APA 7TH REFERENCING MINIMUM 18TH REFERENCESNRSG378: Principles of Nursing - Extended Clinical...

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APA 7TH REFERENCING MINIMUM 18TH REFERENCESNRSG378: Principles of Nursing - Extended Clinical Reasoning NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 1 of 4  ASSESSMENT INFORMATION  Assessment  Title  Assessment Task 3 – Case Study  Purpose  This assessment enables students to apply knowledge from unit learnings to an issue  requiring extended clinical reasoning.  The assessment will engage students with the application of theory to practice and is  designed to facilitate an understanding of the impact of illness on the patient.  It is  also intended to give students the opportunity to demonstrate the ability to use a clinical  reasoning framework to plan the care of an acutely unwell patient.   Due Date Wednesday 24th May 2023  Time Due 14:00   Weighting  50%  Length  2000 words    Assessment  Rubric   Appendix 2 of the NRSG378 unit outline  LEO  Resource  A national pre-recorded video will be uploaded onto LEO in week seven (7), which will  provide students with an overview of the assessment as well as resources and advice on  how to approach the task.  Students are encouraged to post questions on the discussion forum on LEO and to check  for answers there as a first point of query.  LOs  Assessed  LO1, LO2, LO3, LO4  Task Students will assess, prioritise and plan the care of the case study patient using a clinical  reasoning framework.   Sections you need to respond to include:  1. Disease pathophysiology and patient assessment (500 words):  • Provide an initial impression of the patient and identify relevant and significant  features from the patient presentation;  • Discuss in detail, the pathophysiology of the disease and how Kate’s presenting  signs and symptoms reflect the underlying pathophysiology;  • Identify further elements of a comprehensive nursing assessment (this can be  presented as a list) 2. Identify nursing and patient issues (500 words):  • Identify and prioritise 3 nursing issues you must address for Kate and justify why  they are priorities and support your discussion with evidence and data from the case  study. These can be actual or at-risk issues.  • Discuss the potential impact of this admission on Kate’s 2 most important activities  of living (can be biological, psychosocial, spiritual or cultural factors) NRSG378: Principles of Nursing - Extended Clinical Reasoning NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 2 of 4  3. Discuss the pharmacological management (400 words):  • Identify and discuss two (2) common classes of drugs used for Kate, including the  drug mechanism of action, indication and nursing considerations. This does not  mean specific drugs but rather the class that these drugs belong to. 4. Nursing interventions (600 words):  • Identify, rationalise and explain, in order of priority, the nursing care strategies you  should use within the first 24 hours post-surgery for Kate.  Case Study Kate Sansbury is a 22-year-old female who presented to the emergency department (ED)  with abdominal pain, nausea and vomiting, and general malaise.  She stated that the pain  appeared 3 days ago but was dull and localised to the right lower quadrant only, and  resolved when she applied a heat pack and took some paracetamol. She assumed the pain  was due to her upcoming period.     Last night at 3am she woke when the abdominal pain became sharp and was so  “intolerable” she vomited. She has since had 2 further vomits, and states she feels ongoing  nausea. She has not been able to eat or drink her usual amounts for the past day. She  states she has only voided once yesterday and it was “very dark yellow” in colour.    On assessment:  • Kate appears pale, cool and clammy. Her lips appear dry  • She is lying in a semi-Fowler’s position and has her hands across her stomach  (guarding). Kate appears reluctant to move   • Her abdomen is distended and tender, and there are minimal abdominal sounds on  auscultation  • On abdominal palpation, she states the pain is 8/10 on the right lower quadrant, but  the pain also occurs across her abdomen, and it is becoming worse    Health assessment findings and laboratory results at presentation:  • HR 118 bpm, regular pulse  • BP 90/60 mmHg  • RR 24 bpm, mild WOB  • Temp 39.2C  • SpO2 97% on RA  • Alert and orientated to time, place, and person. GCS 15  • CRT 2 seconds   • Last bowel motion – yesterday but patient states she feels “constipated”  • Weight – 62kg      Result  Normal Values   Haemoglobin (Hb) 145 g/L 150-160 g/L (females)  WBC  15 x 109/L  4-11 x 109/L   Sodium  132 mmol/L 135 to 145 mmol/L  Potassium  3.5 mmol/L 3.5 to 5.2 mmol/L  Lactate  2.0 mmol/L

Dr Insiyah R. · Accepted Answer

Introduction	1
Conclusion	9
References:	9
Introduction 
The method through which a therapist engages with a patient is known as clinical reasoning. During this process, the therapist gathers data, develops and tests hypotheses, and then uses this data to determine the best course of action for diagnosis and therapy (Sullivan et al,2019). According to one definition, it is an inferential procedure used by practitioners to gather and assess data and make decisions on the diagnosis and treatment of patient issues. Healthcare workers are trained to use clinical reasoning to make the best decisions possible in regard to the patient and setting (Kendall et al,2023). With the help of a case study this assignment will provide a brief discussion regarding the topic. 
1. Initial Impression and Presentation of the Patient:
Kate Sansbury is a 22-year-old female presenting to the emergency department with abdominal pain, nausea, vomiting, and general malaise. Significant features of her presentation include the onset of pain three days ago with the recent exacerbation of symptoms, pain being localized to the right lower quadrant of her abdomen, difficulty eating and drinking, and the appearance of being pale, cool, and clammy. Her pain is also described as intolerable and she has distended and tender abdomen (Sullivan et al,2019). The assessment findings, patient history, and laboratory results suggest that Kate may be suffering from an acute appendicitis and secondary peritonitis.
2. Pathophysiology of the Disease and its Relation to Kate's Symptoms:
Appendicitis occurs when the appendix becomes inflamed and infected. In Kate's case, this could be due to a blockage of the appendiceal lumen by fecal matter or a foreign body, leading to bacterial infection, inflammation, and swelling. The pain initially presenting in the right lower quadrant of her abdomen is a typical location for appendicitis pain, also known as McBurney's point. As the infection worsens, the pain may spread across her abdomen, which is consistent with Kate's description of her pain (Kendall et al,2023).
In the case of secondary peritonitis, bacteria from the infected appendix leak into the peritoneal cavity, causing inflammation and infection of the surrounding tissues. This can lead to the formation of abscesses and the spread of infection to other organs. Kate's elevated white blood cell count (15 x 10^9/L), fever (39.2C), and increased C-reactive protein levels (150 mg/L) indicate an ongoing infection and inflammation in her body. Additionally, her increased heart rate (118 bpm), respiratory rate (24 bpm), and low blood pressure (90/60 mmHg) may suggest that her body is compensating for the infection and inflammation, leading to an increased demand on her cardiovascular and respiratory systems (Sullivan et al,2019).
3. Further Elements of a Comprehensive Nursing Assessment:
A comprehensive nursing assessment for Kate Sansbury should include the following elements:
- Pain assessment: Location, intensity, quality, aggravating or relieving factors, and the effect of pain on her daily activities and mental well-being.
- Gastrointestinal assessment: Presence of nausea, vomiting, bowel movements, constipation or diarrhoea, and any change in appetite or eating habits.
- Genitourinary assessment: Urination frequency, colour and clarity, and any pain or discomfort during urination (Wolfgang and Wolfgang, 2018).
- Respiratory assessment: Breathing patterns, presence of wheezing, use of accessory muscles, and any previous history of respiratory issues such as asthma.
- Cardiovascular assessment: Heart rate, rhythm, and strength, presence of peripheral oedema or cyanosis, and assessment of capillary refill time.
- Neurological assessment: Level of consciousness, orientation, memory, and cognitive function.
- Psychosocial assessment: The impact of her illness on her emotional and mental health, as well as on her relationships, work, and studies.
- Cultural and spiritual assessment: Potential cultural or spiritual needs related to her illness and treatment.
- Assessment of allergies and potential medication interactions: Given the medications she is currently taking, such as sertraline and salbutamol (Herdman, Kamitsuru & Lopes, 2021).
- Physical examination: Inspection, palpation, percussion, and auscultation of the abdomen and other relevant body systems.
- Review of laboratory and diagnostic test results: To monitor the progress of her condition and the effectiveness of treatment.
Nursing Issue 
1: Infection Control and Pain Management
The most immediate concern in Kate's care is the management of her infection due to appendicitis and impending peritonitis, and the control of her acute pain. It is evident from her elevated heart rate (118 bpm), low blood pressure (90/60 mmHg), fever (39.2°C), and increased white blood cell count (15 x 10^9/L) that she is experiencing an inflammatory response (Gómez-Urquiza et al,2019). Furthermore, her abdominal pain is significant with a score of 8/10, prompting her to guard her abdomen and limit her movement. 
This issue is a priority because uncontrolled pain can lead to decreased mobility, which could further exacerbate her risk of bacterial infection. Additionally, appropriate and timely intervention is necessary to reduce the risk of complications such as abscess formation, septicemia, and postoperative pain (Wolfgang and Wolfgang, 2018). Pain relief via IV morphine and initiating antibiotic therapy with ceftriaxone are essential for managing her symptoms and controlling the infection.
Nursing Issue 2: Fluid and Electrolyte Balance
Kate is also at risk for fluid and electrolyte imbalances due to her reduced intake of food and water, nausea, vomiting, and fever. Her dark yellow urine, dry lips, and increased respiratory rate (24 bpm) all indicate potential dehydration (Kendall et al,2023). The administration of IV fluids (NaCl 0.9% 500ml bolus and 70ml/hr) aims to address this, but careful monitoring of her vital signs and hourly urine output would help ensure the effectiveness of this intervention and prevent complications such as hypovolemia and electrolyte derangements (Wolfgang and Wolfgang, 2018).
Nursing Issue 3:

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