NRSG370 Assessment Task 2: Case Study – High Dependency

Mrs. Connie Brownstone

Mrs. Connie Brownstone is a 79 year old women admitted to the Emergency Department (ED).  Connie was brought into the ED by her daughter with a one-day history of fluctuating shortness of breath/dyspnoea unrelieved by medication.

Triage Nurse Assessment:

• Vital signs: RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 168/70;
• Physical assessment: Dyspnoea, very anxious, audible expiratory wheeze;
• Past history: Asthma, allergies to pollen and dust mite, ICU admission 5 years ago (endotracheal intubation and ventilation for 2 days – status asthmaticus).
• Medications: (1) Ventolin, and (2) Ipratropium bromide.

Due to her respiratory distress, Connie was triaged as a category 2, as per the Australasian Triage Scale, and brought directly from the waiting room into a HDU monitored cubicle where you are the ED nurse allocated to her care (Department of Health and Aging, 2009). Oxygen of 6L/min was applied via the Hudson Mask.

Cubicle Nurse Assessment:

• Vital signs: RR 35, SpO2 89% (6L oxygen), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 172/75;
• Physical assessment: Pt. seated and leaning forward, use of accessory muscles evident (sternocleidomastoid, scalene, and intercostal muscles), bilateral expiratory wheeze on auscultation, height 145cm;
• Peak Flow 210 L/min (last normal reading 320 L/min)
• Secondary survey revealed no other abnormalities.

Investigations/Results:

FBE                                                     Within normal limits

Urea & Electrolytes                             Within normal limits

C-Reactive Protein                              Within normal limits

Blood Cultures                        Pending

Troponin                                              Within normal limits

Chest XRAY                                        Hyperexpanded lungs, no consolidation or effusion

Arterial Blood Gas (ABG)                    pH 7.48, PaO₂ 60, PaCO₂ 30, HCO₃ 24 (Respiratory Alkalosis)

Normal ABG Ranges                          pH 7.35-7.45, PaO₂ 85-90, PaCO₂ 35-45, HCO₃ 22-26

(Vincent, 2011)

References

Vincent, J. L., Abraham, E., Kochanek, P., Moore, F. A., & Fink, M. (2017). Textbook of Critical Care (7^th ed.). St. Louis, Missouri: Elsevier.

Assessment 2: Case Study – North Sydney

Students will complete a case study which discusses the provision of ethical, legal, evidence based, holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle (Levett-Jones, 2013). Students must select and respond to the case study question that reflects their allocated clinical placement specialty. If you have not been allocated a specialty placement, OR you are repeating this unit, please refer to your LEO campus announcements forum and the 3-hour lecture for instructions on how to proceed (you should not repeat the same case study question twice). Case study questions can be found on LEO via this link: https://leo.acu.edu.au/course/view.php?id=27543&section=4

• There are a variety of case studies on LEO page under the case study tile
• Choose the one that best reflects your specialty placement
• BNBP students – must do ‘High Dependency’ Case Study

The Clinical Reasoning Cycle

Student are expected to use the Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care. You are being asked to think through the case scenario and then discuss how data was collected and the type of data collected, identify problems and nursing issues, identify and state the objectives and discuss how care was provided in order to address the issues and evaluate the interventions carried out: (analyse and identify a nursing issues/problems/needs, set objectives, discuss the nursing interventions and evaluate the interventions of care carried out). As per lecture notes, students are expected to apply the clinical reasoning cycle to address the case scenario:

• Consider the person’s situation
• Collect, process and present related health information
• Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
• Establish goals for priority of nursing care related to the nursing problem/issues identified
• Discuss the nursing care of the person; link it to assessment data and history.
• Evaluate your nursing care strategies to justify the nursing care provided
• Reflect on the person’s outcomes

Adapted from Tracy Levett-Jones, et al. (2010)

Application of the Clinical Reasoning Cycle

Based on the stages of the clinical reasoning cycle, the outline of the essay should have:

Title Page: (not included in the essay)

• Unit Title: NRSG370 – Clinical Integration – Speciality Practice
• Student Name:
• Student ID Number:
• Speciality Area:
• Scenario:
• Total number of words:
• Essay should be formatted
  1. Introduction

• introduces/outlines/situates the topic of the essay
• clearly describes the way in which the essay will proceed
• the essay is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the paper)

2. Content

1. Consideration of facts from the patient or situation

Consider the case scenario of your choosing based on your clinical elective as per assessment “Choose the one that best reflects your specialty placement” this is where you determine what information should be collected and how information is going to be collected.

1. Collection of information

You need to discuss the type of information collected and why this information was collected based on the scenario for the clinical elective. For instance, the type of information collected should consider and include the history, current presenting issues and treatment plan, observations, results of investigations done medical records etc.

1. Processing gathered information (analysing and interpreting)

• The most important thing is to analyse the information that you have collected and identify areas of nursing care needs and problems. In this section, your discussion should reflect analysis and interpretation of the patient’s current health status using your established knowledge of physiology, pharmacology, pathology, culture, and ethics to establish needs and issues drawn from the information. This stage allows you to demonstrate synthesis of theory and experience acquired in previous and concurrent nursing units.

1. Identify the problem

• Identify and state the problems/needs or issues you have identified. It is important to identify the problems/needs/issues and the potential cause to determine the reason behind the patient’s current issue. Examples:

• Dehydration as a result of loose bowel motion x 4 and vomiting x 2 during am shift
• Falls risk as a result of confusion and unsteady gait
• Loss of weight as a result of poor oral intake for one weeks
• Pain due to post -operative procedure – laparotomy
• Hyperglycaemia due to poor diet and lack of knowledge on diabetes

Please note these are examples only, the nature of the problems you identify will depend on the nature of the case study and your analysis and interpretation of the situation.

1. Establish goals

• Here, you determine the nursing goals for the patient’s situation. Identify and prioritise at least three (3) nursing problems/issues based on your assessment and collected data.

1. Take action

• Here you discuss the nursing interventions or measures you will undertake in order to address the three nursing issues or problems. These measures should take in consideration the ethical, legal, evidence based, holistic -person-centred approach.

1. Evaluation and Reflection

• Evaluate the effectiveness of the nursing interventions you have discussed (presumably which could have been carried out or actually carried out) and reflect on how the interventions could have been improved or done better- State the potential measures that could have been considered or could have been carried out to address the problem. This phase allows you to critically analyse what has been done and how best the care was carried out or could have been improved.
•  

3. Conclusion

• the essays ends with a cogent, defendable conclusion that summarises the discussion

4. References

• Provide a list of references used in your discussion