Assignment 1: Critical Essay
Word limit: 2000 words
Task:
Choose one of the five case studies to address in an essay format.
Consider the patient information provided, and the nurses’ role in providing care for this patient.
Discuss relevant pathophysiology to demonstrate your understanding of the underlying condition for this patient.
Outline your plan for a comprehensive assessment of this patient, using both general and focussed nursing assessment.
You need to support your nursing assessment and management with high quality evidence, consisting of a broad range of literature sources including clinical practice guidelines, systematic review and evidence summaries, and recent journal publications.
Utilising the information from one of the scenarios below you are to:
(1) Provide background to the case provided, including pathophysiology and patient condition (Approx. 300 words)
(2) Outline your nursing assessment, and how you would prioritise the provision of care for the patient (approx. 1200 words). This can be achieved through use of a systematic framework for patient assessment. An A to G assessment is suggested, however you can use any other relevant and recognised framework, supported by evidence
(3) Identify and discuss the interventions/treatments that are required and the associated nursing management priorities (Approx. 500 words)
(3.1) Provide a rationale and critique of potential treatment and nurse management priorities in conjunction with current evidence based practice, through the application of the scholarly literature
Case studies – Choose one
(1) Seizure
You have taken over care of Jaxon, a 26-year-old patient who has been admitted for observation following a fall at home with a short loss of consciousness. At handover, Jaxon had a GCS of 15, and the neuro exam was within normal limits. His vital signs at handover were BP 124/74 HR 72 R 22 SaO2 99% on room air. He is waiting for a CT head to assess for trauma or bleeding to the brain. While awaiting radiology to call for the patient, you hear Jaxon call out and observed the patient to lose consciousness. He stiffened his entire body and then had violent muscle contractions. His respirations are very shallow, and you have noted some signs of cyanosis. The patient bit his tongue and there is a small amount of blood coming from the mouth. The radiology department calls as they are ready for the patient.
Post-operative care
Peggy is 83 years of age. She admitted to the surgical unit postoperatively for a laparoscopic colectomy (removal of a section of the colon for colorectal cancer). The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a surgical drain intact with minimal haemoserous drainage. The patient has a Salem sump nasogastric tube that is draining a small amount of brown liquid. There is an IDC insitu with a small amount of dark amber coloured urine without sediments. The patient has antithromboembolism stockings and pneumatic compression boots in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 litres via nasal cannula with a pulse oximetry reading of 95%. The vital signs include: BP100/50, HR 110, R 16, and the patient is afebrile. The patient is alert and orientated to person, place and time.
Pancreatitis
Jane is a 38 year old who is usually fit and well. She was admitted to the medical ward with sudden onset, two-hour history of epigastric pain. She describes the pain as excruciating and indicates it is located in the midepigastrium with radiation into the back. The pain eased slightly when she sat forward. She felt nauseated with the pain and had vomited twice. She has not eaten since yesterday, and has not been able to drink any oral fluids this morning.
Her serum amylase and lipase are significantly elevated. You note that she appears pale and is grimacing with pain. Her pulse is 88, BP 120/72 and she is very tender in her epigastrium with mild rebound tenderness but no guarding. Her temperature is 376C and her respiration rate is 24, with SaO2 at 98%. Jane is speaking in sentences, but catches her breath and splints her upper abdomen with her hand when she tries to take a deep breath or cough. Her urinalysis shows no abnormalities except for ketones ++ and SG 1.030.
GIT bleed
Reggie is 69 years old and presents to the ED after noticing blood in the toilet after he has passed a stool today. He has a previous history of diverticular disease and hemicolectomy. He does not have any pain at the moment but states that he has noticed dark stools over the past few weeks. His vital signs are BP 104/72, HR 98, R 22, SaO2 97% on room air. His T is currently 365C.
His haemoglobin is 105 g/L (normal range for males is 130 – 180 g/L). He says that he has been experiencing some shortness of breath and that he has been feeling a little more tired than usual of late. He is able to speak in full sentences at rest but it is noted that he becomes short of breath on minimal exertion, like walking to the bathroom. He is nil by mouth awaiting a colonoscopy.
ENT
Gemma is a 17 year old who presents to the clinic with dizziness following a 3 day history of fever and general malaise. On examination, they have an inflamed right tympanic membrane, red and inflamed throat, dry mucous membranes, and look generally unwell. Gemma’s parent asks if they can lie down in the waiting area as sitting up is difficult.
Temp is 386C, HR 99, BP 99/57, R 14, SaO2 99% on room air. Gemma says that it hurts to swallow so they haven’t been taking regular analgesia. Gemma has been trying to keep fluids up, but has vomited several times over the past few days. Gemma is drowsy but rousable, and orientated to place and person.
