An Acute Life-Threatening Condition Case Study Analysis

Aim of assessment

The aim of this assessment is to enable students to:

1. Demonstrate knowledge by analysing the information provided in the case study.
2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework.
3. Discuss nursing strategies and evidence-based rationales to manage a patient with sepsis
4. Discuss the pharmacological interventions related to the management of a patient with sepsis

Details

You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past five years with at least two references from the resources provided in the vUWS site including peer-reviewed journal articles, textbook material or other appropriate evidence-based resources.

 Case study

Mrs Casey Smith is a 28-year-old lady presenting to the emergency department at 1900hrs with fevers and right flank pain. Unwell for last 10 days with right loin flank pain and suprapubic pain. Developed fevers, dysuria, frank haematuria 2 days ago. Complains of myalgia, nil respiratory symptoms. Nil diarrhea. Has nausea, nil vomiting. Nil chest pain. Unsure of pregnancy status.

  Received 500mL Normal Saline IV bolus on arrival.

Past Medical History:

Nil

Current Medications:

Elevit

Nursing Assessment at 2000hrs:

1. Patent, own
2. RR-18/mt, SPO2-99%RA. Spontaneous, no increased work of breathing, chest clear, good

  air entry B/L, no added sounds.

1. Heart Rate Regular- 124/mt, tachycardic. BP- 90/58 mmHg. Capillary Refill Time <3>
2. GCS-14/15 E4V4M6 (was GCS-15/15 on arrival).
3. Febrile T: 38.9 C. No peripheral edema. No rashes.

Abdo: Suprapubic tenderness, not peritonitic, bilateral flank tenderness R>L, bowel sounds

Present.

  IVCx2 Rand L antecubital fossa in situ.

1. No IV fluids in progress.
2. BSL-4.8 mmol/L

Weight: 58 kg

Bedside Urinalysis: Leucocytes ++, nitrites ++, blood +++, BHCG +ve

Midstream Urine sent to lab for culture

Lab Results:

Clinical Impression: Sepsis (Urosepsis)

Plan:

1) Transfer to ICU within 1 hour

2) Chase urine and blood culture results

Question 1 (600 words)

Explain the pathophysiology causing all the clinical manifestations with which Mrs Smith presents.

= 1.Fever, 2.myalgia, 3.dysuria, 4.frank haematuria

Please use information from diagnostic results where relevant.

Question 2 (400 words)

Mrs. Smith has been prescribed the below two interventions.

–        Briefly explain/provide rationale why each of these two (both) interventions are prescribed for Mrs Smith using pathophysiological linking and appropriate evidence

–        Discuss briefly the specific mechanism of action of the medication and relate the medication to the underlying pathophysiology

–        Describe briefly the impact of not performing the interventions

• Inj. Ceftriaxone 1gm IV stat
• Normal Saline 1000mL IV stat