NRSG378 Nursing Case Study Assignment 3

NRSG378 Nursing Case Study Assignment 3

Shaun Morely is a 35 year-old male who was taken by ambulance to the emergency department (ED) this evening due to worsening cough, shortness of breath, fever, and general weakness, and was accompanied by his husband George. Shaun is only able to speak a few words at a time, before becoming fatigued. George stated that they both tested positive for SARS-CoV-2 virus (tested on PCR) 4 weeks ago, but Shaun has been struggling to recover from his symptoms since then. George noticed that his symptoms were progressively getting worse over the last two (2) days, but they have not been able to make an appointment with their local GP due to a lack of availability.
NRSG378 Nursing Case Study Assignment 3

Shaun states that he has not had an appetite for weeks now, and feels he has lost weight since being unwell (although he hasn’t weighed himself).

A CT scan was ordered which showed bilateral consolidation most likely due to pneumonia,
secondary to his initial SARS-CoV-2 infection.

 

On assessment:

• Shaun appears pale, cool and clammy. His lips appear dry and his tongue is cracked
• He appears lethargic and George states he “just wants to sleep all the time”
• He is lying in a semi-Fowler’s position but keeps pushing himself upright, while holding his chest
• He has a frequent productive cough, with purulent green phlegm
• Bilateral crackles in the lower and middle lobes are audible on auscultation. Occasional expiratory wheeze noted across all lung fields
• His last urine output was this morning at 9am

Health assessment findings and laboratory results at presentation:

• HR 124 bpm, regular pulse
• BP 95/56 mmHg
• RR 30 bpm, moderate WOB with use of accessory muscles
• Temp 38.7C
• SpO2 91% on RA
• Alert and orientated to time, place, and person
• CRT 2 seconds
• Weight – 92kg, Height – 1.65m

Haemoglobin (Hb)                 – Normal Values : 140-180 g/L (males)  Result : 143 g/L

WCC                                           – Normal Values : 11.8 x 10⁹/L                  Result : 4-11 x 10⁹/L

Sodium                                      – Normal Values : 132 mmol/L                 Result :  135 to 145 mmol/L

Potassium                               – Normal Values :  3.5 mmol/L                  Result :  3.5 to 5.2 mmol/L

Lactate                                     – Normal Values :  2.4 mmol/L                  Result : <1.0 mmol/L

C-reactive protein (CRP)  – Normal Values :  22 mg/L                        Result : <5 mg/L

Creatinine                              – Normal Values :  115 umol/L                    Result :  60-110 umol/L

Sputum culture                   – Normal Values :  Pending                           Result :  Negative

Blood cultures                     – Normal Values :  Pending                          Result : Negative.

Patient history:

Shaun lives with his husband in an outer suburb in Sydney. He is currently studying civil
engineering at university full-time, while working at his local café as a barista on the
weekends.

Shaun does not smoke and only drinks alcohol on special occasions, but uses a vape daily,
although he has stopped since becoming unwell with COVID-19.

Family history:

• Parents live overseas and are both well with no medical concerns

Medical history:

• Asthma, diagnosed as a child although now well controlled

Medications:

• Salbutamol 4-6 puffs via MDI PRN

Management :

• Administer IV bolus NaCl 0.9% 500ml over less than 15 minutes
• Commence IV NaCl 0.9% at 100ml/hr
• Administer IV ceftriaxone 1g BD
• 30/60 vital obs and 1/24 respiratory assessment
• Administer high flow oxygen

 

NRSG378 Extended Clinical Reasoning

Overview of Assessment 3

• This assessment enables students to apply knowledge from unit learnings to an issue requiring extended clinical reasoning.
• The assessment will engage students with the application of theory to practice and is designed to facilitate an understanding of the impact of illness on the patient.

• It is also intended to give students the opportunity to demonstrate the ability to use a clinical reasoning framework to plan the care of an acutely unwell patient.

Guidelines

Word limits : • Stick to the word limit for each question • It aligns with the weighting for each criterion in the rubric.• +/- 10% applies to the overall assessment

Stick to what you know : • Use the clinical reasoning framework process we have followed every week

Link it back to Shaun : • It is a case study, not an essay written in isolation • Make it relevant

How do you know? : • Everything needs to be supported with evidence, and cited/referenced

1. Patient assessment (250 words):

• Provide an initial impression of the patient and identify relevant and significant features from the patient presentation. Ensure you identify what the presenting condition/issue/concern is;

• Identify further elements of a comprehensive nursing assessment (this is addition to what has been done already, and can be presented as a list. If you repeat assessments, provide a rationale)
• Be specific with timing: vital obs , 1/24 vital obs ✓

2. Disease pathophysiology and complications (750 words):

• Discuss in detail, the pathophysiology of the presenting condition/issue/concern and how the patient’s presenting signs and symptoms reflect the underlying pathophysiology;
• Based on the patient’s history and presenting condition, he is at risk for complications. Choose two (2) possible complications from the list below, and explain why he is at risk of developing these. You need to refer back to the patient details to support your answer

• Septic shock
• Fluid overload
• Respiratory failure
• Acute kidney injury

3. Identify nursing issues (400 words):

• Identify and prioritise 3 nursing issues you must address for the patient for their current admission, and justify why they are priorities and support your discussion with evidence and data from the case study.
• These can be actual or at-risk issues, and need to written using the “issue, cause, evidence” format.
• Nursing issues must follow the format of: • ACTUAL: Issue/problem, caused by/ due to XXX, as evidenced by XXX
• AT RISK: Issue/problem, caused/ due to by XXX

These must be prioritised, i.e. if your focus is not on the acute stages of Shaun’s condition, thenit is not considered prioritised

Example:

• Simon has a history of Type 1 DM and has been playing footy this morning. He has insulin due before lunch which he administers, then realises he has forgotten his lunch at home. After a short while, he notices he is sweaty, tired and has a dull headache. A BGL check shows a reading of 3.1 mmol/L.
• What is an actual issue?
• Hypoglycaemia caused by increased exercise, lack of carbohydrate consumption and too much insulin, as evidenced by Simon’s sweating, tiredness, headache and BGL 3.1mmol/L
• What is an at risk issue?
• Severe hypoglycaemia caused by continued decrease in BGL
• Cardiovascular disease caused by poor long term control of diabetes
Which one is prioritised and relevant?

4. Nursing interventions (600 words):

• Identify, rationalise and explain, in order of priority, the nursing care strategies you should use or plan for within the first 24 hours of admission for the patient.

• All nursing strategies must be rationalised and prioritised, ie. Why are you doing XYZ for Shaun at this time? Can it wait? Why/why not? What is the evidence to support your actions?

• You can include some of the management listed in the case study, as long it needs to be repeated and you can justify its inclusion
• If there is a drug you think Shaun needs, word it so it becomes a nursing intervention

Example:

• Which of the following interventions would be implemented for a patient who has chest pain 7/10 with SpO2 at 95% on RA? How would you prioritise these interventions from 1 to 6? Justify your answers

1. ECG
2. Patient education
3. Vital obs
4. 2L O2 via NP
5. IV morphine
6. GTN via SL 5/60 x 3 doses