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NRSG378 Assessment 3 – Case study
Shaun Morely is a 35-year-old male who was taken by ambulance to the emergency
department (ED) this evening due to worsening cough, shortness of
eath, fever, and
general weakness and was accompanied by his husband George. Shaun is only able to
speak a few words at a time, before becoming fatigued. George stated that they both tested
positive for SARS-CoV-2 virus (tested on PCR) 4 weeks ago, but Shaun has been struggling
to recover from his symptoms since then. George noticed that his symptoms were
progressively getting worse over the last two (2) days, but they have not been able to make
an appointment with their local GP due to a lack of availability.
Shaun states that he has not had an appetite for weeks now, and feels he has lost weight
since being unwell (although he hasn’t weighed himself).
A CT scan was ordered which showed bilateral consolidation most likely due to pneumonia,
secondary to his initial SARS-CoV-2 infection.
On assessment:
• Shaun appears pale, cool and clammy. His lips appear dry and his tongue is cracked
• He appears lethargic and George states he “just wants to sleep all the time”
• He is lying in a semi-Fowler’s position but keeps pushing himself upright, while
holding his chest
• He has a frequent productive cough, with purulent green phlegm
• Bilateral crackles in the lower and middle lobes are audible on auscultation.
Occasional expiratory wheeze noted across all lung fields
• His last urine output was this morning at 9am
Health assessment findings and laboratory results at presentation:
• HR 124 bpm, regular pulse
• BP 95/56 mmHg
• RR 30 bpm, moderate WOB with use of accessory muscles
• Temp 38.7C
• SpO2 91% on RA
• Alert and orientated to time, place, and person
• CRT 2 seconds
• Weight – 92kg, Height – 1.65m
Result XXXXXXXXXXNormal Values
Haemoglobin (Hb) 143 g/L XXXXXXXXXXg/L (males)
WCC 11.8 x 109/L XXXXXXXXXX4-11 x 109/L
Sodium 132 mmol/L XXXXXXXXXX135 to 145 mmol/L
Potassium 3.5 mmol/L XXXXXXXXXX5 to 5.2 mmol/L
Lactate 2.4 mmol/L <1.0 mmol
C-reactive protein
(CRP)
22 mg/L <5 mg/L
Creatinine 115 umol/L XXXXXXXXXX60-110 umol/L
Sputum culture Pending Negative
Blood cultures Pending Negative
Patient history:
Shaun lives with his husband in an outer subu
in Sydney. He is cu
ently studying civil
engineering at university full-time, while working at his local café as a barista on the
weekends.
Shaun does not smoke and only drinks alcohol on special occasions, but uses a vape daily,
although he has stopped since becoming unwell with COVID-19.
Family history:
• Parents live overseas and are both well with no medical concerns
Medical history:
• Asthma, diagnosed as a child although now well controlled
Medications:
• Salbutamol 4-6 puffs via MDI PRN
Management
• Administer IV bolus NaCl 0.9% 500ml over less than 15 minutes
• Commence IV NaCl 0.9% at 100ml/h
• Administer IV ceftriaxone 1g BD
• 30/60 vital obs and 1/24 respiratory assessment
• Administer high flow oxygen
You are the registered nurse looking after Shaun, and you are required to plan his care
guided by a clinical reasoning framework and the provided case study information.

· Students will assess, prioritise and plan the care of the case study patient using a clinical reasoning framework.
· Your discussion must be cited and supported by a wide range of relevant and credible sources for each question below. There is no need to include an introduction or conclusion.
· You are required to include a final reference list at the end. A minimum of 15 high quality resources are to be used. All answers must be supported using a variety of high-quality primary evidence. Avoid using any one source repetitively.
You will be required to respond to the following sections:
1. Patient assessment (250 words):
· Provide an initial impression of the patient and identify relevant and significant features from the patient presentation. Ensure you identify what the presenting condition/issue/concern is;
· Identify further elements of a comprehensive nursing assessment (this is addition to what has been done already, and can be presented as a list. If you repeat assessments, provide a rationale)
2. Disease pathophysiology and complications (750 words):
· Discuss in detail, the pathophysiology of the presenting condition/issue/concern and how the patient’s presenting signs and symptoms reflect the underlying pathophysiology;
· Based on the patient’s history and presenting condition, he is at risk for complications. Choose two (2) possible complications from the list below and explain why he is at risk of developing these. You need to refer back to the patient details to support your answe
·
· Septic shock
· Fluid overload
· Respiratory failure
· Acute kidney injury
3. Identify nursing issues (400 words):
· Identify and prioritise 3 nursing issues you must address for the patient for their cu
ent admission, 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 and need to be written using the “issue, cause, evidence” format.
4. Nursing interventions (600 words):
· Identify, rationalise and explain, in order of priority, the nursing care strategies you should use or plan for within the first 24 hours of admission for the patient.
Answered 2 days After May 16, 2024

Solution

Dilpreet answered on May 19 2024
5 Votes
Case Study Analysis         2
CASE STUDY ANALYSIS
Table of Contents
Patient Assessment    3
Initial Impression of the Patient and Identification of Significant Features    3
Further Elements of Comprehensive Nursing Assessment    3
Disease Pathophysiology and Complications    4
Pathophysiology of the Presenting Condition    4
Risk for Complications    5
Identifying Nursing Issues    6
Nursing Interventions    8
References    11
Patient Assessment
Initial Impression of the Patient and Identification of Significant Features
    A 35-year-old male named Shaun has been admitted to the emergency department with symptoms of respiratory distress. One of the possible causes of the respiratory distress in the initial phase of inspection is determined to be post COVID-19 pneumonia. Relevant and significant features identified include cough with green phlegm, bilateral lung crackles, and expiratory wheeze. These features are indicative of the fact that Shaun is suffering from an infection in the lower respiratory tract. He also seems to show features of lethargy, and dehydration as he could barely speak and he has dry lips, and cracked tongue. His CT scan confirm pneumonia. His condition is deteriorating at a very fast pace over the last two days and demands immediate medical attention.
Further Elements of Comprehensive Nursing Assessment
    After analysing the condition of Shaun, further elements of comprehensive nursing assessment will include monitoring the vitals of the body such as oxygen saturation, temperature, heart rate, and blood pressure (Dall'Ora et al., 2021). As Shaun is showing symptoms of dehydration as well so it is essential to focus on accessing the hydration status of Shaun. The next element would be assessing Shaun for any kind of discomfort in the chest such as chest pain. Sinc, Shaun is feeling lethargic, fatigue, and is barely able to speak, it is important to keep a check on his neurological status to ensure that he does not faints. It is also important to focus on his nutritional status to ensure speedy recovery (James et al., 2021). As a nurse it is also important to review the vitals of the laboratory tests such as blood culture, and sputum culture.
Disease Pathophysiology and Complications
Pathophysiology of the Presenting Condition
    Shuan’s condition indicates that he is suffering from pneumonia after he has been detected positive for SARS-CoV-2 infection. His condition is deteriorating rapidly with symptoms of severe respiratory distress. The underlying pathophysiological process of the disease indicates that there has been a direct viral damage to the respiratory system particularly the function of the lungs owing to the COVID-19 infection (Chernyak et al., 2022). There is a high probability that this viral infection can ultimately lead to hypoxia, as there is a possibility that the alveolar may be damaged, and capillary permeability may increase significantly (Brosnahan et al., 2020).
    Furthermore, Shaun’s CT scan has indicated that post COVID-19 infection, he has developed bacterial pneumonia. The bilateral consolidation in the CT scan can directly be linked to the lungs being filled with either blood, pus, or immune cells (Yu et al., 2020). This is the primary cause of the respirator distress, which Shaun is experiencing. Shuan’s bacterial infection can further be confirmed as he is showing continuous symptoms of cough with green phlegm since he has been detected positive for COVID-19. There seems to be an infection in the airways as well as he is suffering from shortness of
eath, chest pain, and fatigue (Achkar, Jamal & Chaaban, 2022). Shaun is barely able to speak as well.
    Also, Shaun’s body is indicating dehydration as his present condition indicates dry lips and cracked tongue. In response to bacterial infections, human body tends to consume the body fluid at a faster pace leading to dysfunction of many organs. Since, Shaun is not taking in enough fluid and other nutritious diet he has developed symptoms such as dry lips, and crackled tongue. Fever, continuous cough, and poor respiration also contribute to the loss of fluid adding to worsen the condition of the patient (Vijayakumar et al., 2022). Shaun’s body language such as his efforts to sit upright highlight the fact that he is having
eathing troubles and is making extensive efforts to ease out his
eathing process. In addition to this, the urine test output done at 9 AM indicates that he is having some trouble with the kidneys as there is decreased renal perfusion. Reduced urine output is indicative of sepsis as well.
Risk for Complications
    On analysing the medical condition of Shaun based on his presenting condition and the body vitals including the laboratory reports, it is evident that out of the give list, Shaun is at the risk of septic shock and respiratory failure.
Septic Shock: Shuan is showing multiple symptoms of sepsis, which can be a lethal septic shock as well. He is suffering with fever for...
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