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NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 1 of 4
ASSESSMENT INFORMATION
Assessment
Title Assessment Task 3 – Case Study
Purpose This assessment enables students to apply knowledge from unit learnings to an issue
equiring extended clinical reasoning.
The assessment will engage students with the application of theory to practice and is
designed to facilitate an understanding of the impact of illness on the patient. It is
also intended to give students the opportunity to demonstrate the ability to use a clinical
easoning framework to plan the care of an acutely unwell patient.
Due Date Wednesday 24th May 2023
Time Due 14:00
Weighting 50%
Length 2000 words
Assessment
Ru
ic Appendix 2 of the NRSG378 unit outline
LEO
Resource
A national pre-recorded video will be uploaded onto LEO in week seven (7), which will
provide students with an overview of the assessment as well as resources and advice on
how to approach the task.
Students are encouraged to post questions on the discussion forum on LEO and to check
for answers there as a first point of query.
LOs
Assessed LO1, LO2, LO3, LO4
Task
Students will assess, prioritise and plan the care of the case study patient using a clinical
easoning framework.
Sections you need to respond to include:
1. Disease pathophysiology and patient assessment (500 words):
• Provide an initial impression of the patient and identify relevant and significant
features from the patient presentation;
• Discuss in detail, the pathophysiology of the disease and how Kate’s presenting
signs and symptoms reflect the underlying pathophysiology;
• Identify further elements of a comprehensive nursing assessment (this can be
presented as a list)
2. Identify nursing and patient issues (500 words):
• Identify and prioritise 3 nursing issues you must address for Kate and justify why
they are priorities and support your discussion with evidence and data from the case
study. These can be actual or at-risk issues.
• Discuss the potential impact of this admission on Kate’s 2 most important activities
of living (can be biological, psychosocial, spiritual or cultural factors)
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 2 of 4
3. Discuss the pharmacological management (400 words):
• Identify and discuss two (2) common classes of drugs used for Kate, including the
drug mechanism of action, indication and nursing considerations. This does not
mean specific drugs but rather the class that these drugs belong to.
4. Nursing interventions (600 words):
• Identify, rationalise and explain, in order of priority, the nursing care strategies you
should use within the first 24 hours post-surgery for Kate.
Case Study Kate Sansbury is a 22-year-old female who presented to the emergency department (ED)
with abdominal pain, nausea and vomiting, and general malaise. She stated that the pain
appeared 3 days ago but was dull and localised to the right lower quadrant only, and
esolved when she applied a heat pack and took some paracetamol. She assumed the pain
was due to her upcoming period.

Last night at 3am she woke when the abdominal pain became sharp and was so
“intolerable” she vomited. She has since had 2 further vomits, and states she feels ongoing
nausea. She has not been able to eat or drink her usual amounts for the past day. She
states she has only voided once yesterday and it was “very dark yellow” in colour.

On assessment:
• Kate appears pale, cool and clammy. Her lips appear dry
• She is lying in a semi-Fowler’s position and has her hands across her stomach
(guarding). Kate appears reluctant to move
• Her abdomen is distended and tender, and there are minimal abdominal sounds on
auscultation
• On abdominal palpation, she states the pain is 8/10 on the right lower quadrant, but
the pain also occurs across her abdomen, and it is becoming worse

Health assessment findings and laboratory results at presentation:
• HR 118 bpm, regular pulse
• BP 90/60 mmHg
• RR 24 bpm, mild WOB
• Temp 39.2C
• SpO2 97% on RA
• Alert and orientated to time, place, and person. GCS 15
• CRT 2 seconds
• Last bowel motion – yesterday but patient states she feels “constipated”
• Weight – 62kg

Result Normal Values
Haemoglobin (Hb) 145 g/L XXXXXXXXXXg/L (females)
WBC 15 x 109/L 4-11 x 109/L
Sodium 132 mmol/L 135 to 145 mmol/L
Potassium 3.5 mmol/L 3.5 to 5.2 mmol/L
Lactate 2.0 mmol/L <1.0 mmol/L
C-reactive protein
(CRP)
150 mg/L <5 mg/L
Human chorionic
gonadotropin (hCG)
5 IU/L Not pregnant < 5 IU/L
Blood cultures Pending Negative
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 3 of 4
Patient history:
Kate cu
ently lives with two friends in a share house in an inner-city subu
in Melbourne.
She works part-time as a retail worker in a bookshop, and studies veterinary nursing at
TAFE full-time. She states that she is due to commence placement soon for her studies,
and is “wo
ied I won’t be able to attend and fail”.
She consumes a healthy diet, and only eats takeout once every few weeks. Kate exercises
4 days a week, for approximately 1 hour each time and considers herself “fit and healthy”.
She does not smoke and has 2 standard alcohol drinks every Saturday when she goes out
with her friends. She also smokes marijuana recreationally when she becomes “stressed
out”.
Family history:
• Parents live in Darwin and are both well with no medical concerns
• Kate visits them once a year during Christmas
Medical history:
• Depression
• Asthma

Medications:
• Sertraline 50mg daily
• Salbutamol 4-6 puffs via pMDI PRN

Following the review of her laboratory tests and assessment results, Kate has been
diagnosed with ?perforated appendix leading to secondary peritonitis

Management

• Administer IV bolus NaCl 0.9% 500ml over less than 15 minutes
• Commence IV NaCl 0.9% at 70ml/hr
• Administer IV ceftriaxone 1g BD
• Administer IV morphine 2mg PRN
• Administer IV ondansetron 4mg PRN
• 1/24 vital obs and pain assessment
• Repeat UEC 2 hours post IVF commencement
• SFBC
• NBM
• Pre-op preparation for an emergency appendectomy and peritoneal cleanout

You are the registered nurse looking after Kate, and you are required to plan her
care guided by a clinical reasoning framework and the provided case study
information.


Submission Via the Turnitin dropbox in the NRSG378 LEO site under the “Assessment” tile.
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 4 of 4
FORMATTING
File format The information will be presented as a question-and-answer format. There is no
need to include an introduction or conclusion.
Do not include the question in your assessment, just label it as 1), 2), etc.
Each answer has a word limit; answers beyond this limit will not be considered in
your mark.
The assessment will be submitted as a Microsoft Word document file via
Turnitin. Please do not submit pdf files.
REFRENCING
Referencing Style APA 7th edition
Minimum References
A minimum of 15 high quality resources are to be used. All arguments must be
supported using a variety of high-quality primary evidence. Avoid using any one
source repetitively.
Age of References Published in the last 5 years unless using seminal text.
Alphabetical Order References are a
anged alphabetically by author family name
Hanging Indent Second and subsequent lines of a reference have a hanging indent
DOI Presented as functional hyperlink
Spacing Double spacing the entire reference list, both within and between entries
ADMINISTRATION
Late Penalties
Late penalties will be applied from 2:01pm on the due date, incu
ing 5% penalty
of the maximum marks available up to a maximum of 15%. Assessment tasks
eceived more than three calendar days after the due or extended date will
eceive feedback but will not be allocated a mark.
Penalty Timeframe Penalty Marks
Deducted
2:01pm Wednesday to 2pm Thursday 5% penalty 5 marks
2:01pm Thursday to 2pm Friday 10% penalty 10 marks
2:01pm Friday to 2pm Saturday 15% penalty 15 marks
Received after 2:01pm Saturday No mark allocated
Example:
An assignment is submitted 12 hours late and is initially marked at 60 out of
100. A 5% penalty is applied (5% of 100 is 5 marks). Therefore, the student
eceives 55 out of 100 as a final mark.
Final Assignment
Marks for this last assessment will be returned after release of final unit results.
Assessment template project informed by ACU student forums, ACU Li
arians and the Academic Skills
Unit.
Total marks - 100, Weighting - 50%
Criterion HD XXXXXXXXXX%) DI (75.04%) CR (e574%) PA (064%) WN (50%) No Attempt
(weighting)
Considers the | Provides an inital Provides an ntl Provides an ntl ‘Provides an intial Provides an ntl No intial impression of
patient situation, | impression of the patient | impression of the patient | impression of the patient | impression of the patient | impression of the patient | the patient is provided
discusses and can entry al and can idenify most | and can ideniy some | and can ieny only a few | but does not deniiy ‘and does not ent
elevant relevant and signiicant | relevant and significant | relevant and significant | relevant and significant | relevant and signiicant | relevant and significant
pathophysiology, | features of the sation. | features ofthe situation. | features ofthe situation. | features of the station. | features of the itation. | features of the
and identifies the | A comprehensive and in | A thorough and in depth | A sound understanding | A basic understanding of | A minimal understanding | Station
key oloments of | depth understanding of the | understanding of the ith adequate depth of he | the pathophysiology a | of the pathophysiology is | No understanding of
patient pathophysiology is evident. | pathophysiology is evident. | pathophysiology is evident | evident Sufficient depth is | evident. Insufficient depth | the pathophysiology is
assessment | ign qualty evidence and | Appropriate evidence and | Evidence and examples | Provided. is provided. evident and not
(S00 words) | examples are presented | examples are presenied | are presented of varying | Evidence and examples | Evidence and examples | Supported by any.
‘and supported by a wide | and supported by a range | ualty and supported by | are presented of basic | are minimal and not credible sources.
oo range ofrclevaniand | of relevantand credible | most credible sources. | qualty and supported by | supported by credble | No patent assessment
credit sources. sources. Asound assessments | some credible sources. | sources. has been provided.
A comprehensive Athorough assessments | conducted on the patient | A basic assessmentis | A minimal assessment is
‘assessments conducted | conducted on the patent. conducted on the patient. | conducted on the patient.
on the patient.
Identifies ‘Appropriately denifies | Appropriately dentiles | Appropriately denies | Appropriately dentfies. | Inappropratly or "No appropriate
nursingand | and priorises three (3) | and priortses tree (3) | and priorises three (3) | and prorises three (3) | inco
ectly ideniifes and | identiicaton.
patient issues | nursing issues wih nursing issues with nursing issues with sound | nursing issues with basic | priortses thre (3) nursing | prioritisation and
(S00 words) | comprehensive justification | thorough justification and | justification and inks to he | justiicaton and links to he | issues wih minimal or | justiicaton of tree (3)
and inks to te case links 10he case study. | case study. case study inelevant justification. nor | nursing issues, and is
study. Athorough discussion of | A sound discussion of two | A bie discussion of two | I not inked tothe case | not linked to the case
=% A comprehensive wo (2) relevant activities | (2) relevant acivites of | (2) relevant aces of | St. study
discussion of two (2) of iving (ALS) that could | ving (ALS) that could be | ving (ALS) that could be | denies but does not | No dentiication o
elevant aces o ing | be affected for the patient. | affected for the patent. | affected forthe patent. | discuss two (2) relevant | discussion of two (2)
(ALS) tha couid be aciiviies of ing (ALs) | relevant aces of
affected fo th patient. that could be affected for | ving (ALS) hat could
the patent. be affected for the
patient.
Discussion of | Two (2) classes of drugs | Two (2) dasses of rugs | Two (2) diasses of drugs. | Two (2) classes of drugs |
Answered 2 days After May 23, 2023

Solution

Dr Insiyah R. answered on May 24 2023
20 Votes
Introduction    1
Conclusion    9
References:    9
Introduction
The method through which a therapist engages with a patient is known as clinical reasoning. During this process, the therapist gathers data, develops and tests hypotheses, and then uses this data to determine the best course of action for diagnosis and therapy (Sullivan et al,2019). According to one definition, it is an inferential procedure used by practitioners to gather and assess data and make decisions on the diagnosis and treatment of patient issues. Healthcare workers are trained to use clinical reasoning to make the best decisions possible in regard to the patient and setting (Kendall et al,2023). With the help of a case study this assignment will provide a
ief discussion regarding the topic.
1. Initial Impression and Presentation of the Patient:
Kate Sansbury is a 22-year-old female presenting to the emergency department with abdominal pain, nausea, vomiting, and general malaise. Significant features of her presentation include the onset of pain three days ago with the recent exace
ation of symptoms, pain being localized to the right lower quadrant of her abdomen, difficulty eating and drinking, and the appearance of being pale, cool, and clammy. Her pain is also described as intolerable and she has distended and tender abdomen (Sullivan et al,2019). The assessment findings, patient history, and laboratory results suggest that Kate may be suffering from an acute appendicitis and secondary peritonitis.
2. Pathophysiology of the Disease and its Relation to Kate's Symptoms:
Appendicitis occurs when the appendix becomes inflamed and infected. In Kate's case, this could be due to a blockage of the appendiceal lumen by fecal matter or a foreign body, leading to bacterial infection, inflammation, and swelling. The pain initially presenting in the right lower quadrant of her abdomen is a typical location for appendicitis pain, also known as McBurney's point. As the infection worsens, the pain may spread across her abdomen, which is consistent with Kate's description of her pain (Kendall et al,2023).
In the case of secondary peritonitis, bacteria from the infected appendix leak into the peritoneal cavity, causing inflammation and infection of the su
ounding tissues. This can lead to the formation of abscesses and the spread of infection to other organs. Kate's elevated white blood cell count (15 x 10^9/L), fever (39.2C), and increased C-reactive protein levels (150 mg/L) indicate an ongoing infection and inflammation in her body. Additionally, her increased heart rate (118 bpm), respiratory rate (24 bpm), and low blood pressure (90/60 mmHg) may suggest that her body is compensating for the infection and inflammation, leading to an increased demand on her cardiovascular and respiratory systems (Sullivan et al,2019).
3. Further Elements of a Comprehensive Nursing Assessment:
A comprehensive nursing assessment for Kate Sansbury should include the following elements:
- Pain assessment: Location, intensity, quality, aggravating or relieving factors, and the effect of pain on her daily activities and mental well-being.
- Gastrointestinal assessment: Presence of nausea, vomiting, bowel movements, constipation or dia
hoea, and any change in appetite or eating habits.
- Genitourinary assessment: Urination frequency, colour and clarity, and any pain or discomfort during urination (Wolfgang and Wolfgang, 2018).
- Respiratory assessment: Breathing patterns, presence of wheezing, use of accessory muscles, and any previous history of respiratory issues such as asthma.
- Cardiovascular assessment: Heart rate, rhythm, and strength, presence of peripheral oedema or cyanosis, and assessment of capillary refill time.
- Neurological assessment: Level of consciousness, orientation, memory, and cognitive function.
- Psychosocial assessment: The impact of her illness on her emotional and mental health, as well as on her relationships, work, and studies.
- Cultural and spiritual assessment: Potential cultural or spiritual needs related to her illness and treatment.
- Assessment of allergies and potential medication interactions: Given the medications she is cu
ently taking, such as sertraline and salbutamol (Herdman, Kamitsuru & Lopes, 2021).
- Physical examination: Inspection, palpation, percussion, and auscultation of the abdomen and other relevant body systems.
- Review of laboratory and diagnostic test results: To monitor the progress of her condition and the effectiveness of treatment.
Nursing Issue
1: Infection Control and Pain Management
The most immediate concern in Kate's care is the management of her infection due to appendicitis and impending peritonitis, and the control of her acute pain. It is evident from her elevated heart rate (118 bpm), low blood pressure (90/60 mmHg), fever (39.2°C), and increased white blood cell count (15 x 10^9/L) that she is experiencing an inflammatory response (Gómez-Urquiza et al,2019). Furthermore, her abdominal pain is significant with a score of 8/10, prompting her to guard her abdomen and limit her movement.
This issue is a priority because uncontrolled pain can lead to decreased mobility, which could further exace
ate her risk of bacterial infection. Additionally, appropriate and timely intervention is necessary to reduce the risk of complications such as abscess formation, septicemia, and postoperative pain (Wolfgang and Wolfgang, 2018). Pain relief via IV morphine and initiating antibiotic therapy with ceftriaxone are essential for managing her symptoms and controlling the infection.
Nursing Issue 2: Fluid and Electrolyte Balance
Kate is also at risk for fluid and electrolyte imbalances due to her reduced intake of food and water, nausea, vomiting, and fever. Her dark yellow urine, dry lips, and increased respiratory rate (24 bpm) all indicate potential dehydration (Kendall et al,2023). The administration of IV fluids (NaCl 0.9% 500ml bolus and 70ml/hr) aims to address this, but careful monitoring of her vital signs and hourly urine output would help ensure the effectiveness of this intervention and prevent complications such as hypovolemia and electrolyte derangements (Wolfgang and Wolfgang, 2018).
Nursing Issue 3:...
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