Assignment Task

Purpose

This assessment enables students to apply knowledge from unit learnings to an issue requiring 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 reasoning framework to plan the care of an acutely unwell patient.

Task

Students will assess, prioritize and plan the care of the case study patient using a clinical reasoning framework.

1. Disease pathophysiology and patient assessment

• 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

• 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)

3. Discuss the pharmacological management

• 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

• 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 resolved 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.

Patient history:

Kate currently lives with two friends in a share house in an inner-city suburb 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 “worried 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

• The 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