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NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 3: Case Study © Australian Catholic University 2023 _ Page 1 of 4
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
ic Appendix 2 of the NRSG378 unit outline
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.
Assessed LO1, LO2, LO3, LO4
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
• 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
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
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

• 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


• 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
• 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

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
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.
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
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
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
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
Total marks - 100, Weighting - 50%
Criterion HD XXXXXXXXXX%) DI (75.04%) CR (e574%) PA (064%) WN (50%) No Attempt
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
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 15, 2023


Dr. Saloni answered on May 17 2023
34 Votes
Case Study of Kate
In this case study, Kate Sansbury, a 22-year-old woman complaining of stomach pain, nausea, vomiting, and general malaise, will be discussed in terms of her presentation, assessment, and treatment. She has been identified as having a perforated appendix with secondary peritonitis following a thorough evaluation. This assignment will additionally examine the pathophysiology of the disease in addition to performing a comprehensive nursing assessment, identifying and prioritising nursing issues, discussing the potential effects of admission on Kate's activities of daily living, analysing the pharmacological management, and suggesting nursing interventions for the first 24 hours following surgery.
Disease Pathophysiology:
Faecal matter and bacteria released during perforation of the appendix cause an inflammatory reaction in the peritoneal cavity. During this inflammatory process, immune cells like neutrophils migrate to the infection site. These cells start an immune reaction to fight infection by releasing proinflammatory cytokines. However, the peritoneal cavity's bacterial, inflammatory, and pus buildup causes extensive inflammation and tissue damage. The peritoneum, the thin tissue lining the abdominal organs and cavity, becomes i
itated and inflamed as peritonitis worsens as the inflammatory exudate spreads throughout the abdominal cavity (Banoth & Venkatesh , 2022).
Increased vascular permeability caused by infection and inflammation leads to fluid and inflammatory mediators building up in the peritoneal space. The fluid buildup contributes to abdominal tenderness and distension. Systemic manifestations can be caused by the release of bacterial toxins, inflammatory mediators, and the following systemic inflammatory response. Kate's increased white blood cell count, fever, and elevated heart rate are signs of a systemic infection response. Additionally, hypovolemia triggered by fluid sequestration in the peritoneal cavity may be responsible for lower blood pressure. Without prompt treatment, the infection could worsen and lead to septic shock or severe sepsis, endangering Kate's general health (Ramteke et al., 2023).
Patient Assessment:
A thorough nursing assessment is essential in determining Kate's overall condition and identifying potential complications in addition to the symptoms she is cu
ently exhibiting. Several facets of her health status should be assessed. Monitoring vital signs is necessary to create a baseline and find any abnormalities. Kate's temperature, respiratory rate, heart rate, blood pressure, and oxygen saturation should all be monitored regularly. In Kate's case, the elevated heart rate and fever were signs of a systemic infection response (Rohma et al., 2023). Understanding the type and severity of Kate's abdominal pain requires a thorough assessment of the pain. The nurse needs to assess the pain's characteristics, location, and intensity. Initially dull and localised to the right lower quadrant, Kate describes the pain as becoming more diffuse and intense over time. A validated pain scale can be used to assess pain intensity and inform pain management strategies (Moore, 2022).
It is critical to assess Kate's fluid and electrolyte balance due to her poor oral intake, vomiting, and dark urine. Monitoring intake and output, determining hydration status, and analysing laboratory data, including electrolyte levels, may be helpful to determine any imbalances and lead to appropriate interventions to address fluid deficits and keep organ function at its best (Ramteke et al., 2023). It is important to conduct a gastrointestinal assessment by paying attention to the patient's bowel movements, checking for tenderness and distention in the abdomen, and watching for any fluctuations in bowel sounds. Kate's case involves minimal abdominal sounds, distension, and tenderness, all of being indicative of peritonitis. Kate complained of being constipated, so monitoring bowel movements and looking for signs of impaction or constipation is also crucial (Moore, 2022).
The effect of the condition on Kate's psychological health must be considered. The nurse should assess her emotional state, anxiety levels, and any wo
ies or concerns she may have about the surgery, the recovery process, or how it might affect her academic and social lives. Her psychological needs during hospitalisation can be met by giving her emotional support, information, and appropriate refe
als to other healthcare providers, like a psychologist or counsellor (Rohma et al., 2023).
Nursing Issues:
In this situation, Kate's primary nursing concerns are infection control, fluid and electrolyte imbalance, and pain management. Due to her excruciating abdominal pain, Kate has a significant nursing concern with pain management. Using a validated pain scale, the nurse should evaluate the type, location, and characteristics of the pain. To reduce Kate's pain, increase her comfort, and enable early mobilisation, analgesics like IV morphine should be administered promptly. Regularly, the nurse should reevaluate the patient's level of pain and change the dosage as necessary (Nissen & Tröbs, 2021).
Unbalanced fluid and electrolyte levels are yet another serious nursing issue for Kate. Her limited oral...

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