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·      Word count: 2750

 

·      The aim of this academic paper is to synthesise your nursing knowledge and clinical practice.

·      INSTRUCTIONS: 
This assignment is based on a case scenario provided below. You are required to answer the stated questions and present these in an academic paper.

·      Case – Catherine’s Story

You are a graduate nurse and have just commenced your morning shift on the medical ward of a large tertiary hospital. You have been allocated the care of four patients, including Catherine Bexley, a 77 year old woman who was admitted last night via the Emergency Department with R) lower lobe pneumonia. Catherine has a past history of ischemic heart disease, hypertension, and hypercholesterolaemia. Her current medications are Aspirin 100mg mane, Ramipril 10mg mane, Spironolactone 50mg mane, Atorvastatin 80mg nocte.

In ED: The night shift staff hand over that Catherine was initially quite short of breath in the ED and so the team were wondering if she may need HDU, however post oxygen and antibiotics she improved in the ED and so was safe for the ward. Catherine received 1gm of Ceftriaxone in the ED at 0030. She was transferred to the ward at 0130. On arrival to the ward Catherine’s vital signs were RR 24 breaths/min, SpO2 98% on 2L via nasal prongs, HR 96 regular, BP 140/90mmHg, GCS 15/15, Temp 37.1oC, pain 3/10 in her R) lower chest with deep inspiration. Her ECG is NAD. The nursing staff state that Catherine has slept well since her arrival on the ward. They state that she has an IDC insitu that was emptied when she arrived at 0130.

In the Word: When you enter Catherine’s room at 0720 you find Catherine to appear short of breath, she has an increased work of breathing and is talking to you in short sentences. She appears confused and she has removed her IV line from her right cubital fossa and there is blood on the sheets. You don gloves and begin an assessment.

Observations:

Cardiovascular: BP 90/65mmHg, HR 120 bpm, weak, thready radial pulse, skin flushed and sweaty. Capillary refill is 3 seconds.


Respiratory: RR 36 breaths/min; increased work of breathing, she is using her upper accessory muscles. She has decreased air entry to her R) lobe to midzone, pulse oximetry is 91% on 2L O2 via nasal prongs.


Temperature: 38.9oC


Neurological: 14/15, confused to day and place, PEARL 3mm, she is complaining of 5/10 pain in the lower part of R) chest with deep inspiration


BSL: 14.4 mmol/L

Renal: 30mL in IDC drainage bag since 0130

You call the nurse in charge who agrees you need to call a MET call.

The Medical Emergency Team (MET) is called for Catherine, and they insert a triple lumen CVC into her R) subclavian vein, which is sutured so Catherine is unable to remove this. They

·      Order 2L of Normal Saline 0.9% STAT and ask you to

·      Administer 500mg of Azithromycin, which they have charted.

·      They ask you to increase her oxygen.

·      The ICU registrar asks you collect the pathology tests she has written on the pathology slip.

Your essay – What you need to answer

1. Provide an introduction to your essay. Outline what the context of the paper is, and the scope / structure of your essay. 


Provide a succinct but detailed description of the structured primary assessment approach you would use when assessing Catherine. For each assessment step provide a rationale and example of what has been assessed. 
DRABCDE (Danger
Response
Airway Breathing  Circulation
  Disability
Exposure)

 

2. Based on the assessment findings discuss ONE relevant focused assessment that you would perform on Catherine. Provide a succinct rationale for each step in the assessment process. 
(Respiratory system)

3. Provide a definition of the type of shock that Catherine is experiencing (Septic shock). Explain the pathophysiology of Septic shock. In your answer explain the pathophysiology of each clinical manifestation that Catherine is experiencing that directly relates to Septic shock. 


4. When the MET team arrives they provided you with strategies to treat Catherine’s shocked state (Septic shock). Prioritise four (4) of the evidenced based nursing interventions the MET team has instructed you to implement (above) so you can care for Catherine. Describe each intervention and rationalise it. Your nursing interventions need to specifically relate to Catherine’s presentation and shock management. You need to discuss these interventions in order of priority 


1- oxygen             2- normal saline          3- antibiotic                  4- pathology test

 

Format:
A guide to the headings you may like to use:

   Introduction                                                       200 words

·      Outline what the context of the paper is, and the scope / structure of your essay.  The reader needs to know what will be coming their way.

·      Don’t include all the case details, but you want to introduce 
your patient, the type of shock she is experiencing and 
why that type of shock is significant. 


·      Clear and engaging introduction to the essay 


·      The presented context is clear, succinct and relevant. 


·      Clearly and succinctly outlines the scope/ structure of the essay 



·      Appropriate length. 


   Assessment:

       The primary assessment performs when you enter Catherine’s room at 0720 on the ward.

1.    Primary Assessment     
DRABCDE                       300 words

 

1-   Provide a succinct but detailed description of the structured primary assessment approach you would use when assessing Catherine DRABCDE.

2-   For each assessment step provide a rationale and example of what has been assessed.

Assessment is systematic. 


    D: For each assessment step provide a rationale and example of what has been assessed.

    R: For each assessment step provide a rationale and example of what has been assessed.

    A: For each assessment step provide a rationale and example of what has been assessed.

    B: For each assessment step provide a rationale and example of what has been assessed.

    C: For each assessment step provide a rationale and example of what has been assessed.

    D: For each assessment step provide a rationale and example of what has been assessed.

    E: For each assessment step provide a rationale and example of what has been assessed.

·      Comprehensive and relevant discussion of the primary assessment that relates to the patient.

·      On primary assessment you should provide a detailed description and link this to the patient presentation. Try to keep your assessments specific to the section (don’t blend them together).

·      You do not need to provide large amounts of detail but want to demonstrate that you can identify the application of the primary assessment in the context of this patient.

 

2.    Focused Assessment 
  Respiratory                   300 words

3-   Based on the assessment findings discuss ONE relevant focussed assessment that you would perform on Catherine (Respiratory Assessment). Provide a succinct rationale for each step in the assessment process.

RR:  what should nurses do / assess in respond to RR with Catherine case and then Provide a succinct rationale (rational related to result/ finding for Catherine case).

WOB: what should nurses do / assess in respond to WOB with Catherine case and then Provide a succinct rationale (rational related to result/ finding for Catherine case).  

Pulse oximety: what should nurses do / assess in respond to Oxygen saturation with Catherine case and then Provide a succinct rationale related to result/ finding for Catherine case). 

Auscultation of breath: what should nurses do / assess in respond to Auscultation of breath with Catherine case and then Provide a succinct rationale (rational related to result/ finding for Catherine case).    

These could be also considered and related to focus assessment

·      Oxygen flow rate and delivery device

·       Respiratory effort 


·      
Palpation–identify pain , deformities ,chest wall 
movement

·       Enquire about chest pain 


   Pathophysiology

A.  Shock pathophysiology                              400 words

1-   Provide a definition of the Septic shock that Catherine is experiencing. Explain the pathophysiology of this type of shock. 


 

2-   Critically analyses the pathophysiology of the shock state Septic shock

 

B.   Clinical Manifestations                               
 600 words

1-   In your answer explain the pathophysiology of each clinical manifestation that Catherine is experiencing that directly relates to the septic shock.

1.     Tachypnea and Desaturation  (Explain the pathophysiology that directly related to septic shock)

2.     Hypotension                      (Explain the pathophysiology + then directly related to septic shock)

3.     Oliguria                             (Explain the pathophysiology + then directly related to septic shock)

4.     Hyperthermia                    (Explain the pathophysiology + then directly related to septic shock)

5.     Confusion                         (Explain the pathophysiology + then directly related to septic shock)

6.     Hyperglycemia                  (Explain the pathophysiology + then directly related to septic shock)

 

Make sure you cover these clinical manifestation well by explain pathophysiology and why the patient (Catherine who has septic shock) compensate in related to these clinical manifestation.

 

2-   Clear, comprehensive and accurate links between the clinical manifestations relevant to the patient presentation are critically discussed. 


·      Make sure you address it by this order

 

   Nursing interventions                                                 1000 words

1-   Your nursing interventions need to specifically relate to Catherine’s presentation and septic shock management. You need to discuss these interventions in order of priority.

2-   Appropriately prioritises nursing interventions1- Oxygen, 2- fluid, 3- antibiotics, 4- bloods

 

1.     Oxygen: (describe the intervention and rationalize it + this interventions need to specifically relate to Catherine’s presentation and shock management).

2.     Normal saline: (describe the intervention and rationalize it + this interventions need to specifically relate to Catherine’s presentation and shock management).

3.     Antibiotic: (describe the intervention and rationalize it + this interventions need to specifically relate to Catherine’s presentation and shock management).

4.     Pathology tests: (describe the intervention and rationalize it + this interventions need to specifically relate to Catherine’s presentation and shock management).

 

3-   Comprehensive detailed discussion of each interventions 


4-   Critically analyses the strengths and limitations of each intervention. 


   Conclusion                                                              200 words

5-   Summarise your key points in a conclusion. 

6-   Succinct and points are clearly presented 


7-   Analytical and stated in own words, excellent summary of ideas 


8-   Take home message clear 


9-   No new ideas are introduced. 


 

 

Academic writing and Presentation

ü Grammar and spelling are accurate 


ü Sentence and paragraph structure are excellent 


ü Discussion is presented in a logical order making it easy to follow the authors train of thought 


ü Easy to follow 


ü Within word count excluding in-text citation and reference list.

ü  Please use headings 


ü Look at your paragraph structure. One topic of discussion per 
paragraph. 


Referencing and use of literature

ü Referencing is consistently accurate 


ü References are used well and in an appropriate manner 


ü Reference list is appropriately formatted 


ü Reference list and in-text references match 


ü Evidence of a wide range of primary, peer reviewed references relevant to the topic. 
with DOI

ü References no greater than 8 years old. 


ü Minimum 15 peer reviewed articles used. 


ü Demonstrate appropriate APA 6th referencing skills

ü Use Australian primary sources only

ü Make sure sources in English language.

ü Students should encourage using a combination of textbooks and journal articles to demonstrate their knowledge and understanding of the content.

ü A combination of journals and textbooks for the pathophysiology and assessment is appropriate.

 

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