NUR356: Complex Care Case Study Assignment Help
Question
NUR356: This assignment is a case study based response assessment where the students are required to carefully review three case studies related to law and ethics in nursing, airway and breathing, and circulation related to nursing in complex care settings to answer the questions provided to them.
Solution
The solution comprises answers to all the questions related to the respective case studies, some snippets of which you can find below. Our experts assure detailed and comprehensive responses to each of the answers, through the help of studies and literature most relevant to the concerned topics. The solutions are structured into three segments concerning to each case study. These further incorporate all the questions concerning the respective case study.
CASE 1
The first case study is a law and ethics related case study, which our experts analyse in detail to answer the related questions.
The first question for this law and ethics case study requires the students to recognize two NSHQS standards which the nurse was unable to meet, along with highlighting what implications meeting the NSHQS standards held for protecting Beth. Read a short part of how our experts have explained this question in detail.
Beth is a known case of COPD with recently diagnosed pneumonia, which puts her at a risk of mortality from serious ventilatory compromise (Restrepo et al., 2006). As seen in the case study, Beth’s ADDS chart maps her deterioration from the time of her admission at 8 pm to 7 am the following day. The chart shows a continuous acceleration of her respiratory rate, heart rate, and the blood pressure. By 6 am Beth has an ADDS score of 5, which calls for an immediate review by a senior nurse or a junior medical officer (Campbell et al., 2020). However, the nurse fails to communicate the deterioration in Beth’s health to any of her colleagues.
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It is remarked in Beth’s case study that she went to the ED, where it was found that her GCS got rejected. Eventually, she was deemed palliative after which she passed away within two hours. The students are required to discuss the reasoning behind this situation becoming a coroner and if the nurse should suffer any repercusions for her actions.
As per Section 8(3) of the Coroner’s Act, a death in hospital must be reported to the coroner if the patient, dies as result of failure to provide medical care (Studdert et al.,2016). Beth’s death occurred in hospital because of the lack of timely medical attention, which makes her case reportable to coroner’s investigation as defined in the coroner’s act (Walter et al., 2012). The hospital or the treating physician may report the coroner directly (Queensland Court, 2022). Also, the occurrence of pneumonia in a patient of COPD, as in case of Beth, is associated with high mortality and therefore requires vigilant care (Restrepo et al., 2006).
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The next question surrounds the risk of patients suffering from COPD, as Beth started suffering from insufficiency of oxygen and excess of carbon dioxide. The experts have described the pathophysiology of the event and actions which could have been taken to prevent the situation.
COPD is a preventable disease resulting from prolonged exposure to noxious gases or particles, causing aberrant airway inflammation, which impairs gas exchange (Halpin et al., 2021). Together with pneumonia, COPD forms a lethal combination that raises the symptom severity and mortality due to development of tachypnoea, hypoxaemia, hypercapnia and acidosis; all of these findings were positive in case of Beth (Restrepo et al., 2006). Hypercapnia leads to the development of alveolar oedema and subsequently worsens gas exchange (Csoma et al, 2022). In addition, because hypercapnia impairs cell proliferation and induces mitochondrial dysfunction, the repair mechanisms of the airway epithelial cells are also harmed (Lecuona et al., 2007).
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CASE 2
The next case study of Jenny is aimed at assessing the student’s learning around airway and breathing, who is suffering from cough and respiration issues.
The first question for this case study requires the student to differentiate and explain the importance of Jenny’s three distinct medications. Through evaluation of the case study, our experts have formulated an appropriate response to this question along with proposing one another medicine which Jenny might benefit from.
The pathology of COPD involves cigarette smoking that generates reactive-oxygenspecies (ROS) that damage lung tissue through airway inflammation, cell aging and cell death (Hikichi et al., 2019). It involves pathological constriction of smooth muscles in the bronchi and bronchioles resulting in airway narrowing thus producing symptoms of dyspnoea and wheezing as seen in Jenny (Bacsi et al., 2016). In order to relieve this airway narrowing, Salbutamol has been prescribed. Salbutamol is a ‘Short-Acting-β-Agonist (SABA),’ a type of bronchodilator that acts by binding β2 adrenergic receptors and causes relaxation of smooth muscles in the airways.
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The second question urges the student to think about three interventions related to nursing that are appropriate for Jenny, in addition to the mechanism to ensure the effectiveness of the specified interventions.
Three important nursing interventions are identified in Jenny’s case. The first intervention involves maintenance of clear airway. The copious amounts of tenacious secretions in pneumonia can cause obstruction of airways resulting in breathlessness, tachypnoea and laboured breathing as seen in case of Jenny (Chen et al., 2020). The nurse must assess breathing for rate, rhythm, chest movement and use of accessory muscles and lungs must be frequently auscultated for abnormal breath sounds (Poston et al., 2020). The head end of the bed must be elevated and she may be assisted in deep breathing as it helps in allowing expansion of lungs.
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CASE 3
The next case study relates to circulation for a patient named Rainey who patient history and issues are described in detail in the case study. The questions for this case study are as follows:
For the first question concerning this case study, the students are needed to carefully interpret the patient’s ECG, and describe the diagnosis that the doctor is likely to provide for Rainey. The students are also supposed to explain the area that is impacted and the reasoning behind it in consideration to the PQRST.
The case study, discusses Rainey, a 64-year-old woman presenting with the complaint of acute chest pain radiating to the back and neck after climbing stairs. The symptom complex is likely to raise a suspicion of Acute Myocardial Infarction (AMI) that results from an infarction or death of cardiac muscle due to impaired blood supply in coronary arteries (Saleh & Ambrose, 2018). It is a fairly common condition seen in people with hypertension, sedentary lifestyle, Body Mass Index and high fat intake that leads to an increase in blood cholesterol levels as in the case of Rainey (Niedziela et al., 2014).
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The second question is aimed at making the student think about the need to use three of the medicines prescribed for Rainey. It is also needed that the student clearly propose a response directed at the patient concerning each medication’s pharmacokinetics and pharmacodynamics.
Aspirin is commonly used analgesic, anti-inflammatory, and anti-pyretic drug that also prevents formation of thrombi (Angiolillo et al.,2022). The medicine is orally administered and absorbed in the small intestine and to some extent in the stomach (Leonards & Levy, 1965). In the circulation it undergoes hydrolysis to form salicylic acid. It is transported bound to plasma proteins and metabolised in the liver. It is majorly excreted by the kidneys in the form of urine (Angiolillo et al., 2022). It acts as an analgesic by disrupting the production of Prostaglandins, a potent inflammatory and pain inducing compound.
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In the last question, there is a need for the student to remark how differently they would assess chest pain felt by Rainey in order to exclude the condition of pulmonary embolus, and diagnose a heart-related condition.
Rainey’s chest pain may be confused with another clinical diagnosis, that is, Pulmonary Embolism (PE). PE results when venous emboli become lodged inside the lung vasculature. It is usually associated with Deep Vein Thrombosis, wherein the deep veins in the legs become the source of wandering thrombi (Morici, 2014). To differentiate PE from AMI the following points may be considered. Firstly, PE may exhibit sudden traditional symptoms like shortness of breath and pleuritic chest pain, as well as less typical ones including gradual dyspnoea that develops over days to weeks or syncope with only mild respiratory symptoms.
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