Submission Details:
\n1250 words handed in through Turnitin
\nAim of assessment
\nThe purpose of the assessment is to enable students to demonstrate knowledge by accurately analysing information in a case study of complex critical care patient.
\nRead the case study attached and answer the following questions-
\n1. analyse the pathogenesis in relation to the clinical manifestations in the case study (15 marks).
\n2. Select ONE (1) appropriate nursing strategy, and explain the underpinning evidence base for this rational (5 marks) ( NON PHARMACOLOGICAL NURSING STRATEGIES Eg: fluid resuscitation, OXYGEN THERAPY, WITH RATIONALE WHY YOU USING IT AND HOW DOES IT HELPS ?
\nCritically analyse the Arterial blood gas results, and relate them to the underlying pathogenesis (10 marks) DISCUSS ALL THE FACTORS OF ARTERIAL BLOOD GAS IN DETAIL. Eg: why is the pH is low ?
\n3.
\n4. Academic Writing (5 marks).<\/p>\n
Case Study Details: Mr Kirkman a 75-year-old male, presented to ED complaining of burning sensation upon urination and lower abdominal pain radiating into the right flank. Mr Kirkman was admitted to the ward with a diagnosis of Urinary tract infection. He was placed on IV NaCl and IV Sulfamethoxazole-trimethoprim 10 mg\/kg\/day IV in 2 equally divided doses daily and an Indwelling catheter was inserted.
\nTwenty-four hours later, his condition deteriorates HR135, BP 80\/42, RR 35, TEMP 39 and looks generally unwell.
\nHistory from ED notes
\n\u2022 Wife died 12 months ago
\n\u2022 Social drinker
\n\u2022 Heavy smoker 2 packs a day since commencing as a teenager.
\n\u2022 Chronic bronchitis on Ventolin and Atrovent.
\n\u2022 Previous UTI
\n\u2022 No cardiac history
\nDiagnosis 24 hours later
\n\u2022 UTI with severe sepsis
\nPRIMARY SURVEY O\/E
\nexplain the pathogenesis of the below mentioned A-G clinical manifestations and relate it to the case study 15Marks OR
\nanalyse the pathogenesis in relation to the clinical manifestations in the case study (15 marks).
\n1.
\nclues: (Q V MISMATCH, INFLAMMATORY SYSTEM, OXYHAEMOGLOBIN CURVE, RAAS SYSTEM )
\nwhy he\u2019s respiratory rate is 35?
\nWHAT COMPENSATION IS RESULT OF DECREASED RR?
\nWhy he\u2019s saturation low?
\nwhy is bp DROPING AS A RESULT OF SIRS ?
\nAS A Result of low bp what other system is initiating (RAAS SYSTEM) TO TRYING TO CONSERVE THE FLUID ? WHY HE IS HAVING DECREASE URINE OUT PUT?
\nWHATS HAPPENING TO HIM TO INCREASE HIS TEMP ?
\nWhy he\u2019s using accessory muscles ?,
\nWHY HE IS TACHYCARDIC? WHILE HIS SATURATION IS LOW AND RR HIGH.
\nAND WRITE FULL BLOOD COUNT IN QUESTION 1?
\nhow UTI leads to severe sepsis within 24 hrs ~ WHAT DOES IT DO TO OUR BODY MECHANISM ~ WHAT COMPENSATES
\nA \u2013 Patient speaking in single words
\nB \u2013 RR 35bpm, accessory muscle use. SPO2 82%, in obvious distress.
\nC \u2013 Sinus rhythm 135bpm, Blood pressure 80\/42mmHg, Temperature 39\u00b0C
\nD \u2013 E4, V4, M5
\nE- Use of accessory muscles, lower abdominal pain 6\/10, flushed face
\nF- IVC insitu, IDC- Dark urine passed small amounts approximately 40mls in last 8 hours
\nG- 8.4mmol\/L<\/p>\n
Diagnostics
\n3 Critically analyse the Arterial blood gas results, and relate them to the underlying pathogenesis (10 marks)
\nUrinalysis
\nPositive \u2013 nitrite, leukocytes & blood.
\nArterial blood gases (ABGs) DISCUSS ALL THE FACTORS OF ARTERIAL BLOOD GAS IN DETAIL. Eg: why is the pH is low ? AND RELATE TO THE UNDERLYING PATHOGENESIS
\nABGs Result Normal range
\npH 7.25 7.35-7.45
\nPaO2 75 mmHg 80-100 mmHg
\nPaCO2 32 mmHg 35-45 mmHg
\nHCO3 15 mmol\/L 22-32 mmol\/L
\nBE -6 mmol\/L -2 – +2mmol\/L
\nLactate 3.2 mmol\/L 0.3-0.8 mmol\/L
\nFull blood count (FBC)
\nFBC Result Normal range
\nHaemoglobin (Hb) 140g\/L 130-180 g\/L
\nRed cell count (RCC) 5.0 x 1012\/L 4.5-6.5 1012\/L
\nPacked cell volume (PCV) 0.42 0.40-0.54
\nTotal white cell count (WCC) 15.2 x 109\/L 4.0-10.0 x 109\/L
\nPlatelets 290 x 10 9\/L 150-400 x 109\/L
\nCoagulation (\u2018Coags\u2019)
\nCoags Result Normal range
\nAPTT 30 25-35
\nPT 15 11-15
\nINR 2.2 2.0-3.0
\nElectrolytes, urea & creatinine (EUC)
\nEUC Result Normal range
\nNa+ 148 mmol\/L 135-145mmol\/L
\nK+ 5.2 mmol\/L 3.8-4.9 mmol\/L
\nCl- 111 mmol\/L 95-110 mmol\/L
\nMg2+ 0.82 mmol\/L 0.8-1.0 mmol\/L
\nUrea 15 mmol\/L 3.0-8.0 mmol\/L
\nCreatinine 130 \u00b5mol\/L 60-120 \u00b5mol\/L
\nMarking criteria and standards: Assessment 2: Short Answer Questions
\nCriteria Mark High Distinction Distinction Credit Pass Fail
\nCriteria 1 \u2013 Using the case study analyse the pathogenesis in relation to the clinical manifestations. \/15 Provides an accurate, clear and comprehensive analysis of the pathogenesis in relation to the clinical manifestations. Provides an accurate analysis of the pathogenesis in relation to the clinical manifestations. Provides an accurate analysis of the pathogenesis in relation to the clinical manifestations. However, the information may be incomplete or lack clarity. Provides a basic analysis of the pathogenesis in relation to the clinical manifestations.
\nThere may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow. Superficial analysis of the pathogenesis in relation to the clinical manifestations.
\nThere are major inaccuracies, omissions or repetition of information, lack of clarity or logical flow.
\n13-15 11.5-12.5 10-11 7.5-9.5 =7.0
\nSelect ONE (1) appropriate nursing strategy, including the rationale. \/5 Provides an appropriate, accurate, clear and comprehensive nursing strategy and rationale. Provides an appropriate and accurate nursing strategy and rationale. Provides an appropriate and accurate nursing strategy and rationale. However, the information may be incomplete or lack clarity. Provides an appropriate but basic nursing strategy and rationale. There may be minor inaccuracies, omissions and lack of clarity. Incorrect prioritisation.
\nDoes not accurately identify the nursing strategy OR identifies the strategy but does not accurately explain the rationale.
\n4.5-5 4 3.5 2.5-3 =2
\nCriteria 2 \u2013 Critically analyse diagnostic result Arterial blood gas, and relate to the underlying pathogenesis
\n\/10 Critically analyses ABG diagnostic result, and comprehensively and accurately relates to the underlying pathogenesis. Critically analyses ABG diagnostic result, and accurately relates to the underlying pathogenesis. Analyses ABG diagnostic result, and accurately relate to the underlying pathogenesis
\nHowever, response may lack some relevant information or clarity in relating to pathogenesis. Discusses ABG diagnostic result with little analysis. Some inaccuracies in relating to the underlying pathogenesis. refers to ABG diagnostic result with inaccuracies in relating to the underlying pathogenesis
\nInaccurately discusses ABG diagnostic results with little\/no relating to the underlying pathogenesis.
\n8.5-10 7.5-8 6.5-7.0 5-6
\n=4.5
\nAcademic Writing Style. \/5 Writes in an advanced style exhibiting highly coherent and logical flow of ideas.
\nNo errors in referencing, spelling, grammar, punctuation or sentence structure. Writes clearly and succinctly with a coherent, logical flow of ideas exhibiting advanced clarity.
\nNo errors in spelling, referencing grammar, punctuation or sentence structure. Ideas are clearly documented
\nUse of written word enables effective flow of ideas.
\nMinor errors in spelling, grammar, referencing punctuation or sentence structure that do not impede the logical flow of ideas and meaning. Writes in a reasonably clear, but limited use of language sometimes hinders the effective flow of ideas and meaning.
\nMinor, frequent errors in spelling, referencing grammar, punctuation or sentence structure sometimes impede meaning and the flow of ideas. Writes in an elementary style with basic use of language and poor articulation of ideas.
\nOrganisation of material and main points are unclear, confused or disorganised
\nMultiple errors in spelling, referencing grammar, punctuation and sentence structure.
\n4.5-5 4 3.5 2.5-3 =2<\/p>\n","protected":false},"excerpt":{"rendered":"
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