You are required to submit a fully referenced academic paper on the following case– study. With reference to evidence based practice, the primary goal of this assignment is to synthesis your nursing knowledge and practice. This assignment will demonstrate your ability to link theory to practice, clinical prioritization, issue identification, care planning, assessment and evaluation
Patient Profile
You have just commenced the morning shift on the medical ward of a large tertiary hospital. You have been allocated the care of four patients, including Elsie, an 86 year old women who was admitted last night via the Emergency Department with R) basal lobe pneumonia.
Elise has a past history of hypertension and hypercholestremia. She takes Lipitor 40mg nocte and Captopril 50mg BD.
The night staff handover that Elsie was administered 1gm Ceftriaxone in the ED at 2200 and was transferred to the ward at midnight. On arrival to the ward, Elsie’s recorded observations were:
Temperature 37.7, BP 142/94, Pulse 96, RR 26.
The night staff report that Elsie has slept well and “has not been a problem “
When you enter Elsie’s room at 0715, you find Elsie is talking but confused and short of breath. She has removed her IV line. There is blood on the sheets and over Elsie. You don gloves and begin an assessment. You find that Elsie’s skin is flushed and sweaty. Her IDC has drained 80mls of concentrated urine since midnight.
Observations:
Cardiovascular: BP 90/65mmhg, pulse 126 bpm, weak radial pulse. She feels warm to touch
Respiratory: RR 35 breaths/min; labored breathing, reduced air entiry to R) base, pulse oximetry 92% on 6LPM humidified oxygen
Temperature: 38.6 Celsius Tympanic
Glasgow Coma Score: 14, confused to day/ place
BGL: 10.2mmol/L
Diagnostic studies
Chest x-ray: Consolidation to R) Lower lobe
With reference to the above scenario and patient:
1. Outline the structured approach to primary assessment you would use
when first assessing Elsie. Provide a rational for each step of this
assessment
2. Discuss the focused assessment required. Provide a rationale for why
you need to collect this data
The decision is made to call the Medical Emergency Team (MET) for Elsie. The team conclude that Elsie is going into shock. They insert a triple lumen CVC via the right subclavian vein, which is sutured in. They order a litre of Normal Saline 0.9% to be given over 2 hours and add Azithromycin 500mg daily to the drug chart
3. Identify and define the type of shock Elsie is experiencing. Discuss the pathophysiology of that type of shock. Include in your answer a
Written Case Study NUR3022
discussion of the pathophysiology of each clinical manifestation, Elsie
presents with
4. Prioritize five (5) appropriate evidence based interventions required for