NURBN2022: Written analysis of case-based scenario Essay Assignment help
Question
NURBN2022: This is a case-study-based assignment for the Federation University Australia. The assessment aims to evaluate the student’s learnings related to the use of clinical reasoning in conjunction with the best evidence-based nursing practices for the specified nursing case. The essay needs to incorporate a clinical reasoning cycle based on the analysis of the case study provided in the assessment file. The student is supposed to provide a scenario-based nursing care plan for the patient.
Solution
The solution for this assignment incorporates a comprehensive essay presenting a Clinical reasoning cycle for a patient named Sarah. It has been remarked that Sarah was brought to the Emergency room due to respiratory issues. Based on the assessment of Sarah’s medical and social history, our experts have presented a clinical reasoning cycle for Sarah’s case.
The essay begins by providing a short summary of Sarah’s presenting symptoms along with a brief background of her medical condition. This section presents the information that was derived from collection of information for Sarah’s case.
The clinical reasoning cycle entails a methodical strategy of eight steps which enables healthcare professionals to plan and implement a person-centred care plan (Levett-Jones, 2017). This essay will analyse the application and role of the clinical reasoning cycle and evidenced based nursing practice to plan a person-centred care plan for a patient with symptoms of community acquired pneumonia. Firstly, this essay will begin by assessing the patient’s position, taking into account their age, gender, medical history, and social background. Secondly, the presenting symptoms of the patient will be evaluated, and additional information will be obtained by performing a physical examination correlating it with clinical knowledge. Thirdly, a final diagnosis of the patient’s issues will be made. Furthermore, the nurse will collaborate with the patient to establish realistic goals along with a treatment plan that is specific to their needs and preferences. Finally, the actions will be evaluated and adjustments will be made to ensure person-centred care. This essay will end with a brief reflection on how to improve the quality of care in future. Sarah is a 36 year old female living with her partner and two children. She presented to the emergency department with a three-day history of productive cough, fever and increasing shortness of breath. She has a mild history of asthma, although it is well managed with seretide mdi and salbutamol inhalers. Sarah is too out of breath to eat and is currently taking small sips of fluid. Her urine output is 350ml/12 hours and is orange in colour. Additionally, she is experiencing a productive cough with green/ brown sputum together with mild pleuritic thoracic pain and appears pale, exhausted and has sunken eyes.
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The next section of the essay delves into two issues that would need immediate attention to stabilize Sarah’s condition and eventually prepare a scenario-based nursing care plan.
Although Sarah has multiple issues, the productive cough and shortness of breath are the two nursing priorities that need immediate attention as these are fatal for asthmatic patients like Sarah. Firstly, persistent productive coughs cause sleep disruption, fatigue. Additionally, it can lead to chest pain, fatigue, insomnia and respiratory failure in severe cases which will further reduce the oxygen perfusion to the body. Reduced perfusion can lead to end-organ dysfunction and cause renal and liver failure. Kidney failure will reduce the elimination rate of the drugs used to treat asthma in Sarah’s case, thereby causing toxicity and worsening her health condition (Lea-Henry et al., 2018).
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Following this, our experts have proposed two goals for the nursing interventions that must be prioritized immediately. The solutions written by our experts demonstrate critical thinking and reasoning skills along with a thorough evaluation of Sarah’s case.
In order to reduce the frequency of Sarah’s productive cough, the nurse would administer nebulization therapy with bronchodilators like 2.5mg salbutamol every 4 hours to help relax the constricted airways (ElHansy et al, 2017). Mucolytic agents such as acetyl cysteine can be administered at a dosage of 5 ml of 10% solution every 4 hours will help decrease airway secretion. Cough and sputum will be monitored by assessment tools like cough index by the nurse every 4 hours to assess the effectiveness of the treatment (Baddini-Martinez et al., 2021). Additionally, Sarah would be positioned on her left side with head and chest inclined downwards. This along with the medication will promote mucus drainage from her middle-left lobe of the lung (Arik & Cevik, 2021). It is often used in conjugation with various coughing techniques like huffing manoeuvres for airways clearance.
Secondly, to improve Sarah’s dyspnoea, the nurse would initiate oxygen therapy with 30–60 l/min via high flow nasal cannula oxygen therapy (Cutuli et al, 2021). Nebulization can be used as an adjunct to manage respiratory distress and improve oxygen perfusion.
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The last section of this essay provides a reflective remark on how this exercise helped in developing knowledge about nursing practice and clinical learning. In addition to this, our experts have also provided an evaluation of the actions which are prescribed above.
The process of clinical reasoning in Sarah’s case study helped me analyze the effectiveness of my nursing practice and clinical knowledge. In this case, Sarah was not vaccinated against influenza which is essential, especially for asthmatic patients. Next time I will make sure to educate such patients regarding various vaccinations and preventive measures to be undertaken in order to prevent disease. I will develop my communication skills to ensure effective patient education tailored to address the individual needs. This will ensure a person-centred care and make the patient feel informed and empowered. Also, Sarah’s lab reports of influenza were still awaited which delayed the definitive diagnosis thereby increasing the risk of complications. If I will face a similar situation in future, I will try to collaborate with other members of the healthcare team in order to provide definitive diagnosis in a timely manner. Sarah’s case helped me understand the importance of timely management and identifying potential issues in order to develop effective interventions
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