion and effusions
GOAL | within 48 h: weight down ≥1 kg, less oedema and breathlessness, BP/renal indices within team limits
PRIORITY 2 | activity intolerance related to reduced cardiac reserve and AF
EVIDENCE | worsening exertional dyspnoea and reduced capacity for family activities
GOAL | within 72 h: bed-to-chair transfer and basic self-care with dyspnoea ≤3/10 and stable observations
Slide 8. Evidence-based interventions and evaluation
Administer prescribed IV frusemide; assess response and adverse effects
Maintain accurate fluid balance, prescribed 1.5 L restriction and daily morning weights
Monitor respiratory status, oxygenation, rhythm, BP, electrolytes and renal function
Replace potassium as ordered; escalate worsening hypoxaemia, hypotension, oliguria or arrhythmia
Pace activity, cluster care and assist with ADLs during decompensation
Urgent cardiology / valve-team review: severe MR with LVEF 40% requires specialist assessment
Slide 9. Long-term management and independence
SECONDARY PROPHYLAXIS | 2025 guideline default: BPG every 28 days; 21-day regimen for selected patients
RECONCILE | confirm rationale for Taleisha’s existing three-week schedule; do not alter without specialist review
ACCESS | local community-controlled service, GP or outreach clinic; named RHD coordinator and recall system
CARDIAC | cardiology follow-up, AF stroke-risk/anticoagulation review, valve intervention planning
PREVENTION | dental care, prescribed HF treatment, daily weights and symptom action plan
Slide 10. Health education and culturally safe partnership
BEHAVIOUR | receive each scheduled BPG injection; contact the team promptly if unable to attend
METHOD | yarning-style conversation, plain language, visual injection calendar, chosen support person
PARTNERSHIP | ask permission; explain procedures; involve an Aboriginal health worker if Taleisha agrees
TEACH-BACK | patient explains purpose, date, local venue and missed-dose plan in her own words
SAFETY NET | booked next dose, written contact details, RHD register follow-up and urgent symptom instructions
Full narration script
Approximate spoken word count: 1,309 words. At a measured pace, this is designed to fit the 10-minute ceiling; rehearse and adjust pauses before recording.
Slide 1. Case and nursing role
Taleisha Cooper is a 27-year-old Aboriginal woman from regional Central Queensland who has lived with rheumatic heart disease since age 15. After two episodes of acute rheumatic fever, she was prescribed three-weekly benzathine benzylpenicillin G. She now reports worsening exertional breathlessness, orthopnoea, ankle swelling and a dry cough. Her weight has risen four kilograms in twelve days. Echocardiography shows severe mitral regurgitation, a left ventricular ejection fraction of 40 per cent and left atrial enlargement; her rhythm is atrial fibrillation. These findings suggest acute cardiac decompensation. Nursing priorities are early recognition, close monitoring, safe treatment and a discharge plan that fits her family and community circumstances.
Slide 2. Epidemiology and nursing significance
Rheumatic heart disease remains an important and unequal health burden. At 31 December 2024, 7,510 people were registered with RHD in Queensland, Western Australia, South Australia and the Northern Territory; 78 per cent were First Nations people (Australian Institute of Health and Welfare [AIHW], 2025). Globally, an analysis using 2021 estimates reported 3.85 million new RHD cases and 373,345 deaths (Tang et al., 2025). The Australian figures matter because they show how often RHD affects First Nations communities, including people living outside major cities. The international figures show that the condition remains a major cause of preventable illness and death. For nursing practice, epidemiology supports earlier recognition of heart failure symptoms, reliable secondary prophylaxis and practical access to follow-up. It also cautions against treating missed injections as an individual failure when distance, clinic availability and service relationships shape access.
Slide 3. Impact on Taleisha
Taleisha’s symptoms affect daily life as well as cardiovascular health. Breathlessness, fatigue and oedema limit mobility and may make caring for two young children harder. Admission could interrupt breastfeeding and her support for her mother, so her concerns require discussion. The 90-minute clinic journey and appointment clashes also make repeated injections difficult. Taleisha recalls staff discussing her care without explaining it to her. That experience may reduce trust. Research on RHD describes how illness and healthcare relationships shape daily life; cultural-safety research calls for action on power imbalances and support for Aboriginal leadership (Oliver et al., 2024; Mitchell et al., 2022). Her care plan must protect her health while respecting family responsibilities and shared decision-making.
Slide 4. Pathophysiology
Taleisha’s valve disease follows repeated acute rheumatic fever. An immune response to group A streptococcal infection can inflame the heart and leave permanent valve scarring. With severe mitral regurgitation, the valve fails to close, allowing blood to flow from the left ventricle back into the left atrium during systole. Atrial pressure rises and is transmitted to the pulmonary veins and capillaries. Fluid enters lung tissue and, in more severe cases, the alveoli. This explains her crackles, cough, orthopnoea, effusions, respiratory rate of 26 and oxygen saturation of 92 per cent. Regurgitation also increases left ventricular volume load. Her ejection fraction of 40 per cent indicates systolic impairment. The apical pansystolic murmur reflects backward flow, while the S3 reflects rapid filling of a volume-loaded ventricle. Reduced forward output activates sodium and water retention, contributing to weight gain and ankle oedema. Atrial enlargement promotes atrial fibrillation, which can further reduce ventricular filling and cardiac output (Menzies School of Health Research, 2025; Heidenreich et al., 2022).
Slide 5. Medication: intravenous frusemide
Intravenous frusemide is a loop diuretic used to relieve fluid congestion in heart failure. It blocks sodium, potassium and chloride reabsorption in the thick ascending limb of the loop of Henle, increasing urinary sodium and water loss. The resulting reduction in circulating volume and filling pressures helps relieve pulmonary and peripheral congestion. Nurses should assess urine output, fluid balance, daily weight, respiratory findings and oedema. Blood pressure and renal function need close review because excessive diuresis can cause hypotension or worsen renal impairment. Taleisha’s potassium is 3.4 mmol/L, so replacement must follow the prescription and levels require rechecking. Hypokalaemia increases arrhythmia risk in a patient already in atrial fibrillation. Frusemide is useful only with clinical and biochemical monitoring (Heidenreich et al., 2022).
Slide 6. Clinical reasoning: situation and cues
The clinical reasoning cycle begins with the situation: Taleisha likely has acute decompensated heart failure associated with severe rheumatic mitral regurgitation. The next step is to collect and verify cues. Respiratory findings include tachypnoea, oxygen desaturation, crackles, cough and orthopnoea. Circulatory findings include atrial fibrillation at 104 beats per minute, blood pressure of 104/68, an S3, an apical pansystolic murmur and ankle oedema. Her weight trend, chest radiograph and echocardiogram support congestion and structural valve disease. Sodium 133, potassium 3.4, creatinine 112 and raised NT-proBNP need review. Creatinine should be compared with baseline before renal impairment is assumed. Structured cue collection supports prioritisation and reduces the risk of overlooking deterioration (Levett-Jones et al., 2010; Giuffrida et al., 2023).
Slide 7. Two acute priorities and goals
Priority one is excess fluid volume related to severe mitral regurgitation and impaired left ventricular function. Evidence includes a four-kilogram weight gain, oedema, orthopnoea, crackles and radiographic congestion. Within 48 hours, Taleisha’s weight should fall by at least one kilogram, with reduced oedema and breathlessness, while blood pressure and renal indices remain within the treating team’s limits. Priority two is activity intolerance related to reduced cardiac reserve and atrial fibrillation. She reports worsening exertional breathlessness and difficulty with usual family activities. Within 72 hours, she should transfer from bed to chair and complete basic self-care with breathlessness no greater than three out of ten and stable observations. These goals measure patient outcomes; the team should refine them against her baseline and response.
Slide 8. Interventions and justification
Frusemide, strict fluid balance, daily weights and the prescribed 1.5-litre restriction address congestion. Weigh Taleisha each morning on the same scale, record intake and output, assess oedema and lung sounds, and monitor oxygenation and respiratory effort. Repeat electrolytes and renal tests; replace potassium as prescribed. Telemetry is important because atrial fibrillation and hypokalaemia increase arrhythmia risk. Upright positioning, rest periods, paced mobilisation and help with self-care reduce exertion. Follow local protocols for oxygen and escalate worsening desaturation, hypotension, oliguria, chest pain, altered consciousness or rhythm deterioration. Diuresis relieves symptoms but does not repair the valve. Severe mitral regurgitation with systolic impairment requires urgent cardiology and valve-team assessment (Menzies School of Health Research, 2025; Heidenreich et al., 2022).
Slide 9. Long-term management
Discharge planning must prevent further rheumatic injury and support cardiac function. The 2025 Australian guideline recommends benzathine benzylpenicillin G every 28 days for most patients; a 21-day schedule is reserved for selected cases after specialist review (Menzies School of Health Research, 2025). Taleisha’s current three-week schedule therefore needs confirmation, not an independent change. She received 50% of her last eight doses, below the 80% coverage associated with adequate protection (AIHW, 2025). Identify a nearby Aboriginal community-controlled service, GP or outreach clinic that can store and give the injection. A named RHD coordinator, shared register, reminders and flexible appointment times can improve continuity. Cardiology must review her severe regurgitation, reduced ejection fraction, atrial fibrillation and need for valve intervention and stroke prevention. Arrange dental follow-up. Community programmes support health navigation and integration with local services (Kerrigan et al., 2021; Govender & Müller, 2023).
Slide 10. Education and culturally safe partnership
Education should focus on receiving each prophylaxis injection and contacting the team if an appointment cannot be kept. Ask Taleisha how she prefers to discuss her health, explain care before acting and invite an Aboriginal health worker or family member only with her consent. A visual calendar can show the next dose and local clinic. Teach-back checks the plan: Taleisha explains why the injection matters, when it is due and whom she will contact if she cannot attend. The written plan should list urgent symptoms, including breathlessness at rest, chest pain, fainting or rapidly increasing swelling. Heart-failure reviews associate teach-back with better self-care and possible reductions in readmission, although the evidence includes small studies (Oh et al., 2023; Zare-Kaseb et al., 2024). Cultural safety requires reflection on power, respectful listening and accessible services. Success means Taleisha can use the plan in daily life (Curtis et al., 2019; Nursing and Midwifery Board of Australia, 2018; Cullen et al., 2024).
References
APA 7th edition. DOI links are presented as hyperlinks where available. The reference list includes current clinical and nursing literature alongside seminal professional and clinical reasoning sources.
Australian Institute of Health and Welfare. (2025). Acute rheumatic fever and rheumatic heart disease in Australia, 2024. https://www.aihw.gov.au/reports/indigenous-australians/arf-rhd
Cullen, T., Griffith, M., Damodaran, A., Lewis, E., McMillan, F., Sammel, A., Honeysette, R., Biles, B., Beadman, K., & Nathan, S. (2024). The First Nations experience of accessing rheumatology services in a metropolitan hospital: A qualitative study. Health Expectations, 27(2), e14049. https://doi.org/10.1111/hex.14049
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
Giuffrida, S., Silano, V., Ramacciati, N., Prandi, C., Baldon, A., & Bianchi, M. (2023). Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review. Nurse Education in Practice, 67, 103548. https://doi.org/10.1016/j.nepr.2023.103548
Govender, K., & Müller, A. (2023). Secondary prophylaxis among First Nations people with acute rheumatic fever in Australia: An integrative review. Journal of Transcultural Nursing, 34(6), 443–452. https://doi.org/10.1177/10436596231191248
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. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012
Kerrigan, V., Kelly, A., Lee, A. M., Mungatopi, V., Mitchell, A. G., Wyber, R., & Ralph, A. P. (2021). A community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia. BMC Health Services Research, 21(1), 1127. https://doi.org/10.1186/s12913-021-07159-9
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y.-S., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2010). The five rights of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically at risk patients. Nurse Education Today, 30(6), 515–520. https://doi.org/10.1016/j.nedt.2009.10.020
Menzies School of Health Research. (2025). Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd ed., Version 3.3). RHDAustralia. https://rhdaustralia.org.au/wp-content/uploads/2025/09/Australian-ARF-RHD-Guideline-2025_August_1.pdf
Mitchell, A., Wade, V., Haynes, E., Katzenellenbogen, J., & Bessarab, D. (2022). “The world is so white”: Improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease. Australian and New Zealand Journal of Public Health, 46(5), 588–594. https://doi.org/10.1111/1753-6405.13219
Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Oh, S., Choi, H., Oh, E. G., & Lee, J. Y. (2023). Effectiveness of discharge education using teach-back method on readmission among heart failure patients: A systematic review and meta-analysis. Patient Education and Counseling, 107, 107559. https://doi.org/10.1016/j.pec.2022.11.001
Oliver, J., Fualautoalasi-Lam, L., Ferdinand, A., Tiatia, R., Jones, B., Engelman, D., Gibney, K. B., & Steer, A. C. (2024). Living with rheumatic fever and rheumatic heart disease in Victoria, Australia: A qualitative study. PLOS Neglected Tropical Diseases, 18(8), e0012038. https://doi.org/10.1371/journal.pntd.0012038
Tang, H., Zhang, K., Chen, J., Zhang, X., Yu, X., Ren, J., Wang, Y., Ma, Y., Hou, N., Kan, C., & Sun, X. (2025). Global burden of rheumatic vs. non-rheumatic valvular heart disease, 1990–2021: A systematic analysis of the Global Burden of Disease Study. Clinical Rheumatology, 44(12), 4807–4817. https://doi.org/10.1007/s10067-025-07739-8
Wyber, R., Noonan, K., Halkon, C., Enkel, S., Cannon, J., Haynes, E., Mitchell, A. G., Bessarab, D., Katzenellenbogen, J. M., Bond-Smith, D., Seth, R., D’Antoine, H., Ralph, A. P., Bowen, A. C., Brown, A., Carapetis, J. R., & END RHD CRE Investigators and Collaborators. (2020). Ending rheumatic heart disease in Australia: The evidence for a new approach. Medical Journal of Australia, 213(10 Suppl), S3–S31. https://doi.org/10.5694/mja2.50853
Zare-Kaseb, A., Emami Zeydi, A., Bakhtiari-Dovvombaygi, H., & Nazari, A. M. (2024). Effects of education based on teach-back methods on self-care and quality of life of the patients with heart failure: A systematic review. BMC Cardiovascular Disorders, 24, 591. https://doi.org/10.1186/s12872-024-04264-5
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