Case study, APA 7th Referencing, intext citationNRSG378: Principles of Nursing - Extended Clinical...

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Case study, APA 7th Referencing, intext citationNRSG378: 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. Saloni · Accepted Answer

Case Study of Kate
Introduction:
In this case study, Kate Sansbury, a 22-year-old woman complaining of stomach pain, nausea, vomiting, and general malaise, will be discussed in terms of her presentation, assessment, and treatment. She has been identified as having a perforated appendix with secondary peritonitis following a thorough evaluation. This assignment will additionally examine the pathophysiology of the disease in addition to performing a comprehensive nursing assessment, identifying and prioritising nursing issues, discussing the potential effects of admission on Kate's activities of daily living, analysing the pharmacological management, and suggesting nursing interventions for the first 24 hours following surgery.
Disease Pathophysiology:
Faecal matter and bacteria released during perforation of the appendix cause an inflammatory reaction in the peritoneal cavity. During this inflammatory process, immune cells like neutrophils migrate to the infection site. These cells start an immune reaction to fight infection by releasing proinflammatory cytokines. However, the peritoneal cavity's bacterial, inflammatory, and pus buildup causes extensive inflammation and tissue damage. The peritoneum, the thin tissue lining the abdominal organs and cavity, becomes irritated and inflamed as peritonitis worsens as the inflammatory exudate spreads throughout the abdominal cavity (Banoth & Venkatesh , 2022). 
Increased vascular permeability caused by infection and inflammation leads to fluid and inflammatory mediators building up in the peritoneal space. The fluid buildup contributes to abdominal tenderness and distension. Systemic manifestations can be caused by the release of bacterial toxins, inflammatory mediators, and the following systemic inflammatory response. Kate's increased white blood cell count, fever, and elevated heart rate are signs of a systemic infection response. Additionally, hypovolemia triggered by fluid sequestration in the peritoneal cavity may be responsible for lower blood pressure. Without prompt treatment, the infection could worsen and lead to septic shock or severe sepsis, endangering Kate's general health (Ramteke et al., 2023). 
Patient Assessment:
A thorough nursing assessment is essential in determining Kate's overall condition and identifying potential complications in addition to the symptoms she is currently exhibiting. Several facets of her health status should be assessed. Monitoring vital signs is necessary to create a baseline and find any abnormalities. Kate's temperature, respiratory rate, heart rate, blood pressure, and oxygen saturation should all be monitored regularly. In Kate's case, the elevated heart rate and fever were signs of a systemic infection response (Rohma et al., 2023). Understanding the type and severity of Kate's abdominal pain requires a thorough assessment of the pain. The nurse needs to assess the pain's characteristics, location, and intensity. Initially dull and localised to the right lower quadrant, Kate describes the pain as becoming more diffuse and intense over time. A validated pain scale can be used to assess pain intensity and inform pain management strategies (Moore, 2022).
It is critical to assess Kate's fluid and electrolyte balance due to her poor oral intake, vomiting, and dark urine. Monitoring intake and output, determining hydration status, and analysing laboratory data, including electrolyte levels, may be helpful to determine any imbalances and lead to appropriate interventions to address fluid deficits and keep organ function at its best (Ramteke et al., 2023). It is important to conduct a gastrointestinal assessment by paying attention to the patient's bowel movements, checking for tenderness and distention in the abdomen, and watching for any fluctuations in bowel sounds. Kate's case involves minimal abdominal sounds, distension, and tenderness, all of being indicative of peritonitis. Kate complained of being constipated, so monitoring bowel movements and looking for signs of impaction or constipation is also crucial (Moore, 2022).
The effect of the condition on Kate's psychological health must be considered. The nurse should assess her emotional state, anxiety levels, and any worries or concerns she may have about the surgery, the recovery process, or how it might affect her academic and social lives. Her psychological needs during hospitalisation can be met by giving her emotional support, information, and appropriate referrals to other healthcare providers, like a psychologist or counsellor (Rohma et al., 2023).
Nursing Issues:
In this situation, Kate's primary nursing concerns are infection control, fluid and electrolyte imbalance, and pain management. Due to her excruciating abdominal pain, Kate has a significant nursing concern with pain management. Using a validated pain scale, the nurse should evaluate the type, location, and characteristics of the pain. To reduce Kate's pain, increase her comfort, and enable early mobilisation, analgesics like IV morphine should be administered promptly. Regularly, the nurse should reevaluate the patient's level of pain and change the dosage as necessary (Nissen & Tröbs, 2021).
Unbalanced fluid and electrolyte levels are yet another serious nursing issue for Kate.

Case study, APA 7th Referencing, intext citation

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