NUR5002: Written Assessment Assignment Help
Question
NUR5002: This is a case-study-based written Contemporary Nursing Practice assessment for Monash University where the students are provided with a case scenario of a patient based on which the students are expected to demonstrate their learnings corresponding to nursing in contemporary practice. The assignment urges the student to assess the patient’s case and elaborate on the pathophysiology, clinical manifestations, nursing management, diagnostic studies, and collaborative management of the case.
Solution
The case study provided for the task is about a patient named Tom, who is displaying symptoms of respiratory distress. It is the second time Tom has been admitted with similar symptoms. His vitals are also recorded and presented for the case. The solution incorporates a detailed critical analysis of the patient’s case to demonstrate how this respiratory distress case needs to be handled.
Through extensive analysis of the case, our experts have written a solution that includes: Pathophysiology, clinical manifestations, nursing management, diagnostic studies, and collaborative management for Tom’s case.
PATHOPHYSIOLOGY
The solution begins by providing a section on the pathophysiology of Tom’s case. Keep reading to know how our experts have analyzed the solution critically and depicted an application of learnings related to the pathophysiology of pneumonia.
Tom Bates, a 72-year-old male, is brought to the emergency department (ED) by his wife for complaints of a fever, worsening cough and shortness of breath (SOB) for three days. Tom’s past history reveals that this is his second admission to the ED in past six months for similar complaints. He also has a history of smoking, recurrent respiratory infections and hypertension. He has dysphagia that developed after a cardiovascular accident, three years back. He is preliminarily diagnosed with aspiration pneumonia for his presenting complaints. Tom’s case is a classical example of ‘stroke-associated pneumonia,’ which has a complex and multifactorial pathophysiology (Brodsky et al., 2020). The primary mechanism of development of pneumonia post-stroke is the weakening of neurological pathways that control swallowing, mastication and cough reflexes (Chang et al., 2022). Dysphagia is a difficulty in swallowing that may develop from a structural abnormality of the organs of deglutition or a defect in the neuronal pathway. In Tom’s case, since the dysphagia developed after stroke, it is likely that the supra-tentorial, infra-tentorial regions of the brain or the brainstem (chiefly regulating deglutition) were the areas of ischaemic injury (Grossman et al., 2022). The swallow reflex consists of a sensory pathway, composed of nerve fibers from cranial nerves V, IX and X, that initiates deglutition and a motor pathway, composed of nerve fibers from cranial nerves V, VII and XII, that regulates muscles of the pharynx for deglutition (Ouahchi et al., 2019).
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CLINICAL MANIFESTATIONS
Our experts have analyzed the case and highlighted the clinical manifestations of pneumonia related to Tom’s case. You can find a snippet of the answer written by our experts below.
On admission to the ED, Tom appears short of breath, alert and tachypneic. He records a respiratory rate of 29 breaths/minute and an oxygen saturation of 90% on 2L/min of oxygen supply. He is febrile with a temperature of 38.8C, a heart rate of 110 beats/minute and a blood pressure of 105/62mmHg. On auscultation, it is found that the air entry into the right lower lobe of lung is diminished. He is preliminarily diagnosed with pneumonia resulting from aspiration. Numerous symptoms and clinical features support this diagnosis. Firstly, Tom is known to have dysphagia since he had a stroke, three years back. In patients with stroke, neurological injury results in diminution of swallow and cough reflexes which are protective mechanisms that prevent aspiration of food and fluids and also help cough up aspirated particulate matter and microbes that gain entry into the lower respiratory tract (Quinton et al., 2018). The abolition of both these reflexes results in higher risk of aspiration pneumonia (Grossmann et al., 2021). Secondly, on admission, Tom has a severe respiratory distress as evident by his respiratory rate of 29 breaths/minute, oxygen saturation of 90% on 2L of oxygen supply. Despite being continuously supplemented with oxygen, his respiratory rate remains higher than the normal adult respiratory rate of 12 to 20 4 breaths/minute and fluctuates between 20-24 breaths/minute as per his OBSERVATION chart (Nicolò et al., 2020).
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NURSING MANAGEMENT
The next section presents the process of nursing management of pneumonia related to Tom’s case which further incorporates a focused assessment, escalation, oxygen management, and pharmacological management for the case.
The management of pneumonia comprises of four essential components: focused assessment, escalation, oxygen management and pharmacological management.
Focused assessment
The nurse must assess Tom for respiratory symptoms primarily. Any worsening of respiratory distress, tachypnea, and cyanosis are ominous symptoms suggesting severe ventilatory compromise (Hanada et al., 2018). Additionally, the character of sputum must be carefully analyzed as it is 5 suggestive of causative agent; for example, Streptococcus pneumoniae produces a characteristic rust colored sputum; Klebsiella spp. produce a characteristic redcurrant-jelly sputum; Pneumococcus, Pseudomonas, Haemophilus, may produce green sputum (Musher et al., 2020).
Escalation
It is of paramount importance for the nurse to prioritize care and management for Tom’s symptoms. As part of a procedure called as care escalation, nurses are expected to express their concerns to senior team members such as fellows or attending physicians as soon as they recognize a sick or worsening patient. Failure to address patient concerns can delay therapy, increase the risk of patient harm, and/or trigger sentinel occurrences (Cotter et al., 2019). Firstly, two tools described above, the observation chart and the SMART-COP score are useful in predicting escalation of patients to ICU.
Oxygen management
The nurse must ensure that Tom is positioned comfortably for proper expansion of lungs. The most comfortable position is the semi-Fowler’s position, wherein the head end of the bed is raised at a 15 to 45 angle with the plane (Zhu et al. 2020). This position prevents pulmonary congestion allows easy gaseous exchange between alveoli and pulmonary capillaries (Mezidi & Guérin, 2019).
Pharmacological management
Two important medications that are prescribed to Tom include warfarin and cefazolin. Cefazolin belongs to a class of first-generation cephalosporins used for parenteral administration (Lupia et al., 2020). Cephalosporins are wide spectrum antibiotics that are used to treat a great variety of bacterial infections of the lung, skin and urinary tract. The medication acts by binding to specific penicillin-binding proteins (PBPs) inhibiting cell wall synthesis and killing bacteria (Ryu et al., 2022).
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DIAGNOSTIC STUDIES
In the following section, our experts have discussed how the case needs to be investigated and diagnosed. We have provided a part of the complete section here.
The next important step in the management of pneumonia is the referral for investigations. Most investigations indicate that clinical judgement alone is relatively inaccurate and that a history and clinical examination alone do not provide a high level of certainty with regard to the diagnosis of pneumonia (Kundu et al., 2021). To diagnose or rule out pneumonia, primary care physicians typically rely on the patient’s medical history and physical examinations, which do not guarantee a certain diagnosis due to errors in subjective reporting. Chest Xrays, which can identify pneumonia from other respiratory tract illnesses, are considered to be the gold standard diagnosing pneumonia according to the majority of clinical guidelines worldwide (Htun et al, 2019). Patients receiving primary care are quite far from having access to the higher gold standard, the CT scan. In a chest X-ray, the typical finding of a lobar consolidation can be found within 12-18 hours of the onset of illness. The chest X-ray may also reveal pleural effusion or lung abscess (Makhnevich et al., 2019).
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COLLABORATIVE MANAGEMENT
The last section of this written assessment includes how the care provided to Tom can be enhanced through collaborative management and fostering teamwork in his case. Our experts have also incorporated how this is in alignment with the NMBA standards to demonstrate knowledge related to nursing in contemporary practice.
As a nurse, it is important to value teamwork and collaboration with multidisciplinary team to achieve the highest standards of patient care. As per standard 2 of ‘Nursing and Midwifery Board Aphra’ (NMBA) standards, a registered nurse must engage in therapeutic collaboration and engage in maintaining good professional relations to ensure assistance of experts from different fields in the delivery of patient care (Nursing and Midwifery Board Aphra, 2023). Besides therapeutic and supportive care, Tom needs specialized care for his respiratory discomfort to aid early recovery. The nurse must seek collaborative assistance of a chest/respiratory physiotherapist for Tom (Wasim et al., 2021). A specialization of physiotherapy, respiratory physiotherapy plays a critical role in managing and treating patients with respiratory illnesses (Wang et al., 2019). It seeks to clear the patient’s airways and enable them to resume exercise and physical effort.
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