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You will be required to respond to the following sections: Patient assessment (250 words): Provide an initial impression of the patient and identify relevant and significant features from the...

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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 answer



        • Septic shock

        • Fluid overload

        • Respiratory failure

        • Acute kidney injury









  3. Identify nursing issues (400 words):

    • Identify and prioritise 3 nursing issues you must address forthe patient for theircurrentadmission, 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 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

Dr. Saloni answered on May 18 2024
6 Votes
A Case Study
 
Patient assessment
A complete nursing assessment is required to determine Shaun's overall state and detect any consequences beyond the symptoms he has been experiencing. He has a history of COVID-19 infection, following which he has developed severe symptoms which are indicative of Sepsis, causing septic shock and organ failure. Additionally, his CRT was greater than 2, and a CRT longer than two seconds or greater indicates an early sign of shock. Septic shock, which often necessitates emergency care and hospital admission, is linked to potentially fatal organ dysfunction caused by coronavirus disease 2019 (COVID-19). It is necessary to evaluate many aspects of his health (Vincent, 2021).
It is imperative to conduct an early evaluation and identification of the infection to prevent its spread. An identification of the bacteria causing the sickness requires the performance of a blood culture. A liver function test ought to be ca
ied out to identify any changes in the liver's functionality. Hematologic tests must also be performed to assess blood perfusion. Assess whether Shaun has a positive blood culture, is taking antibiotics at the moment, received a chest x-ray or examination, or if there is a possible infection on one of his wounds. Examine him for the presence of clotting disorder, liver abnormalities, tachypnea, hypotension, and tachycardia. To closely monitor vital signs (Shappell et al., 2023),
Shaun should be provided with continuous cardiopulmonary monitoring. He should have a comprehensive evaluation of his end-organ function and peripheral perfusion to establish where he might lie on the pathophysiologic continuum of sepsis. A mental status evaluation or Glasgow Coma Scale (GCS), a measurement of urine output, and an analysis of mixed/lactate venous saturation (using central lines) must all be part of this. Additional lab tests including a disseminated intravascular coagulation (DIC) panel and arterial blood gas might identify crucial details on Shaun's sepsis syndrome severity. For the best possible patient care, sepsis and related severe illness must be identified as soon as possible. The co
elation of sepsis with como
idities and age should be the focus of the initial patient assessment (Alhazzani et al., 2020).
 
Disease pathophysiology and complications
Septic shock is a systemic inflammatory disorder associated with various infectious illnesses such as influenza, urinary tract infections, and pneumonia. Sepsis is also characterized as serious organ failure caused by the dysregulated host defense against infection. A subgroup of sepsis patients experience septic shock, which is linked to a higher death rate and consists of an underlying metabolic/cellular and circulatory imbalance. Despite sufficient volume resuscitation, septic shock is characterized by persistent hypotension that necessitates the use of vasopressors to sustain a mean arterial pressure around 65 mm Hg or deliberately higher along with a serum lactate concentration above 2 mmol/L (approximate 18 mg/dL) (Heubner et al., 2022).
Septic shock, the most severe consequence of sepsis, has a significant fatality rate. The immune system's anti-inflammatory and pro-inflammatory
anches activate upon exposure to an inciting agent. Monocytes, neutrophils, and macrophages are also activated. These cells commune with the endothelial layer through pathogen recognition receptors to produce cytokines, kinins, proteases, nitric oxide, and reactive oxygen species. The endothelium, which is the main location of this reaction, sustains microvascular damage as well as triggers the coagulationand complement cascades, which worsen vascular damage and cause capillary leak. The clinical manifestations of sepsis and the gradual shift from sepsis into septic shock are caused by this series of events (Shappell et al., 2023).
In the case of Shaun, septic shock is a significant complication for him. The immune response throughout sepsis includes a cytokine-mediated hyper-inflammatory period and an additional immunosuppressive period. Immunodeficiency has a significant influence on how sepsis progresses to septic shock. In Shaun’s case, In Shaun's instance, anaerobic metabolism may have turned glucose into lactate due to extended tissue hypoxia. Overproduction of pro-inflammatory cytokines may lead to pathological inflammatory reactions, including tissue damage, capillary leakage, and organ failure (Vincent, 2021). These responses can also interfere with the immune system's effective regulation. Septic shock can also be caused by a distu
ance in inflammation, viral or bacterial infection, and a complex relationship with the host immune system that sometimes results in an excessive or severe inflammatory response—also known as a "cytokine storm"—triggering a significant inflammatory response. In individuals suffering from COVID-19-induced septic shock, there is a strong chronological co
elation between the beginning of shock as well as the period leading up to death, and numerous individuals exhibiting evidence of septic shock before fatality (Liu et al., 2020).
Sepsis is an excessive host response to infection that causes significant mo
idity and mortality. Sepsis, also known as septicemia, was first used in 1914, and the term itself has evolved throughout time as a result of the disease's consequences. Sepsis is characterized by systemic inflammatory response syndrome...
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