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CNA772 Interpreting Patient Deterioration: Assessment task 2 Case study

CNA772 Interpreting Patient Deterioration: Assessment task 2 Case study 50% 2,000 words

Case Study
This assessment task enables you to deeply engage with the literature around the health status of an acutely ill patient. You must select a case for analysis who has experienced an alteration in their condition which may have resulted in either shock, or acute respiratory or cardiac failure. We are looking for demonstration of a deep understanding of the applied pathophysiology that underpins the key problem experienced by the patient. You will need to selectone nursing management regime and one other management strategy used to address the problem the patient experienced.

In constructing the paper,discuss thepatientvital signs to explain theidentified changesas linked tothealtered physiology. Then having selectedonenursing and one othermanagement strategydiscuss in detail the strategies and linkthese to the altered physiology, so that you can showtotheassessorthatyou understand the relationship between theidentification of theproblem and thesubsequentmanagement provided.

Please note, that we are not looking for a great deal of detail about the patient. The introductory information on the case can be conveyed in one or two paragraphs and should not exceed more than one page. Institutional approval is not required as no patient details are to be included in the paper. In the paper, if you wish to include test results, then you must present them in the form of your analysis, it is not sufficient to list them, as a list does not convey your interpretation and therefore does not add to the grading. For example, you could say:

The patient presented with hypotension with a mean arterial pressure of 48 mmHg, hypoxic as evidenced by low arterial oxygen saturations, acidotic as indicated by a pH value of 7.16 and carbon dioxide levels of 55.

In terms of case selection, it does not have to be a recent patient you cared for, everyone will have looked after someone whose vital signs changed. In relation to topics, as you will cover these in another unit, please note that cardiovascular students may not select heart failure as a topic, and intensive care students may not discuss positive pressure ventilation as a management option. Also note that STEMI or AMI is not a suitable topic for an essay of this nature. The maximum word count for this assessment task is 2,000 words.

Examples of topics/cases for review
The topic/case does not need to be complicated nor recent. It can be as simple as selecting a patient who experienced

* a drop in blood pressure (hypotension or hypovolaemia as example)

* a drop in oxygen saturations (from a variety of causes)

* a vasovagal episode

* aspiration of gastric contents

* pneumonia (Community acquired or hospital acquired or other)

* hypertension

* sepsis

and so on.

Regardless of the topic area, it is your role to explain the underlying physiology and any compensatory mechanisms that are activated in response to the problem. You then link at a nursing and other management strategy to explain the related physiology.

As example

To address the hypoxia which resulted from the aspiration of gastric content, as a nursing measure, the patient was turned onto their side. As per Smith, Evans and Jones (2018), this allowed for drainage of the affected pulmonary lobe, improved ventilation to perfusion matching by aerating the elevated lobe of the lung and as a result, maximising perfusion. The paper will now detail the relationship between patient positioning and the physiology underpinning aspiration pneumonia.

FAQs – If you have any questions about the case study – look here for answers

Do I write my case study in the first or third person?

You can write in the first or third person. It is up to you.

The instructions sayidentify two management strategies, but I have more than that. Can I talk about more than two?

The key here is to remember you only have 2000 words, so I would focus on 2 interventions (one must be nursing) so you can demonstrate depth of knowledge.

Can I name the hospital/agency is which I work?

No, please ensure that you maintain the confidentiality of your workplace.You can identify the type of health care setting you work in eg. Renal unit, emergency department, community health, medical ward, neonatal unit without specifying the facility.

What is the word count and does the plus/minus 10% rule apply to the word count?

The word count is 2,000 words and yes, you can go 10% under or over the word count.

Are referencesincluded in the word count?

No, in-text references, direct quotes and your reference list are not included in the word count.

I am wondering if there are any specifics on how the assessment task is to be presented.

You will find the guide to presenting academic work under Assessments and Resources tab>guide to presenting academic work. It will answer all of your questions.

I am not sure of my topic. Can you give me an example?

Think about a situation in your career where you witnessed a patient deteriorate. It doesn’t have to be a medical emergency, in fact, the interventions implemented may have prevented further deterioration. Some of the examples I have seen used include the list below. You don’t have to use any of these, you may have one that stands out for you.

Hypovolaemia
Haemorrhage post-surgery
Reduced level of consciousness/respiratory depression due to opioid
APO
Sepsis
Heart failure
Pneumonia
Neonate with a acute respiratory distress
Acute onset AF
Pleural effusion
Cardiac tamponade
Vaso vagal
Aspiration pneumonia
Type 1 respiratory failure
Acute respiratory distress
PE
Hypotension
I don’t understand what a nursing strategy is. Can you give me an example?

This could be anything that a nurse initiates. The list below are some of the examples that have been used in the past, but keep in mind the list is not exhaustive.

Positioning of Patient
Fluid balance monitoring
Nursing strategies to reduce pain or reduce dyspnoea
Monitoring respiratory status – deep breathing and coughing exercises, respiratory assessments
Management of ICC
Management of oxygen therapy
Direct pressure to bleeding site
Haemodynamic monitoring
Cardiac monitoring
Monitoring of vital signs
Chest physio
Therapeutic communication
Can you give me an exampleof amedicalstrategy?

Again, the list is not exhaustive but should give you an idea of the types of medical interventions that have been used in the past.

Administration of oxygen therapy
Administration of particular IV medications
Insertion of ICC
IV fluid resuscitation
Administration of blood products
IV antibiotics
Inotropes
Surgery
I work on a medical ward. Would it be appropriate to discuss my patient with exacerbation of COPD who had increasing SOB and WOB.

That sounds like an appropriate scenario. The issue of an acute drop in oxygenation in a patient with a chronic condition is fine to cover in the paper as you will be addressing right down to cellular level how the body systems responded.

I am worried about using a patient I have looked after as I don’t want to breach confidentiality

Please don’t worry, if you use a pseudonym to de-identify your patient and do not specify the facility you were working in you will maintain confidentiality.

Can I use references from 2018?

The usual advice is to try to use references that are no older than 5 years so this fits that brief, but please take care to critique your sources for quality. When it comes to evidence to support nursing and medical interventions, the most recent evidence is preferred, and if that comes from 2018 that is fine.

Just wondering what “Addresses ethical requirements of using patient data” means? It is in the rubric but not quite sure what it means for me? Do I need to address this in my essay

It just means that you need to ensure you maintain confidentiality by de-identifying the patient and the health care facility in your essay. So that it is very clear that you have done so, I often state that in order to maintain confidentiality, the pseudonym Mr X has been used.

Academic referencing

The referencing style to be used in the paper is Harvard. Please note that there are many versions of Harvard, and we do not mind which one you use as long as you use it consistently. The Library and libraries from other universities have a range of resources to assist you with referencing. Please be consistent in their application.

You can access the link here to the Harvard Style Guide from the University of Tasmania Library here -Harvard Referencing Style Guide

__________________________________

Patient Demographics

Name: Mr. Smith
Age: 65
Gender: Male
Diagnosis: COPD
Date of Admission: 03/08/2023

History of Present Illness

Mr. Smith is a 65-year-old male with a history of COPD who presented to the emergency department with an acute exacerbation of his disease. He reported increasing shortness of breath over the past 24 hours, as well as a productive cough with green sputum. He also reported fatigue, fever, and chills.

Physical Examination

On physical examination, Mr. Smith was found to be in moderate respiratory distress. His respiratory rate was 32 breaths per minute, his heart rate was 110 beats per minute, and his blood pressure was 140/90 mmHg. His oxygen saturation was 88% on room air. His lungs were clear to auscultation bilaterally.

Laboratory Findings

Laboratory findings were significant for an elevated white blood cell count (12,000 cells/µL) and a decreased oxygen saturation (88%). A chest X-ray showed hyperinflation and diffuse infiltrates.

Diagnosis

Mr. Smith was diagnosed with an acute exacerbation of COPD.

Management

Mr. Smith was started on oxygen therapy, bronchodilators, and antibiotics. He was also admitted to the hospital for observation.

Course of Treatment

Mr. Smith’s condition improved over the next few days. He was discharged from the hospital on day 3 of his admission.

Discussion

COPD is a chronic lung disease that is characterized by airflow obstruction. The most common cause of COPD is smoking. COPD can cause a number of symptoms, including shortness of breath, cough, and wheezing.

An acute exacerbation of COPD is a sudden worsening of the symptoms of COPD. Acute exacerbations can be caused by a number of factors, including infection, changes in the weather, and exposure to irritants.

The management of an acute exacerbation of COPD includes oxygen therapy, bronchodilators, and antibiotics. In some cases, hospitalization may be necessary.

With appropriate treatment, most people with COPD can live long and productive lives.

Nursing Management

The nursing management of a patient with COPD who is experiencing an acute exacerbation includes the following:

Administering oxygen therapy as prescribed
Administering bronchodilators as prescribed
Administering antibiotics as prescribed
Monitoring the patient’s respiratory status
Providing emotional support to the patient and their family

Other Management Strategies

In addition to the nursing management described above, other management strategies for COPD include the following:

Quitting smoking
Getting regular exercise
Eating a healthy diet
Managing stress
Getting vaccinated against influenza and pneumonia

Conclusion

COPD is a chronic lung disease that can cause a number of symptoms, including shortness of breath, cough, and wheezing. An acute exacerbation of COPD is a sudden worsening of the symptoms of COPD. Acute exacerbations can be caused by a number of factors, including infection, changes in the weather, and exposure to irritants. The management of an acute exacerbation of COPD includes oxygen therapy, bronchodilators, and antibiotics. In some cases, hospitalization may be necessary. With appropriate treatment, most people with COPD can live long and productive lives.

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