Assessment 3 Case study Analysis

Assessment 3 Case study Analysis

Case Study 1

1)

Ms. Chris Brown was diagnosed with type 1 diabetes at the age of 8; therefore, a precise pathophysiology of this disorder is crucial. According to Quinn et al. (2022), type 1 diabetes is an autoimmune disorder in which the immune system starts to attack the insulin-producing beta cells in the pancreas. Thota & Akbar (2023) state that insulin produced by beta cells is a hormone that enables glucose absorption into the cells to produce energy for the body. In type 1 diabetes, the immune system of the body misidentifies these beta cells as foreign bodies and starts an autoimmune attack. This attack results in the gradual death of these vital cells. Due to this autoimmune response, there is a severe decrease or full loss of insulin, resulting in insulin deficiency. Insulin deficiency affects the balance of blood glucose levels and energy requirements, resulting in chronic hyperglycemia (Banday et. al., 2020). Hyperglycemia is the term for elevated blood glucose levels, a characteristic of type 1 diabetes. Even in the absence of insulin, the liver continues to produce glucose. This extra glucose worsens hyperglycemia, which contributes to the typical symptoms of diabetes. The body starts breaking down fats to produce energy to make up for the loss of energy. Syed (2022) explains that excessive thirst (polydipsia), excessive hunger (polyphagia), and excessive urine (polyuria) are common symptoms of type 1 diabetes in people. Further, it results in dehydration and compensates for energy deficiencies.

2)

The two signs and symptoms detected in Ms. Chris Browns case study are moderate dehydration and unstable glucose levels.

3)

Ms. Chris Browns nursing diagnoses from the NANDA list include a risk for deficient fluid volume due to her dehydration risk, and a risk for unstable glucose levels due to her difficulty managing blood sugar levels.

4)

Ms. Chris Browns foremost nursing interventions are fluid replacement therapy to treat dehydration and glycemic management to stabilise blood sugar levels. Fluid therapy seeks to restore and maintain hydration through intravenous or oral rehydration, whereas glycemic control includes monitoring blood glucose levels, delivering insulin or oral medicines, and educating Ms. Brown on diabetic self-care.

5)

The rationale for instituting fluid replacement therapy is to reduce the hazards associated with dehydration, such as electrolyte imbalances and impaired tissue perfusion. Taghavi et. al. (2023) concluded that nurses aim to improve tissue perfusion and avoid potential consequences, such as hypovolemic shock, by restoring intravascular volume. Frequent assessment of vital signs and fluid intake and output guarantees the efficacy of therapy and permits prompt adjustments to meet the patient's fluid requirements (Taylor & Jones, 2022). Similarly, Toschi et. al. (2021) stated that glycemic control measures are critical for stabilising blood glucose levels and preventing acute consequences like hyperglycemia or hypoglycemia, as well as mitigating long-term complications like neuropathy or retinopathy. Nurses encourage patients to actively participate in diabetes treatment by testing their blood glucose levels on a regular basis, administering medications, and educating them.

Case Study 3

1)

The pathophysiology of community-acquired streptococcus pneumonia in the clinical scenario of Mr. Ken Burns is a dynamic interplay between the bodys defence mechanisms and invasive microbes. As explained by Lim (2022), Streptococcus pneumonia is a common and severe bacterial infection of the lungs. It is caused by the bacteria Streptococcus pneumoniae, which is extremely infectious and can spread through respiratory droplets from coughs and sneezes (Dion & Ashurst, 2023). The process starts with the inhalation of Streptococcus pneumoniae, which permits the bacteria to colonise the upper respiratory tract, particularly the nasopharynx, where it binds to respiratory epithelial cells and multiples. Whereas some bacteria migrate from the nasopharynx to the lungs, especially the air sacs (alveoli). The bacteria avoid the bodys defence mechanism and grow rapidly, causing inflammation by activating the innate immune system in the alveoli. This sets off the immune systems reaction, which is characterised by the production of immune cells, especially neutrophils, and inflammatory substances. As a result, the impacted alveoli condense, a process known as consolidation. This causes damage to the alveolar epithelium, impairing its ability to perform normally and hindering the exchange of carbon dioxide and oxygen. Health Direct (2018) concluded that this presents as respiratory distress with symptoms including fever, coughing, and chest pain. Moreover, low urine production could be a sign that the illness is having a systematic effect on the kidneys. The nursing interventions aimed at maximising respiratory function, managing systematic implications, and reducing the risk of complications related to community-acquired streptococcus pneumonia.

2)

The signs and symptoms of community-acquired streptococcus pneumonia in Mr. Ken Burns case are a moist cough and shortness of breath.

3)

The diagnosis of ineffective airway clearance and impaired gas exchange are the two-nursing diagnosis from the NANDA list.

4)

In the case of Mr. Ken Burns, priority nursing interventions are crucial to address the specific issues. First, to improve airway clearance, airway suctioning must be implemented. In addition, the use of continuous oxygen therapy becomes essential to maximise gas exchange.

5)

The nursing diagnosis of ineffective airway clearance mandates airway suctioning. This intervention seems reasonable given its encouragement of efficient airway clearance. Pasrija & Hall (2023) proposed that airway suctioning helps to remove excess mucus and secretions from the airways. This intervention involves the insertion of a tube in the airway for clearance. This proactive strategy is in line with the objective of preserving maximum respiratory function. Simultaneously, to address the nursing diagnosis of impaired gas exchange, continuous oxygen therapy is an essential intervention. Reducing the hazards associated with impaired gas exchange and optimizing oxygenation levels serve as the foundation for the rationale. Raise blood oxygen saturation by giving supplementary oxygen in a constant, regulated flow is the main goal of this intervention (Mart et. al., 2022). This rationale coincides with the broader goals of encouraging effective gas exchange, minimising respiratory distress, and reducing hypoxemia to enhance overall health and wellbeing.

References

Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna journal of medicine, 10(4), 174188. https://doi.org/10.4103/ajm.ajm_53_20Dion, C. F., & Ashurst, J. V. (2023, August 8). Streptococcus Pneumoniae. Nih.gov; Stat Pearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470537/Health Direct. (2018). Pneumonia. Healthdirect.gov.au; Health direct Australia. https://www.healthdirect.gov.au/pneumoniaLim W. S. (2022). PneumoniaOverview. Encyclopedia of Respiratory Medicine, 185197. https://doi.org/10.1016/B978-0-12-801238-3.11636-8Mart, M. F., Sendagire, C., Ely, E. W., Riviello, E. D., & Twagirumugabe, T. (2022). Oxygen as an Essential Medicine. Critical care clinics, 38(4), 795808. https://doi.org/10.1016/j.ccc.2022.06.010Pasrija, D., & Hall, C. A. (2023). Airway Suctioning. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557386/Quinn, L. M., Thrower, S. L., & Narendran, P. (2022). What is type 1 diabetes? Medicine, 50(10). https://doi.org/10.1016/j.mpmed.2022.07.002Syed F. Z. (2022). Type 1 Diabetes Mellitus. Annals of internal medicine, 175(3), ITC33ITC48. https://doi.org/10.7326/AITC202203150Taghavi, S., Askari, R., & Nassar, A. (2023, June 5). Hypovolemic Shock. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513297/Taylor, K., & Jones, E. B. (2022, October 3). Adult dehydration. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555956/Thota, S., & Akbar, A. (2023, July 10). Insulin. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560688/Toschi, E., Atakov-Castillo, A., Clift, A., Bennetti, M., & Gabbay, R. A. (2021). Continuous Glucose Monitoring and Glycemic Control in Young Adults with Type 1 Diabetes: Benefit for Even the Simplest Insulin Administration Methods. Diabetes technology & therapeutics, 23(8), 586589. https://doi.org/10.1089/dia.2020.0624

Case Study

7501255753590Mr. Ken Burns (date of birth 15/10/1956), UR number 891256. He has been admitted with chest crackles, shortness of breath, high respiratory rate, high work of breathing and low saturations. He has copiously green sputum and as a moist cough. He has severe nausea and is very fatigued. He is febrile and has fatigue. He has poor urine output. He is unable to eat or drink due to shortness of breath and was ordered 2L on nasal prongs but keeps removing. He has been ordered high flow.

He has been diagnosed with community acquired streptococcus pneumonia (due to his chest x ray, sputum sample and observations), he is in every few months with pulmonary oedema and is known to the hospital. He has several other comorbidities. He is on a 1.5L fluid restriction.

Past Medical History

Diagnosed with type 2 diabetes at age 48Coronary artery disease (3 myocardial infarctions x 2012, 2013, 2016)

Chronic Heart Failure (2020, ejection fraction [EF] = 35%) Class III: Moderate+ five episode of pulmonary oedema (every few months

Weight 108 kgs; Height 180 cms.

He has a history of smoking for 30 years but reports he does not smoke anymore (since 2020)

COPD since 2020

Medications at home

Enalapril 10 mg PO daily

Irbesartan 300 mg PO daily

Atenolol 100 mg PO BO

Frusemide 80 mg PO BO

Potassium chloride 600 mg PO daily

Ivabradine 5 mg PO BO

Hydralazine 50 mg PO daily

Metformin 500 mg PO TDS

Medications ordered in hospitalActrapid sliding scale SubcutCefotaxime 2 g IV TDS

Morphine 1 - 5 mg IV PRN every 6 hours

Enalapril 10 mg PO daily

Irbesartan 300 mg PO daily

Atenolol 100 mg PO BO

Frusemide 80 mg PO BO

Potassium chloride 600 mg PO daily

Ivabradine 5 mg PO BO

Hydralazine 50 mg PO daily

Salbutamol 5 mg NEB every four hours

Paracetamol 1g PRN PR/PO/IV QID

Metoclopramide 10 mg PRN TDS IM/IV

Metformin withholdInsulin Actrapid Sliding Scale QID before meals SubcutSocial/Family situation

Ken was originally from the United Kingdom and came to Australia in 1986 due to the weather, he lives on his own in the small country town of Plainland, in a flat. He divorced in 2000 and his ex-wife moved back to the United Kingdom to be with her 6 grandchildren. He has little family here and relies on community nurses and his neighbour.

Education

Ken states he is a non-practicing Anglican.

Occupation

Ken is a retired truck driver. He has been unemployed since 2012 after his first MI.

Dietary

Ken has diabetes and does not manage his diet very well, he eats junk food, not regular and frozen food. He does not do his BGL very often.

Sleep

Ken has difficulty sleeping due to his illnesses and sleeps in a recliner chair. He cannot lie down.

Session 1- afternoon shift, short stay ward (14:00 hours). Handover from emergency department (ED) RN (using ISBAR)

I - This is Mr. Ken Burns, born in 1956.

S- Mr. Burns was brought in by ambulance to ED with chest crackles, shortness of breath, high respiratory rate, high work of breathing and low saturations. He had copiously green sputum and as a moist cough. He was febrile and was complaining of fatigue. He was diagnosed with community acquired streptococcus pneumonia (due to his chest x ray, sputum sample and observation). He is nauseated.

B- Mr. Burns was diagnosed with T2DM at age 48, well controlled. He had 3 admissions for acute myocardial infarctions and was managed medically. He has been diagnosed with chronic heart failure with an EF of 35%. He has COPD. He has prodromal angina symptoms (constant angina). He has been moved to the short stay ward for close monitoring and observations.

A- On examination:

7513319164055Airway- Airway patent, patient spontaneously breathingBreathing- bilateral and diffuse lung crackles, shortness of breath, high work of breathing, copiously green sputum, moist cough, pursed lips, slight cyanosis around lips, needs to sit upright, difficulty speaking in sentencesCirculation- peripheries cool to touch, patient dry mucosa, decreased skin turgor, capillary refill 4 seconds, diaphoresisDisability- Cheeks redden and dry, moderately drowsyR- He needs his antibiotic, maintenance fluid (5 ml per hour) of 1L 0.9% Sodium Chloride IV therapy, nebuliser medication and IV dose of frusemide. He needs antiemetic medication. Encourage and monitor fluid intake and urine output. He is on a strict 1.5L fluid restriction.

Vitals -Temp39.5C, BP 180/110, P125 b/min, R40 b/min, SpO2 89%, Lung sounds bilateral crackles, BGL 18.2 mmol/L, Sedation score 2, Pain constant and 8/10

You are required to prioritise the care of Ken throughout your shift

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs act if necessary Assess for specific cues, indications of physiological and psychological health

Plan cares Establish goals

IVT- 5 ml N/S, check IVT, IV antibiotic, IV frusemide STAT dose pain relief and antiemetic, subcut insulin, nebuliser

Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation

Legal requirement, communication, document vital signs on QADDS and BGL onto charts, document IVT, NIMC, FBC, file notes

Session 2- am shift, short stay ward (07:00 hours).

Handover from night duty shift RN (using ISBAR)

I- This is Mr. Burns, born in1956.

7498080299297S- Mr. Burns was diagnosed with community acquired streptococcus pneumonia. He has had 2 doses of his antibiotic and IVT maintenance dose, the pain seems to have settled.

B- Mr. Burns - he has T2DM, acute myocardial infarctions, chronic heart failure, COPD and has been admitted with pneumonia. He is to remain in the short stay ward for close monitoring and observations.

A- Examination:

Airway- Airway patent, patient spontaneously breathingBreathing- bilateral and diffuse lung crackles, shortness of breath, high work of breathing, copiously green sputum, moist cough, pursed lips, slight cyanosis around lips, needs to sit upright, is now able to speak in sentencesCirculation- peripheries cool to touch, patient dry mucosa, decreased skin turgor, capillary refill 4 seconds, diaphoresis settledDisability- Cheeks redden and dry, moderately drowsyR- Continue to monitor vitals including pain scale and sedation score. Continue IVT, continue with sliding scale insulin, next dose of ordered IVAB's. Continue pain relief administer all 08:00 meds, observe and act on vitals.

Vitals - T38.3 C, BP 160/95, P103 b/min, R36 b/min, SpO2 90%, BGL 12.4

mmol/L

You are required to prioritise the care of Ken for your shift and prepare to handover to the ward.

Session 3 Day 3 in hospital, am shift (07:00 hours).

Handover from ward nurse using ISBARI - This is Mr Burns born in 1956S - Mr Burns was transferred to the ward last night

B - Mr Burns has T2DM, CHF, COPD, and pneumonia. He remains stable and can be discharged home.

A Examination:

Airway patent, patient breathing spontaneouslyBreathing reduced lung crackles, SOB improved, small amount of green sputum (which is normal for him), dry cough, pursed lips, needs to sit upright, all of which are normal for him, now able to speak in sentencesCirculation peripheries cool to touch, patient dry mucosa, decreased skin turgor, capillary refill 4 seconds, diaphoresis settledDisability Cheeks redden and dry, alert and talking no complaints of painR Ken requires discharge planning, commenced OABs, cease IVT, BGL, to return to Metformin cease insulin, vital signs act on vitals

You are required to prioritise cares for Ken and provide discharge planning.

Case study

Dr. Narendra Singh (date of birth 01/12/1956), UR number 126897 brought in by wife into emergency department. He is complaining of 10/10 chest pain radiating down his left arm and into his jaw. Has been diagnosed with acute myocardial infarction. He has a history of 3x myocardial infarctions and peripheral vascular disease. He has chest crackles, shortness of breath, high respiratory rate, high work of breathing, pallor, diaphoretic and saturation of 90%. He has been ordered an extra dose of Aspirin and frusemide as well as PRN Sublingual Nitro-glycerin. He is allergic to Morphine reaction is severe nausea has been ordered Fentanyl patch to manage his pain. He has had an intravenous cannula inserted, been ordered an electrocardiograph, chest x-ray, full blood count, electrolytes, and a troponin blood test.

Past Medical History

Diagnosed with 3 myocardial infarctions (2019, 2020, 2021)

Allergic to Morphine reaction severe vomiting

Weight 88 kg; Height 165 cm.

Has a history of smoking for 25 years, wife reports that he still smokes 1-2 cigarettes per day

Medications at home

Aspirin 100 mg PO daily

Sublingual nitroglycerin 1 2 spray PRN

Atenolol 50 mg PO daily

Esomeprazole 40 mg PO nocte

Ticagrelor 90 mg PO daily

Potassium 600 mg PO mane

Medications ordered in hospitalFrusemide 40 mg IV Stat

Aspirin 300 mg PO Stat

Sublingual nitroglycerin 1 2 spray PRN 5 minutes apart (maximum 2 doses at a time)

Aspirin 100 mg PO daily

Atenolol 50 mg PO daily

Esomeprazole 40 mg PO nocte

Ticagrelor 90 mg PO daily

Potassium 600 mg PO mane

Aspirin 300 mg PO STAT

Fentanyl patch 25 microg over 72 hours

Oxygen NP 2 L titrate to saturations

Enoxaparin 40 mg Subcut BD

Paracetamol 1 g PRN PO

Social/Family situation

Education

He has been living in Australia for more than 20 years, originally from India. He has 3 sons and a wife. He states his religion is Hindu.

Occupation

He is a general practitioner and owns his own practice in Ipswich.

Dietary

He is currently nil by mouth. Normal diet when stabilised. He eats a traditional diet which his wife prepares.

Sleep

Narendra cannot lie down; he is having difficulty breathing now.

Session 1- afternoon ED (14:00 hours).

Handover from emergency department (ED) RN to afternoon ED RN. (using ISBAR)

I- This is Dr. Narendra Singh, born in 1956.

S- Dr. Narendra Singh (date of birth 01/12/1956), UR number 126897 brought in by ambulance. He is complaining of 10/10 chest pain radiating down his left arm and into his jaw. He has chest crackles, shortness of breath, high respiratory rate, high work of breathing, pallor, diaphoretic and saturation of 90%. He is to be admitted to ward with AMI and STEMI. He is allergic to Morphine reaction is severe nausea has been ordered Fentanyl patch to manage his continuous pain. He has had an intravenous cannula inserted, been ordered an electrocardiograph, chest x-ray, full blood count, electrolytes, and a troponin blood test. Commence his oxygen on 2L NP.

B- He has a history of 3 x myocardial infarctions and peripheral vascular disease.

A- On examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- bilateral and diffuse lung crackles, shortness of breath, high work of breathing, dry cough, needs to sit upright, difficulty speaking in sentences

Circulation- peripheries cool to touch, decreased skin turgor, capillary refill 4 seconds

Disability- Alert and awake

R- He needs primary survey, full set of vital signs, chest auscultations, ECG his STAT medications and he pain assessment including PQRST pain assessment.

Vitals T37.2C, BP 180/80, P60 b/min, R24 b/min, SpO2 92%, Pain score 3/10 and continuous on NP 2L. ou are required to prioritise the care of Narendra throughout your shift.

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs- act if necessary Assess for specific cues, indications of physiological and psychological health

Plan care Establish goals

IV frusemide STAT aspirin, SLGTN, dose pain relief (Fentanyl patch) Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation Legal requirement, communication, document QADDS, IVT, NIMC, FBC, file notes

Session 2- am shift, short stay ward (07:30 hours).

Handover from night shift RN to day shift RN (using ISBAR)

I- This is Dr Singh, born in 1956.

S- Dr. Singh has diagnosed with refractory angina. On admission, he had chest crackles, shortness of breath, high respiratory rate, high work of breathing and saturations of 90%. He had a 1 L urine output from the frusemide and now has no chest crackles, 3/10 chest pain, no shortness of breath and his saturations are now 95%. He is ordered doses of PRN Sublingual Nitro-glycerine, Enoxaparin 40 mg Subcut BD and is on a fluid restriction. He is allergic to Morphine reaction is severe nausea has been ordered Fentanyl patch to manage his continuous pain (check the patch). He has had an intravenous cannula inserted, his ECG is normal sinus rhythm with broad QRS complexes. His troponin and other bloods are normal.

B- Dr Singh - He has a history of 3 x myocardial infarctions and peripheral vascular disease He is allergic to Morphine which causes a nausea and has been ordered Fentanyl for pain for his AMI. He is to remain in hospital for today and to be transferred to the general ward for close monitoring and observations.

A- Examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- Is sitting upright, is now able to speak in sentences

Circulation- peripheries cool to touch, decreased skin turgor, capillary refill 4 secondsDisability- awake and alert

R- He must have his morning (08:00 hours) medications a Fentanyl patch and continue to monitor vitals including pain scale and sedation score. Continue IVT, observe and act on vitals. He can be discharged to the ward.

Vitals T37.2C, BP 180/80, P68 b/min, R20 b/min, SpO2 95%, Pain score 3/10 and continuous

You are required to prioritise the care of Dr Singh for your shift and prepare to handover to the ward at the end shift.

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs- act if necessary Assess for specific cues, indications of physiological and psychological health

Plan care Establish goals

IVT, oral medications, vital signs Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation Legal requirement, communication, document QADDS, IVT, NIMC, FBC, file notes

Session 3- am shift, general ward (11:30)

Handover from short stay RN (using ISBAR)

I- This is Dr Singh, born in 1956.

S- Dr. Singh has been ordered Sublingual Nitro-glycerine, Enoxaparin 40 mg Subcut BD. He has had an intravenous cannula inserted.

B- Dr. Singh has a history of Myocardial infarction, peripheral vascular disease and has been admitted with AMI.

A- Examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- Chest sounds clearCirculation- Capillary refill 3 seconds

Disability- Awake and alert

R- Dr Singh requires discharge planning, collect vital signs and provide all medsYou are required to prioritise the care of Dr Singh for your shift and complete discharge education.

Case study

Master Jamie Peel UR 263589 DOB 24/12/2013

Jamie has an anaphylactic allergic to peanuts. He has a history of mild asthma triggered by peanuts. Jamie was at school when he accidentally ate peanuts. He has had an injection of his EpiPen (300 microg EpiPen Jr) by the nurse at school. He is now in the emergency department (ED) with a slight wheeze. Jamies inhalers have been given via a spacer. Jamie continues to be lethargic, is on 2 hourly vital signs, he is having regular salbutamol and ipratropium via a metered dose inhaler and spacer. He has an order for IV fluids for dehydration. Oral fluids are to be encouraged.

Past Medical History

Diagnosed with asthma since age of 6 yearsAllergic to peanuts anaphylaxis

Weight 20 kg; Height 125 cm.

Medications at home

Salbutamol 2 puffs 200 microg PRN

Ipratropium bromide 2 puffs (40 microg) TDS

EpiPen (300 microg) PRN for anaphylaxis

Medications ordered in hospitalParacetamol 300 mg QID PO

Ibuprofen 200 mg PRN

Ipratropium 2 puffs (40 microg) TDS

Salbutamol 2 puffs 200 microg every 4 hours

Oxygen 6 L via Hudson mask

Social/Family situation

Current vital signs: HR: 110 BP: 100/60 T36.5 C RR: 28 with bilateral audible wheeze SpO2: 90% on room air, weight: 20kg, height: 115cm

The doctor has commenced Jamie on the following:

MDI reliever and preventer medications

Paracetamol

IV fluids

Education

Jamie lives at Cherbourg and is in grade 4 at Cherbourg State School.

Dietary

He is currently nil by mouth. Normal diet when stabilised.

Sleep

Jamie sleeps 10 hours a night

Session 1- afternoon ED (14:00 hours).

Handover from emergency department (ED) RN to afternoon ED RN. (Using ISBAR)

I- This is Jamie Peel.

S - Jamie has an anaphylactic allergic to peanuts. Jamie was at a school when he accidently ate peanuts. He has had an injection of his EpiPen by the nurse at school. He has had 2 puffs of salbutamol in the ambulance. He is now in the Emergency department, with a slight wheeze and with saturations of 90%. Jamie's inhalers have been via spacer. Jamie continues to be lethargic is on 2 hourly vital signs he is having regular salbutamol and Ipratropium via a Metered Dose Inhaler and spacer. He has an order for IV fluids for dehydration. Oral fluids are being encouraged.

B- He has a history of mild asthma which is triggered when he has peanuts.

A- On examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- shortness of breath, high work of breathing, dry cough, needs to sit upright, difficulty speaking in sentences

Circulation- peripheries warm to touch

Disability- lethargic

R- He needs primary survey, full set of vital signs, chest auscultations, and his 12:00 and 14:00 medications. Commence his oxygen on 6L Hudson mask and pain management.

Vitals T36.4C, HR 110 BPM, BP 100/50, Saturations 90%, RR 32 BPM, Pain hurts whole lot on the Wong-Baker Scale, pain in the chest from coughing.

You are required to prioritise the care of Jamie throughout your shift.

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs- act if necessary Assess for specific cues, indications of physiological and psychological health

Plan care Establish goals

Full set of vitals, oxygenation, medications, pain assessment Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation Legal requirement, communication, document CEWT, IVT, PNIMC, FBC, file notes

Session 2- am shift, short stay ward (07:30 hours).

Handover from night shift RN to day shift RN (using ISBAR)

I- This is Jamie Peel, born in 2013.

S- Jamie has an anaphylactic allergic to peanuts. Jamie was at a school when he accidently ate peanuts. He is now in the short stay ward of the emergency department. Jamie's inhalers are via a spacer. Jamie is on 2 hourly vital signs he is having regular salbutamol and Ipratropium via a Metered Dose Inhaler and spacer. He has an order for IV fluids for dehydration. Oral fluids are being encouraged.

B- He has a history of mild asthma which is triggered when he has peanuts.

A- Examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- Chest sounds clear

Circulation- Peripheries warm to touch

Disability- Awake and alert

R- He must have his morning (06:00 and 08:00 hours) medications and continue to monitor vitals including pain scale and sedation score. Continue fluids and discontinue oxygen.

He can be discharged to the ward.

Vitals T 37.2C, BP 90/60, P 100 b/min, R26 b/min, SpO2 95% on RA, complaining of sore chest: Pain score 3/10

You are required to prioritise the care of Jamie for your shift and prepare to handover to the ward at the end shift.

Session 3- pm shift, general ward (11:30)

Handover from short stay RN (using ISBAR)

I- This is Jamie Peel, born in 2021.

S- Jamie has an anaphylactic allergic to peanuts. Jamie's inhalers have been via spacer. Jamie is on 4 hourly vital signs he is having regular salbutamol and Ipratropium via a Metered Dose Inhaler and spacer. Oral fluids are being encouraged.

B- He has a history of mild asthma which is triggered when he has peanuts.

A- Examination:

Airway- Airway patent, patient spontaneously breathing

Breathing- Chest sounds clearCirculation- Peripheries warm to touch

Disability- Awake and alert

R- Jamie and his mum requires discharge planning include Action Plan for Anaphylaxis and written asthma action plan. Collect vital signs and provide all medsYou are required to prioritise the care of Jamie for your shift and complete discharge education.

Provide Jamie with a flu vaccine as ordered. Remove IV cannula and can be discharged.

Case Study

Mrs. Xia Wang (DOB 14/02/1931), UR number: 226984, recently suffered a fall and fractured her left femoral neck. She has since had a hip replacement to repair the fracture and has arrived on the ward post-operatively. Mrs. Wang is originally from the Jiangxi province of China, migrating to Australia with her husband (now deceased) when they were in their 20s. She has 2 children and several grandchildren and great grandchildren. Her family all live near her nursing home and visit her regularly.

Mrs. Wangs medical history includes hypertension, rheumatoid arthritis in both hands, osteoporosis, urinary tract infections. She suffered a cerebrovascular accident (CVA) ten years ago which left her with mild urinary incontinence and mild left hemiplegia, she uses a wheelie walker and is usually independent when mobilising. She is also slightly forgetful.

Past Medical History

Rheumatoid arthritis in both hands and feet.

Osteoporosis.

CVA 10 years ago resulting in mild left hemiplegia.

Hypertension.

Urinary tract infections.

Height 146cm; Weight 32kg.

No known allergies.

Medications at home

25 mg Atenolol mane PO

35 mg Risedronate weekly/1.25g calcium carbonate other 6 days (Actonel combi) PO

1 g Paracetamol QID PO

Diclofenac (Voltaren) gel applied to hands BD topical0.25 mg Risperidone Quicklet nocte PRN PO

Medications ordered in hospital20 mg Enoxaparin mane Subcut40 mg Gentamicin IV 1800hrs one dose only

1 g Paracetamol QID IV/PO

1 mg Morphine every 6 hours subcut PRN

2.5/1.25 mg Oxycodone/Naloxone (Targin) BD PO

0.25 mg Risperidone Quicklet nocte PRN PO

Diclofenac (Voltaren) gel applied to hands BD topical25 mg Atenolol mane PO

35 mg Risedronate weekly/1.25g calcium carbonate other 6 days (Actonel combi) PO

Social/family situation

Xia is a widow, she has 2 children, 5 grandchildren and 3 great grandchildren. All of whom live nearby and visit her regularly.

She entered the nursing home 10 years previously, following her stroke and the death of her husband.

Xias written and spoken English is good but basic.

Her eldest child, Tao, is her power of attorney.

Education

Xia did not attend school past 13 years old. Once she completed school, she worked on her family farm.

Religion

Xia is a practicing Buddhist.

Occupation

Xia did not work in Australia. When she was younger, she raised their children while her husband worked two jobs. Once her children were grown, she helped them to raise their children and keep their houses clean.

Dietary

Xia does not have any dietary requirements. Her family bring in familiar foods when they visit.

Sleep

Xia usually sleeps well.

Session 1- morning shift, orthopaedic ward (12:00 hours).

Handover from recovery nurse post-op

I- This is Mrs. Xia Wang, born in 1931.

S- Mrs. Wang has had a left total hip replacement to repair a fractured neck of femur she sustained in a fall at her nursing home. She has IVT running, a Bellovac drain, she has staples in situ and her dressing is dry.

B- Xia is originally from China, her English is good but basic. Her power of attorney is her son, Tao, who is waiting for a call once she is settled. Xias medical history is hypertension, osteoporosis, rheumatoid arthritis, she had a CVA 10 years ago. She is not allergic to anything that she knows of.

A- Examination

Airway- she was extubated with no problems and her airway has been clear in recovery.

Breathing- Lungs are clear, she does drop her resp rate and SpO2 when she is asleep but rises again if you disturb her.

Circulation- She has an order for IVT 1 L every 6 hours to be commenced as soon as she is settled into ward. She has a new IVC and needs to have a flush of N/Saline before commencing her IVT. Her dressing is dry, she has a Bellovac drain which is draining a small amount of bright red blood.

Disability- Xia usually walks independently with a wheelie walker as she has mild left hemiplegia following her stroke, she is usually mildly incontinent and has a pad on.

R - IVT, administer STAT IV antibiotic, in 2-4 hours commence oral fluids as tolerated, 12:00 hour IV paracetamol, hourly post-op vitals and wound + drain check, subcut Morphine for pain until she tolerates oral intake then switch to Targin.

Vitals - T36.8C, BP 135/60, HR 86 Bpm, RR 16 Bpm, SpO2 95%, pain 3/10

You are required to prioritise the care of Xia throughout your shift.

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs- act if necessary Assess for specific cues, indications of physiological and psychological health

Plan care Establish goals

IVT- 1L over 6 hours, pain relief (Morphine subcut + IV paracetamol) Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation Legal requirement, communication, document hourly observations onto charts, document QADDS, IVT, NIMC, FBC

Session 2- am shift, orthopaedic ward (06:00 hours)

Q. Complete the Handover from night shift RN (using ISBAR)

I- This is Mrs. Wang, born in 1931.

S-

B-

A- Examination:

Airway-

Breathing-

Circulation-

Disability-

R- She pain relief and meds, IVT, IVAB, collect vitals, administer morning medicationsVitals signs - Temp 36.8C, HR 90 Bpm, RR 16 Bpm, BP 170/80, Oxygen Sats 95%

Session 3 morning shift on discharge day, ward (09:30 hours)

Removal of staples, D/C planning for D/C to NH tomorrow

I- This is Mrs. Xia Wang, born in 1931.

S- Mrs. Wang has had a left total hip replacement to repair a fractured neck of femur she sustained in a fall at her nursing home. She has IVT running, a Bellovac drain, she has staples in situ and her dressing is dry.

B- Xia is originally from China, her English is good but basic. Her power of attorney is her son, Tao, who is waiting for a call once she is settled. Xias medical history is hypertension, osteoporosis, rheumatoid arthritis, she had a CVA 10 years ago. She is not allergic to anything that she knows of.

A- Examination

Airway- clear airway

Breathing- Lungs are clear, SpO2 normal

Circulation- She has an order for IVT 1 L every 12 hours She has a new IVC and needs to have a flush of N/Saline before commencing her IVT. Her dressing is dry, she has a Bellovac drain which is not drainingDisability- Xia usually walks independently with a wheelie walker as she has mild left hemiplegia following her stroke, she is usually mildly incontinent and has a pad on.

R- Mrs. Wangs son has asked for some discharge education for her son. Mrs. Wang will also require education about his discharge antibiotics and pain relief using Targin. Discuss how you will remove the Bellovac, staples and the IVC. Collect vital signs and organise discharge medications.

Case study

Ms Christine Brown (DOB 29/09/1986)

Medical diagnosed from age 8 with type 1 diabetes. She has been admitted with moderate dehydration and unstable glucose levels associated with Quinsy that she has had for the past four days. She has not been able to eat very much for a couple of days and over the past 24 hours has only had sips of liquids. She has not been able to swallow tablets so has not been able to have pain relief and is in considerable pain.

Chris did have several episodes of tonsilitis as a very young child, however a tonsillectomy wasnt considered appropriate. She then grew out of it until a couple of years ago when and she has had worsening tonsilitis 3-4 times per year. She is currently waiting to see a specialist about having her tonsils removed.

Chris reports an allergy to Penicillin causing anaphylaxis. She has no other medical conditions.

Chris is currently afebrile but her partner, Michelle, states she has witnessed Chris having rigors over the past 24 hours.

Medical History

Diagnosed with type 1 diabetes at age 8.

Mild bilateral abdominal Lipodystrophy.

Allergy to Penicillin causing anaphylaxis.

Previous tonsilitis 3-4 times per year.

Weight 78kgs; Height 175cms.

HbA1c 8%.

Medications at home

8 units Novorapid TDS S/C

20 units Levemir nocte S/C

Medications ordered in hospital80 mg Gentamycin IV Daily

1g Paracetamol QID PRN P/R

50mcg Fentanyl TDS PRN IV

10mg Temazepam nocte PRN

10 mg Metoclopramide 10 mg IM TDS PRN

Social/Family situation

Chris is an only child and is close to both of her parents.

She has struggled with anxiety occasionally over the years but has not seen anybody about it. She maintains her parents and partner are supportive.

Chris met her partner three years ago through mutual friends, she reports her partner does not fully understand herdiabetes but tries to help.

Chris and her partner have a close group of friends and struggled with the isolation of COVID restrictions.

Chris has recently taken up smoking due to stress of unemployment.

Education

Chris completed year 12 and a hospitality diploma at TAFE.

Religion

Chris does not identify with any religion.

Occupation

Chris works within the hospitality industry and as such her employment has been sporadic. She finds the uncertainty of unemployment and relying on her partner very stressful and is concerned about the effect this is having on her health.

Dietary

Chris says she usually follows her diabetic regime reasonably well and eats a healthy diet. She checks her blood glucose levels before meals and bedtime. If she feels unwell, she also checks it overnight at 2 oclock am.

She reports drinking a glass of alcohol on occasion and does not use recreational drugs.

Over the past 24 hours Chris has only been able to swallow small amounts of water at a time, she has not taken any insulin for 24 hours.

Sleep

Chris has found she is suffering with moderate insomnia since she has become stressed, having trouble staying asleep.

Session 1- morning shift, short stay ward (14:00 hour).

Handover from ED RN. (Using ISBAR)

I - This is Ms Christine Brown, she prefers Chris, born in 1986.

S -Ms Brown came to ED with dehydration and unstable glucose levels, and Quinsy.

B- Ms Brown was diagnosed with T1DM at age 8, her control is usually good with HbA1c usually around 8%. She currently uses Novorapid and Levemir. She has frequent tonsilitis which has now progressed to Quinsy which she has for 4 days, worsening over the past 24 hours when she has not been able to swallow anything but sips of water. She has not taken any medication including insulin for 24 hours. She has an allergy to Penicillin causing anaphylaxis.

A- On examination:

Airway- Very reddened with marked swelling of tonsils and visible pus. Some obstruction of airway noted.

Breathing- Lungs clear.

Circulation- Heart sound no murmur. Her tongue was coated, with dry mucosa and decreased skin turgor.

Disability- Skin flushed and dry. Stat finger stab reveals a blood glucose of 28 mmol/L. She remains uncomfortable with pain score 8/10.

R-She has been ordered 1L stat and maintenance IV therapy, needs pain relief and insulin. She is for theatre this morning for a tonsillectomy and needs to be readied for OT. Nil By Mouth from 2400.

Vitals T 37.5C, BP 106/86, P92, R20, SpO2 95%, BGL 28 mmoL/s

You are required to prioritise the care of Chris throughout your shift.

Session 2- pm shift ward, post theatre.

Handover from am shift RN. (using ISBAR)

I- This is Ms Christine Brown, She prefers Chris, born in 1986.

S- Ms Brown was admitted through ED with Quinsy, dehydration and unstable BGLs. She had not taken her insulin for 24 hours prior to admission, but this has been sorted now. She had a tonsillectomy this morning which was difficult due to the Quinsy. She is complaining of nausea and has vomited.

B- Ms Brown was diagnosed with T1DM at age 8, her control is usually good with HbA1c usually around 8%. She has an allergy to Penicillin causing anaphylaxis. Her partner Michelle has been contacted as per Chriss wishes.

A- Examination:

Airway- On admission Chriss airway was slightly obstructed due to swelling, the swelling remains post-op with the obvious surgical site and no current bleeding from the tonsil bed.

Breathing- Lungs are clear.

Circulation- Heart sounds normal. Dehydration is improving and skin turgor improving.

Disability- BGLs are now stable however she has Ketones of 1.0 and remains uncomfortable with pain score 6/10.

R- Chris has now been ordered IVABs and sliding scale insulin. She has PRN Fentanyl IV, Metoclopramide IM, a regular Paracetamol PR order and IVT. She requires routine post OT observations and post tonsillectomy vitals of hourly for 6 hours and view her surgical site for signs of bleeding and watch for excess swallowing. She is to remain nil by mouth for 6 hours post-op.

Vitals T 37.5C, BP 122/95, P103, R32, SpO2 95%, BGL 15.4 Ketones 1.0

You are required to prioritise the care of Chris for your shift and commence the recommended cares.

Priority Rationale

Hand hygiene Infection control

Primary survey- act if necessary Ensure patient safe, collect data on health status

Secondary survey including vital signs- act if necessary Assess for specific cues, indications of physiological and psychological health

Plan care Establish goals

IVT- 1L pain relief (Paracetamol), subcut insulin, metoclopramide Attend treatment as ordered, report anomalies, assess for effectiveness

Documentation Legal requirement, communication

Priority Rationale

Session 3- pm shift, ward

Handover from short stay RN (using ISBAR)

I- This is Ms Christine Brown, she prefers Chris, born in 1986.

S- Ms Brown was admitted through ED with Quinsy, dehydration and unstable BGLs. She underwent a tonsillectomy yesterday morning with post-op complication of bleeding in recovery. Her BGLs are stabilising, and she no longer has ketones. She is tolerating a soft diet and normal fluids when her pain is managed. She is to commence oral antibiotics this evening for discharge.

B- Ms Brown was diagnosed with T1DM at age 8, her control is usually good with HbA1c usually around 8%. She has an allergy to Penicillin causing anaphylaxis. Her partner Michelle needs to be contacted to pick her up when Chris is ready for discharge tomorrow.

A- Examination:

Airway- The surgical site looks normal with minimal swelling and no signs of bleeding.

Breathing- Lungs are clear.

Circulation- Heart sounds normal. Dehydration is resolved, skin turgor is normal.

Disability- Pain relief is working with pain remaining 3-4/10.

R- Chris has asked for some diabetes education for Michelle. Chris will also require education about her discharge antibiotics, pain relief and what to do in case of bleeding.

Commence OABs, cease IVT, discharge planning for tomorrow, medsVitals T 36.8, BP 128/86, P84, R18, SpO2 98%, BGL 8.7 Ketones 0.0

You are required to prioritise the care of Chris for your shift and complete discharge education.

List of Current Nursing Diagnoses and Domains

In the 2020 to 2023 edition of NANDA-I, there are 13 domains of nursing diagnoses. Each domain has between three and six classes of nursing diagnoses, that are then broken down into individual diagnoses. Here we will list all 13 domains, related classes, and an example nursing diagnosis. Please see NANDA International- Nursing Diagnoses Definitions and Classification, 12th Edition, for the complete list of diagnoses.

Domain 1: Health PromotionClass 1: Health AwarenessClass 2: Health ManagementDiagnosis: Risk for frail elderly syndrome

Domain 2: NutritionClass 1: IngestionClass 2: DigestionClass 3: AbsorptionClass 4: MetabolismClass 5: HydrationDiagnosis: Risk for unstable blood glucose level

Domain 3: Elimination and exchangeClass 1: Urinary functionClass 2: Gastrointestinal functionClass 3: Integumentary functionClass 4: Respiratory functionDiagnosis: Urinary retention

Domain 4: Activity/restClass 1: Sleep/RestClass 2: Activity/ExerciseClass 3: Energy balanceClass 4: Cardiovascular/pulmonary responsesClass 5: Self-careDiagnosis: Bathing self-care deficit

Domain 5: Perception/cognitionClass 1: AttentionClass 2: OrientationClass 3: Sensation/perceptionClass 4: CognitionClass 5: CommunicationDiagnosis: Impaired memory

Domain 6: Self-perceptionClass 1: Self-conceptClass 2: Self-esteemClass 3: Body imageDiagnosis: Chronic low self-esteem

Domain 7: Role relationshipClass 1: Caregiving rolesClass 2: Family relationshipsClass 3: Role performanceDiagnosis: Impaired social interaction

Domain 8: SexualityClass 1: Sexual identityClass 2: Sexual functionClass 3: ReproductionDiagnosis: Risk for disturbed maternal-fetal dyad

Domain 9: Coping/stress toleranceClass 1: Post-trauma responsesClass 2: Coping responsesClass 3: Neurobehavioral stressDiagnosis: Risk for post-trauma syndrome

Domain 10: Life principlesClass 1: ValuesClass 2: BeliefsClass 3: Value/belief/action congruenceDiagnosis: Moral distress

Domain 11: Safety/protectionClass 1: InfectionClass 2: Physical injuryClass 3: ViolenceClass 4: Environmental hazardsClass 5: Defensive processesClass 6: ThermoregulationDiagnosis: Risk of surgical site infection

Domain 12: ComfortClass 1: Physical comfortClass 2: Environmental comfortClass 3: Social comfortDiagnosis: Impaired comfort

Domain 13: Growth/developmentClass 1: GrowthClass 2: DevelopmentDiagnosis: Delayed infant motor development

List of Common Nursing Diagnoses for care plans

Activity IntoleranceAcute ConfusionAcute PainAnxietyChronic PainConstipationDecreased Cardiac OutputDiarrheaDisturbed Body ImageExcess Fluid VolumeFatigueFluid Volume Deficit (Dehydration)HopelessnessHyperthermiaImbalanced NutritionImpaired ComfortImpaired Gas ExchangeImpaired Physical MobilityImpaired Skin IntegrityImpaired Urinary EliminationImpaired Verbal CommunicationIneffective Airway ClearanceIneffective Breathing PatternIneffective CopingIneffective Health MaintenanceIneffective Tissue PerfusionInsomniaKnowledge DeficitNoncompliance (Ineffective Adherence)Risk For AspirationRisk for BleedingRisk for Electrolyte ImbalanceRisk for FallsRisk for InfectionRisk for InjuryRisk For Unstable Blood GlucoseSelf-Care DeficitSocial IsolationStress OverloadUrinary Retention

Laboratory skill 1

Assessment: Case study analysis

Task overview

Course NUR2102 Clinical Skills for Practice A

Brief task description Written care study analysis for people with musculoskeletal, endocrine, respiratory, circulatory conditions and people with pain and infection

You may refer to the case studies in your residential laboratory manual for more information.

Choose 2 of the following case studies for your case study analysis

You can refer to your Case Studies from the Residential/Laboratory School for more information on the patients

Rationale for assessment task Registered Nurses are required to think through the different aspects of patient care to arrive at a reasonable decision regarding the diagnosis, and treatment of a clinical problem for the person in their care.

Due Date 4th of September 2024 by 11:59pm AEST.

Length 1000 words +/- 10% (includes in-text referencing, excludes your reference list)

Marks out of:

Weighting: Marks out of 100

50 % of overall course

Course Objectives measured Course learning outcomes:

LO1 Apply critical thinking and clinical reasoning skills in the assessment, planning, management, evaluation, and education of individuals experiencing musculoskeletal, endocrinology, respiratory, circulatory, pain and infection.

LO2 Apply theoretical knowledge and evidence-based practice to inform cultural safety, communication, planning, management, and evaluation of individuals experiencing acute illness and episodic health concerns or experiences across the lifespan.

LO3 Develop critical thinking and clinical reasoning skills relating to nursing practice for current regional and National Health Priorities and pre-dominant diseases within the Australian context.

Task information

Task detail Case study 1

Ms. Chris Brown (date of birth 29/09/1986), was diagnosed at age 8 with type 1 diabetes. She has been admitted with moderate dehydration and unstable glucose levels associated with Quinsy which he has had for the past four days. She has not been able to eat very much for a couple of days and over the past 24 hours has only had sips of liquids. She has not been able to swallow tablets so has not been able to have pain relief and is in considerable pain.

Chris did have several episodes of tonsilitis as a very young child, however, a tonsillectomy wasnt considered appropriate. She then grew out of it until a couple of years ago when and she has had worsening tonsilitis 3-4 times per year. She is currently waiting to see a specialist about having her tonsils removed. Chris reports an allergy to Penicillin causing anaphylaxis. She has no other medical conditions. Chris is currently afebrile but her partner, Michelle, states she has witnessed Chris having rigors over the past 24 hours.

Case study questions (500 words)

Briefly describe the pathophysiology for one of the medical diagnoses

List two signs and symptoms that assist in identifying the nursing diagnosis from the medical condition selected for question 1

List two nursing diagnosis from the NANDA list

List two priority nursing interventions that are required for Chris Brown based on the signs and symptoms and nursing diagnosis you selected for questions 2 and 3

Develop rationales for Chris Brown for each of these two nursing interventions listed in question 4

Case study 2

Mrs. Xia Wang (date of birth 14/02/1931), UR number: 226984, recently suffered a fall and fractured her left femoral neck. She has since had a hip replacement to repair the fracture and has arrived on the ward post-operatively. Mrs. Wang is originally from China, migrating to Australia with her husband (now deceased) when they were in their 20s. She has 2 children and several grandchildren and great-grandchildren. Her family all live near her nursing home and visit her regularly.

Mrs. Wangs medical history includes hypertension, rheumatoid arthritis in both hands, osteoporosis, and urinary tract infections. She suffered a cerebrovascular accident (CVA) ten years ago which left her with mild urinary incontinence and mild left hemiplegia, she uses a wheelie walker and is usually independent when mobilising. She is also slightly forgetful.

Case study questions (500 words)

Briefly describe the pathophysiology for one of the medical diagnoses

List two signs and symptoms that assist in identifying the nursing diagnosis from the medical condition selected for question 1

List two nursing diagnosis from the NANDA list

List two priority nursing interventions that are required for Xia Wang based on the signs and symptoms and nursing diagnosis you selected for questions 2 and 3

Develop rationales for Xia Wang for each of these two nursing interventions listed in question 4

Case study 3

Mr. Ken Burns (date of birth 15/10/1956) has been admitted with chest crackles, shortness of breath, high respiratory rate, high work of breathing, and low saturations. He has copious green sputum and a moist cough. He has poor urine output. He is unable to eat or drink due to shortness of breath and was ordered 2 L on nasal prongs but keeps removing them. He has been ordered high flow. He has been diagnosed with community-acquired streptococcus pneumonia (due to his chest x-ray, sputum, and observations), he is in the hospital every few months and is known to the hospital. He has been diagnosed with chronic heart failure, atrial fibrillation, and hypertension.

Case study questions (500 words)

Briefly describe the pathophysiology for one of the medical diagnoses

List two signs and symptoms that assist in identifying the nursing diagnosis from the medical condition selected for question 1

List two nursing diagnosis from the NANDA list

List two priority nursing interventions that are required for Ken Burns based on the signs and symptoms and nursing diagnosis you selected for questions 2 and 3

Develop rationales for Ken Burns for each of these two nursing interventions listed in question 4

Case study 4

Master Jamie Peel (date of birth 24/12/2013) has an anaphylactic allergic to peanuts. He has a history of mild asthma triggered by peanuts. Jamie was at school when he accidentally ate peanuts. He has had an injection of his EpiPen (300 microg EpiPen Jr) by the nurse at school. He is now in the emergency department (ED) with a slight wheeze. Jamies inhalers have been via a spacer. Jamie continues to be lethargic and is on 2 hourly vital signs, he is having regular salbutamol and ipratropium via a metered dose inhaler and spacer. He has an order for IV fluids for dehydration. Oral fluids are to be encouraged.

Case study questions (500 words)

Briefly describe the pathophysiology for one of the medical diagnoses

List two signs and symptoms that assist in identifying the nursing diagnosis from the medical condition selected for question 1

List two nursing diagnosis from the NANDA list

List two priority nursing interventions that are required for Jamie Peel based on the signs and symptoms and nursing diagnosis you selected for questions 2 and 3

Develop rationales for Jamie Peel for each of these two nursing interventions listed in question 4

Case study 5

Dr. Narendra Singh (date of birth 01/12/1956), was brought in by ambulance to the emergency department. He is complaining of 10/10 chest pain radiating down his left arm and into his jaw. Has been diagnosed with Acute Myocardial Infarction. He has a history of 3 x myocardial infarctions and peripheral vascular disease. He has chest crackles, shortness of breath, high respiratory rate, high work of breathing and saturation of 90%.

Case study questions (500 words)

Briefly describe the pathophysiology for one of the medical diagnoses

List two signs and symptoms that assist in identifying the nursing diagnosis from the medical condition selected for question 1

List two nursing diagnosis from the NANDA list

List two priority nursing interventions that are required for Narendra Singh based on the signs and symptoms and nursing diagnosis you selected for questions 2 and 3

Develop rationales for Narendra Singh for each of these two nursing interventions listed in question 4

Writing Style Correct Academic Writing as per USQ guidelinesAPA 7th Edition Referencing (e.g. no less than 6 references)

Contemporary Literature must be sourced (no more than 7 years old)

Formatting Style Double spacing

Font: 12 pointTimes New Roman or Arial

Page numbers

Headings or subheadings to be used

Resources available to complete task USQ academic writing is provided in links on the course

Resources Tab.

https://www.usq.edu.au/library/study-support/assignmentsReferencing

https://www.usq.edu.au/library/referencingArtificial Intelligence Guide

https://usq-qld.libguides.com/artificial-intelligence-students

Plagiarism How to avoid plagiarism

https://www.unisq.edu.au/library/referencing/plagiarism

Submission information

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Note well: All standards of academic integrity, as set out in university policy and procedure, apply to this assessment.

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Students Name: Student Number:

Marking Rubric | NUR2102| Semester 2, 2024 | Case study analysis

Discussion of pathophysiology for each case study

(40 marks in total)

20 - 18.0 17.9 15.00 14.9 10 9.9 5 4.9 - 0

Excellent description of the pathophysiology detailing understanding by clearly, logically, and succinctly paraphrasing well, all the key concepts of the medical diagnosis chosen in case study 1

A very good, description of the pathophysiology however more clarity &/ or logical development &/ or succinctness required in paraphrasing the key concepts to demonstrate understanding of the medical diagnosis in case study 1 A good demonstration of the description of the pathophysiology, however further clarity &/ or logical development &/ or succinctness required in paraphrasing the key concepts.

Not all key concepts are covered to demonstrate understanding of the pathophysiology of case study 1 A satisfactory description of the pathophysiology however over-use of direct quotes, little evidence of paraphrasing, &/ or not succinct & / or logically developed concepts however does demonstrate some understanding of the pathophysiology of case study 1 Very limited or no description of the pathophysiology provided, no evidence or minimal paraphrasing &/or concepts are unclear and / or needs further logical development of concepts providing little evidence of understanding the pathophysiology of case study 1

20 -18.0 17.9 15.00 14.9 10 9.9 - 5 4.9 - 0

Excellent description of the pathophysiology detailing understanding by clearly, logically, and succinctly paraphrasing well, all the key concepts of the medical diagnosis chosen in case study 2

A very good, description of the pathophysiology however more clarity &/ or logical development &/ or succinctness required in paraphrasing the key concepts to demonstrate understanding of the medical diagnosis in case study 2 A good demonstration of the description of the pathophysiology, however further clarity &/ or logical development &/ or succinctness required in paraphrasing the key concepts.

Not all key concepts are covered to demonstrate understanding of the pathophysiology of case study 2 A satisfactory description of the pathophysiology however over-use of direct quotes, little evidence of paraphrasing, &/ or not succinct & / or logically developed concepts however does demonstrate some understanding of the pathophysiology of case study 2 Very limited or no description of the pathophysiology provided, no evidence or minimal paraphrasing &/or concepts are unclear and / or needs further logical development of concepts providing little evidence of understanding the pathophysiology of case study 2

Utilising the Nursing Process for each case study

Signs and symptoms

(20 marks in total)

10 8.0 7.9 6.5 6.4 5.0 4.9 2.0 1.9-0

Excellent demonstration of two signs & symptoms are identified and relate to the pathophysiology listed before and are focused on the chosen case study 1A very good demonstration of understanding of two signs and symptoms are identified and related to the pathophysiology listed before and are mostly focused to chosen case study 1 A good demonstration of two signs and symptoms are identified and related to the pathophysiology listed before and are mostly focused to chosen case study 1 Adequate demonstration of one or two signs and symptoms are provided however they both are only broadly related to the chosen case study 1 Limited or no evidence of understanding of signs and symptoms are provided for chosen case study 1

10 8.0 7.9 6.5 6.9 5.0 4.9 - 2 1.9-0

Excellent demonstration of two signs & symptoms are identified and relate to the pathophysiology listed before and are focused on the chosen case study 2A very good demonstration of understanding of two signs and symptoms are identified and related to the pathophysiology listed before and are mostly focused to simulated patient 2 A good demonstration of two signs and symptoms are identified and related to the pathophysiology listed before and are mostly focused to chosen case study 2 Adequate demonstration of one or two signs and symptoms are provided however they both are only broadly related to the chosen case study 2 Limited or no evidence of understanding of signs and symptoms for chosen case study 2Nursing diagnosis for each case study

(5 marks in total)

2.5-1.75 1.75-1.5 1.45-1.26 1.25-0.6 0.5-0

Excellent demonstration of understanding of the two nursing diagnoses are identified and linked cogently to the signs and symptoms for the chosen case study 1 A very good demonstration of understanding of the two nursing diagnoses are identified and linked to the signs and symptoms for the chosen case study 1 A good demonstration of understanding of two nursing diagnoses are identified however the links to the signs and symptoms are broad for one of the nursing diagnoses identified and further thought needed for chosen case study 1 Two nursing diagnoses identified, however the links to the signs and symptoms are too broad for both nursing diagnosis identified and requires further logical thought and linkage to the signs and symptoms are needed for chosen case study 1 One or two nursing diagnoses are identified however there is a tenuous link to the signs and symptoms identified. Little/ no evidence of clear logical thought in linking the cues with the signs and symptoms identified for chosen case study 1

2.5-1.75 1.75-1.5 1.45-1.26 1.25-0.65 0.5-0

Excellent demonstration of understanding of the two nursing diagnoses are identified and linked cogently to the signs and symptoms for chosen simulated patientcase study 2

A very good demonstration of understanding of the two nursing diagnoses are identified and linked to the signs and symptoms for chosen case study 2 A good demonstration of understanding of two diagnoses identified however the links to the signs and symptoms are broad for one of the nursing diagnoses identified and further thought needed for chosen case study 2 Two nursing diagnoses identified, however the links to the signs and symptoms are too broad for both nursing diagnosis identified and requires further logical thought and linkage to the signs and symptoms are needed for chosen case study 2 One or two nursing diagnoses are identified however there is a tenuous link to the signs and symptoms identified. Little/ no evidence of clear logical thought in linking the cues with the signs and symptoms identified for chosen case study 2

Development utilising the Nursing Process for each case study2 Nursing Interventions

(5 marks in total)

2.5-1.75 1.75-1.5 1.45-1.26 1.25-0.65 0.5-0

An excellent demonstration of understanding of the care required for simulated patient. Excellent link between medical condition, signs and symptoms and nursing diagnosis identified and appropriate nursing care planned for case study 1.

A very good demonstration of understanding of the care required for simulated patient. A very good link between medical condition, signs and symptoms and nursing diagnosis. Two focused nursing interventions are identified and discussed mostly cogently, and concisely in relation to the nursing diagnosis identified. Some further clarity is required at times for case study 1A good demonstration of understanding of the care required for simulated patient. A very good link between medical condition, signs and symptoms and nursing diagnosis. Two nursing interventions are identified. Further clarity & / or elaboration required at times.

The relationship between the intervention and diagnosis is sometimes clear, however needs further explanation at times for case study 1 Two nursing tasks are identified and discussed broadly, however, one or both are not fully focused to the medical condition/sign and symptom/nursing diagnosis identified. Needs further thought. Further clarity & / or elaboration required at times.

The relationship between the intervention and diagnosis is sometimes clear, however needs further explanation at times for case study 1.

No or limited discernible nursing interventions are identified and &/or are discussed minimally.

Interventions do not / or minimally relate to the diagnosis identified.

Does not include relevant information regarding appropriate nursing interventions for chosen patient.

Limited or inappropriate use of academic resources to support clinical decision-making for case study 1

2.5-1.75 1.75-1.5 1.45-1.26 1.25-0.65 0.5-0

An excellent demonstration of understanding of the care required for simulated patient. Excellent link between medical condition, signs and symptoms and nursing diagnosis identified and appropriate nursing care planned for case study 2

A very good demonstration of understanding of the care required for simulated patient. A very good link between medical condition, sign and symptoms and nursing diagnosis. Two focused nursing interventions are identified and discussed mostly cogently, and concisely in relation to the nursing diagnosis identified. Some further clarity required at times for case study 2A good demonstration of understanding of the care required for simulated patient. A very good link between medical condition, signs and symptoms and nursing diagnosis. Two nursing tasks are identified and discussed broadly and needs further edits for conciseness in relation to the problems identified. Further clarity & / or elaboration required at times.

The relationship between the intervention and diagnosis is sometimes clear, however needs further explanation at times for case study 2Two nursing tasks are identified and discussed broadly, however, one or both are not fully focused to the medical condition/sign and symptom/ nursing diagnosis identified. Needs further thought. Further clarity & / or elaboration required at times.

The relationship between the intervention and diagnosis is sometimes clear, however needs further explanation at times for case study 2.

No or limited discernible nursing interventions are identified and &/or are discussed minimally.

Interventions do not / or minimally relate to the diagnosis identified.

Does not include relevant information regarding appropriate nursing interventions for chosen patient.

Limited or inappropriate use of academic resources to support clinical decision-making for case study 2Rationales to support nursing interventions for each case study

(20 marks in total)

10 8.0 7.9 6.5 6.4 5.0 4.9 2.0 1.9-0

Excellent demonstration of understanding of rationales. Rationales are highly relevant, well thought out and focused to the interventions and is supported by key evidence- based literature &/ or theory for case study 1A very good demonstration of understanding of rationales. Rationales are mostly relevant and focused to the interventions, further linkage and elaboration required at times, and is supported by evidence- based literature &/ or theory for case study 1A good demonstration of understanding of rationales. Rationales are mostly relevant to the interventions, however, could be more focused, Requires further explanation at times.

Is supported by evidence-based literature &/ or theory for case study 1Adequate demonstration of understanding of rationales.

The rationales are somewhat relevant to the interventions, too broad, needs to be more focused, linkage is obscure at times, Requires further explanation at times.

Is supported by evidence- based literature &/ or theory for case study 1Rationale is minimally / not relevant to the intervention; link is unclear and explanations irrelevant. Little or no evidence-based literature &/or theory is used for case study 1

10 8.0 7.9 6.5 6.4 5.0 4.9 2.0 1.9-0

Excellent demonstration of understanding of rationales. Rationales are highly relevant, well thought out and focused to the interventions and is supported by key evidence- based literature &/ or theory for case study 2A very good demonstration of understanding of rationales are mostly relevant and focused to the interventions, further linkage and elaboration required at times, and is supported by evidence- based literature &/ or theory for case study 2

A good demonstration of understanding of rationales. Rationales are mostly relevant to the interventions, however, could be more focused, Requires further explanation at times.

Is supported by evidence-based literature &/ or theory for case study 2Adequate demonstration of understanding of rationales.

The rationales are somewhat relevant to the interventions, too broad, needs to be more focused, linkage is obscure at times, Requires further explanation at times.

Is supported by evidence- based literature &/ or theory for case study 2Rationale is minimally / not relevant to the intervention; link is unclear and explanations irrelevant. Little or no evidenced based literature &/or theory is used for case study 2

Academic writing (10 marks)

10 8.0 7.9 6.5 6.4 5.0 4.9 2.0 1.9-0

Word limit: Adhered to word limit +/- 10%

Expression

High standard of academic presentation. Expressed ideas clearly, concisely & fluentlyVery few, if any spelling or grammatical errors 1 or less

Structure

Well-constructed using template provided, clearly expressed & linked main pointsReferencing

Correctly cited sources both within text & reference list

No mistakes in citation or referencing format using highly relevant literature Word limit: Adhered to word limit +/- 10%

Expression

Sound academic structure and presentation. Expressed ideas clearly and concisely. Very few spelling or grammatical errors, less than 3

Structure

Well-constructed using template provided, clearly expressed.

Referencing

References to literature conform to the conventions APA7 and there are limited mistakes 1-2 in citation or referencing format. Word limit: Adhered to word limit +/- 10%

Expression

Sound academic structure and presentation. Expressed ideas clearly and concisely. Very few spelling or grammatical errors less than 4

Structure

Well-constructed using template provided, clearly expressed.

Referencing

References to literature mostly conform to APA7 conventions. Some mistakes, 3-4, in citation or referencing format. Word limit: Adhered to word limit +/-10%

Expression

Limited clarity of expression

Errors in spelling & grammar 4-6

Structure

Used template provided however, main points were inappropriate, or they were not linked key content areas.

Referencing

References to literature mostly conform to APA7 conventions. Mistakes, 4-5 noted in citation or referencing format. Word limit: Not adhered to

Expression

Used incorrect terminology.

Numerous mistakes in spelling and/or grammar, greater than 6

Structure

No or limited structure

Referencing

References to literature minimally / do not conform to APA7 conventions. Numerous mistakes, greater than 5, in citation or referencing format.

MARKS LOST FOR LATE PENALTY (IF RELEVANT -5% of the total marks available for the assessment item per calendar day deducted from total mark gained) Comments from your marker:

Final Mark /100