Case Analysis- Case Study of an Acute Life-Threatening Condition
Word Count
There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% (1100 words) the marker will stop marking.
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.
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:
A. Patent, own
B. RR-18/mt, SPO2-99%RA. Spontaneous, no increased work of breathing, chest clear, good
air entry B/L, no added sounds.
C. Heart Rate Regular- 124/mt, tachycardic. BP- 90/58 mmHg. Capillary Refill Time <3 sec.
D. GCS-14/15 E4V4M6 (was GCS-15/15 on arrival).
E. 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.
F. No IV fluids in progress.
G. BSL-4.8 mmol/L
Weight: 58 kg
Bedside Urinalysis: Leucocytes ++, nitrites ++, blood +++, BHCG +ve
Midstream Urine sent to lab for culture
Lab Results:
| Result | Reference Range | |
| Sodium | 137 mmol/L | 135-147 mmol/L |
| Potassium | 3.9 mmol/L | 3.5-5.2 mmol/L |
| Chloride | 120 mmol/L | 95-107 mmol/L |
| Haemoglobin | 109 g/L | 120-140 g/L |
| White blood cells | 26.3×10^9/L | 4.0-11.0×10^9/L |
| Neutrophils | 13.0×10^9/L | 2.0-7.5×10^9/L |
| Platelets | 64×10^9/L | 150-400×10^9/L |
| C Reactive Protein (CRP) | 116 mg/L | <3mg/L |
| Urea nitrogen (BUN) | 10.0 mmol/L | 3.0-8.0 mmol/L |
| Creatinine | 127 µmol/L | 64 -104 µmol/L |
Coagulation profile:
| Result | Reference range | |
| Partial thromboplastin time (PTT) | 33 sec | 30-45 sec |
| Prothrombin time (PT) | 26 sec | 10-12 sec |
Procalcitonin:
| Result | Reference range | |
| Procalcitonin (PCT) | 37.18 ug/L | 0-10 ug/L |
Arterial blood gas analysis (at 2200hrs)
| Result | Reference Range | |
| pH | 7.12 | 7.35-7.45 |
| PaO2 | 70 mmHg | 80-100 mmHg |
| PaCO2 | 28 mmHg | 35-45 mmHg |
| HCO3- | 16 mmol/L | 22-26 mmol/L |
| SpO2 | 82% | >95% |
| BE | -7.2 mmol/L | -2 – +2mmol/L |
| Lactate | 5.2 mmol/L | 0.5-1.6mmol/L |
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.
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
Criteria 1 –
Explain the pathophysiology causing all the clinical manifestations with which Mrs Smith presents. Use information from diagnostic results where relevant.
Analyses information from a discerning selection of sources and provides an accurate, clear and comprehensive explanation of the pathophysiology causing the clinical manifestation of the patient in the case study. The explanation is developed in a logical sequence and incorporates all clinical manifestations presented in the case study. The discussion is clearly and accurately supported by appropriate sources.
Criteria 2-
Accurately discuss and explain the rationales for the interventions. Discuss briefly the mechanism of action of medication and relate the medication to the underlying pathophysiology of sepsis. Describe the impact of not performing the intervention.
Accurately, clearly, and comprehensively, discusses the rationale for both interventions used to manage the patient with sepsis. Accurately discusses the mechanism of action of the medication and relates the medication to the underlying pathophysiology and clinical manifestations of sepsis. Describes comprehensively the consequences of not performing the interventions. The discussion is clearly and accurately supported by appropriate sources.
Criteria 3- Academic Integrity Search terms/ Search engines used Indicates search terms used to access literature via the nursing e-resources via the library
– Provides names of search engines and search terms used to locate literature. For example
– CINAHL
– MEDLINE (Ovid) – Clinical Key for Nursing
– Cochrane library
– JBI
– Scopus
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