NRSG378: Extended Clinical Reasoning Case Study Assignment Help
Question
NRSG378: This Principles of Nursing: Extended Clinical Reasoning Case Study Assignment for Australian Catholic University aims to assess the student’s learning regarding how a disease impacts a patient as well as how the patient care plan needs to be devised. Students are required to use a clinical reasoning framework to evaluate and devise a care plan for an acutely unwell patient, named Kate Sansbury. The student is required to discuss the pathophysiology and assessment of the patient, challenges related to nursing and patient care, the patient’s pharmacological management, and lastly identify appropriate nursing interventions for the patient.
Solution
The case study revolves around Kate Sansbury, a 22-year-old with abdominal pain and vomiting, who is presented to the ED. Her examination reveals guarding, tenderness, distension, and abnormal vital signs. It is also remarked that she is a veterinary nursing student, and has a history of depression, asthma, and occasional recreational marijuana use, due to which she faces potential placement challenges as well.
The solution written by our experts is divided into four sections based on the requirements for this assignment. These include- Disease pathophysiology and patient assessment, Identifying nursing and patient issues, discussing pharmacological management, and Nursing interventions.
Disease pathophysiology and patient assessment
The solution demands the student to review the case study and propose the pathophysiology for the patient. Here, our experts have given a brief overview of the patient and highlighted the presenting symptoms along with remarking how Kate’s symptoms and signs are a reflection of that pathophysiology.
Kate presented to the Emergency Department (ED) ward with abdominal pain, nausea and vomiting along with fever. She has been experiencing a dull stomach ache for 3 days which is localized to the right lower quadrant. On presentation to ED, Kate describes her pain to be sharp and intolerable and is febrile with 39.2 C. She is also pale, cool and clammy with a low blood pressure of 90/60 and has a distended and tender abdomen. Kate’s symptoms of extreme localized pain, fever, vomiting and constipation are indicative of severe appendicitis. It is a condition in which the appendix gets inflamed and infected due to blockage of its opening thereby causing bacterial overgrowth (Stringer, 2017). It can also be caused due to infection of the gastrointestinal tract which may spread to the appendix thereby causing inflammation. Appendicitis presents with classical features of pain in the right iliac fossa along with fever, abdominal tenderness and anorexia (Perez & Allen, 2018). As the inflammation progresses, the appendix swells and becomes more inflamed causing Kate’s symptom of severe pain in the lower right side of the abdomen. Infection and inflammation of the appendix reduces the blood flow to the area thereby reducing oxygen supply and causing tissue hypoxia and ultimately necrosis (Fikri et al., 2023).
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Identify nursing and patient issues
In this section, the student is required to identify three nursing difficulties to be addressed for Kate. Our experts have provided an in-depth explanation describing why these are important and have supported these points with facts and figures from the case study.
The nursing priorities identified in Kate’s case are pain relief, dehydration and infection control. Firstly, severe abdominal pain can impact Kate’s comfort and quality of life as it causes distress and anxiety (Michaelides & Zis, 2019). Uncontrolled pain also leads to physiological and psychological complications like delayed recovery, impaired immune and respiratory system, decreased mobility (Jiang, 2019). It also interferes with a patient’s ability to cooperate during physical examination and lead to false diagnosis by masking underlying symptoms. Alleviating pain will help minimize patient’s discomfort, facilitate recovery. Secondly, Infection control is another essential nursing priority as it increases the risk of further complications like abscess formation and sepsis (Jones et al, 2021). Kate’s perforated appendix has already spread to the peritoneal cavity, if not controlled at this stage; it can become widespread infection (Clements et al., 2021). Through effective infection control, nurses can minimize the systemic inflammatory response and reduce the risk of complications in Kate’s case. It is also necessary to maintain a sterile condition of Kate’s surgical site, as it can lead to surgical site infection (SSI). Lastly, Dehydration is nursing priority in Kate’s case as she may be experiencing fluid loss due to vomiting which is further exacerbated by secondary peritonitis (Michaelides & Zis, 2019).
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Discuss the pharmacological management
Next, our experts have described two common drug types that Kate takes, along with the medication’s mechanism of action, indication, and nursing considerations. You can read a snippet of the complete answer below:
As Kate is suffering from perforated appendicitis and secondary peritonitis, the two major drugs used for her treatment are antibiotic and analgesics (Stringer, 2017). Firstly, Antibiotics are used to treat the infection due to the bacteria by controlling its spread thereby preventing systemic infections (Dowling et al., 2017). In Kate’s case, initially the broach spectrum antibiotic like beta-lactam antibiotics can be administered as it is effective against both gram-positive and gram-negative bacteria. Once the blood culture report becomes available, antibiotics can be adjusted to target the causative bacteria. These antibiotics bind and inhibit the penicillin-binding proteins involved in the bacterial cell wall synthesis thereby weakening the bacterial cell wall. This leads to disruption and lysis of bacterial cell walls causing their destruction (Pandey & Cascella, 2022). While administering these antibiotics, it is crucial for nurses to assess Kate for any known allergy to antibiotics as it can elicit adverse hypersensitivity reactions and keep her under continuous monitoring (Blumenthal et al., 2019).
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Nursing interventions
In this last section, our experts have determined and justified the nursing care techniques one should apply for Kate in the first 24 hours following her operation, in order of importance. Our experts have proposed interventions that are based on the concepts of the course material. This is how our experts assure best-quality Extended Clinical Reasoning Case Study Assignment Help.
Post-operative care is crucial in Kate’s case after appendectomy and peritoneal cleanout. The nursing interventions in her case will include monitoring of her vitals like blood pressure, heart rate, temperature and oxygen saturation along with pain management, SSI control and maintenance of electrolyte balance post-operatively (Salazar Maya, 2022). Firstly, it is important to monitor vital signs as it aids in assessment of postoperative anaesthetic effects such as hypotension, arrhythmias and respiratory depression to ensure patient safety (Haahr-Raunkjaer et al., 2022). Blood pressure monitoring every two hours aids in detection, quantification and treatment of postoperative hypotension (Michard et al., 2020). Monitoring of body temperature every thrice a day will help detect early signs of underlying infection as Kate is at high risk of infection post-surgically that may present as a change in body temperature (Kim et al., 2019). Monitoring oxygen saturation every 2 hours will help assess respiratory function as Kate may experience respiratory depression postaesthetically (Ramachandran et al., 2017). Secondly, pain management in Kate’s case will help prevent surgical complications and decrease the risk of chronic pain (Bach et al., 2018). The nurse must assess the severity of Kate’s abdominal pain by using pain assessment tools like Verbal descriptor scale which describes pain as “no pain”, “mild”, “moderate” and “severe” or by using Numeric rating scale which rates pain on the scale of 0 to 10, where 0 represents no pain and 10 represents severe pain (Chiarotto et al., 2019). Pain assessment must be performed every 2 hours for Kate to assess the severity of the pain and incorporate appropriate pharmacological interventions. This will also aid in evaluation of effectiveness of pain management interventions and help modify the care plan accordingly. In addition to this, the nurse must assist Kate in attaining a comfortable position that can relieve her pain while considering the surgical incisions. This can be achieved by using pillows or cushions to provide comfort and minimize pressure on the right side
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