Assessment 2: Case study Essay   

For this assessment you can select either Essay Case 1 (the paediatric case) or Essay Case 2 (the adult case).

Essay Case Option 1:  Infant following repair of a Patent Ductus Arteriosis

It is 10am and Annabelle is a 4 month old infant who has returned to the Paediatric Cardiac Care Unit after a surgical repair of her Patent Ductus Arteriosis (PDA).  Her PDA was first identified at her six week post delivery check-up.  Annabelle’s mother noticed that she was not gaining weight prior to the first paediatrician visit.  She states “Belle doesn’t seem interested in feeding, and seems to go to sleep or pull off the breast mid way through a feed.”  Annabelle’s mother also states that Annabelle seems to sleep a lot and doesn’t seem to have the same energy levels as her eldest child did when he was a baby.  Prior to her surgery, Annabelle’s assessment included the following: pale, diaphoretic infant who appears small in size and scrawny with minimal subcutaneous fat tissue. Bare weight is 5.125 kgs (approximately 10th percentile). She has rapid breathing with RR 50 breaths / minute and congested sounds which is typical finding in infants with PDA.  Her medical record stated she was born at term and her birth weight 3.5 kgs (75th percentile). Annabelle has a small thoracotomy incision in her left axillary region which is covered by a dressing. Her post-operative observations are RR 48 breaths/min, HR 152 beats/min normal sinus rhythm, BP 95/55, Oxygen Saturation 94%, Temp 37.2C.  Annabelle is crying but no tears are present, her eyes are shut tightly, her brows are drawn together in a frown and she has an open and square shaped mouth.  As you try to inspect her dressing she pulls her arm away.  Annabelle has intravenous therapy of 0.9% Normal Saline (NaCl)  infusing at 22mls per hour. Annabelle was fasting for hours prior to her surgery.  She was last breastfed at 3am during the night.  Her mother states her nappy was wet about 6am prior to surgery and her current nappy is dry. Annabelle is ordered a nurse controlled analgesia (NCA) infusion of Morphine to commence at 0.01mg//kg/hour which equates to 0.05mg/hour of Morphine Sulphate IV continuously to run as a side line to her fluid infusion. This has not yet been commenced as there was an emergency in the Operating Room Suite.

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Essay Case Option 2:  Adult with Chronic Obstructive Pulmonary Disease (COPD) 

David is a 72 year old male admitted to the medical ward this morning with an infective exacerbation of his Chronic Obstructive Pulmonary Disease (COPD).  David has a history of smoking since he was a teenager but finally managed to quit 3 years ago when he was diagnosed with COPD.  David had noticed he had been coughing more throughout the night and his sputum had turned a thick green colour.  He has also reported that he had not eaten or drank much in the two days before his admission as he was feeling so unwell.  As you examine his mouth you note his tongue is white and his lips are cracked and dry.  The urine bottle on the side of his bed contains a small amount of dark amber urine.  David’s weight on admission was 55kgs and he is 176cms  tall.

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He is currently receiving 3rd hourly nebulised ventolin and is on 2L/min of oxygen via the nasal prongs.  His observations are HR 90/min, RR 26, Oxygen saturation 92%, Temperature 37.8 ^oC.  He has an IV cannula insitu and is his medical chart shows that he is prescribed 6 hourly IV hydrocortisone and IV antibiotics. When you enter the room to ask David how he is feeling you notice that he is sitting up on the side of his bed leaning over his bedside table and coughing.  He is pale and seems to be using his shoulders and upper chest as he breathes. As you listen to his chest with the stethoscope you can hear coarse crackles and there seems to be decreased air entry in both lower lobes.  He also has a prolonged expiratory phase.  He responds that “I can’t seem to get my breath, and my mouth is so dry and I can’t seem to cough this stuff up.”

For this essay, select either Essay Case Option 1 (the paediatric case) or Essay Case Option 2 (the adult case).

Every patient you care for is likely to have a number of actual and potential health related problems. There are at least three (3) priority problems that the patient is experiencing currently. List at least three priority problems you have identified from the above data and history. For each problem identified, list as many nursing interventions as you have discovered in your research of the literature. Include a one to two line rationale for each intervention. Submit this one page list with your essay.

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Please be aware that the main focus should be the essay itself and not this one page list which is essentially a map or plan of your thinking about the case. We have asked for this page as sometimes students choose incorrect priority problems so this page will allow us to see if it was a problem with identification or prioritisation. As with any academic writing it should be referenced and you can include these references in your main essay reference list. Your main focus should be the essay.

For your essay, you must prioritise the problems you identified and select the two highest priority problems from your list.

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The 2000- word essay should cover the points below:

·         Introduction (150 words): State an overview of the patient’s condition and identify the TWO priority nursing problems. Give a brief plan for the essay topics.

·         For the first problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms. Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature.  Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.

·         For the second problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature.   Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.

·         Conclusion (150 words): Briefly restate the patient’s condition and problems and how the nursing interventions can benefit the patient’s health.

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You need to discuss at least one independent nursing intervention in your essay.  For any collaborative nursing interventions you use you must discuss the nursing responsibilities and actions in relation to this collaborative intervention. Medications cannot be both of your chosen collaborative interventions for a problem.  If a medication is one of your collaborative interventions you must identify an appropriate drug that is likely to be/or has been prescribed by the doctor (in the case options some medications have already been prescribed). You must also consider and discuss the nursing responsibilities associated with the medication (action, dose, side effects, prevention and management of same, administration requirements, evaluation).

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WRITING TIPS:

Refer to current academic peer-reviewed journal articles to justify your ideas.

Format of Assessment 2

-All questions should be attempted and written in essay format

-Margins: 2cm on 4 sides;  & line spacing: at least 1.5; Font size: 12

-Adherence to the stated word limit is required

-QUT APA referencing style

-A full reference list is required at the end of the assignment.

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