Assignment Task:
Task:
Case Analysis components
2500 words: 50%
You are assigned to care for Mrs Smith, a 39-year-old who presented with severe abdominal pain and a brief cyanotic episode of syncope. She has a two-day history of nausea, vomiting, severe right upper quadrant and sternal pain with pressure radiating through to her back. Mrs Smith has a family history of gall bladder disease and has had an episode of cholecystitis three weeks ago which required an urgent endoscopic retrograde cholangiopancreatography (ERCP). The patient reports that this pain is more severe than her previous attacks and came on approximately two hours after eating fish and chips two nights ago. Mrs Smith was given IV opioids for pain and an antiemetic for vomiting. One hour later, the pain continues, though it has eased and the vomiting has ceased. Her ECG is normal, her urinalysis was positive for leucocytes and her blood sugar level was 8.6 mmol/L. The results of her blood tests are still pending. Two hours later, while reviewing Mrs Smith you note that her face is pale, she looks nervous and upset and her hands are trembling. While checking her radial pulse you note that her skin is cool and clammy to touch—she is tachypnoeic and tachycardic. The patient informs you that she has never felt this unwell before. You recognise that the patient is rapidly deteriorating and you escalate her care and obtain all relevant clinical results. The blood results show elevated liver enzymes, consistent with fulminant hepatic failure. On discussion with patient and her family, it becomes evident that the Mrs Smith has self-medicated for several years and that her liver failure may be due to chronic overuse of paracetamol and codeine.
Introduction to Assessment 3: 150 words maximum
Provide a brief synopsis of main findings and their implications for this patient’s pathophysiology and management in the critical care setting. Please note: analysis of psychosocial components of medication misuse is not required for this assessment item.
Body of Assessment 3:
Briefly discuss the causes of Mrs. Smith’s hepatic failure and identify the aspects of her metabolic pathophysiology which need to be addressed to prevent further deterioration? Your discussion needs to include the rationale for providing on-going nutritional support. 500 words +/- 10%
(Pain management and immune effects are to be discussed in separate sections listed below)
Subsequent investigations show that the patient has peritonitis, possibly due to a perforation in the gastro intestinal tract.
Pain control for Mrs. Smith provides a complex nursing management challenge. Critically examine the appropriate use of analgesia and sedation to ensure optimal clinical care for this patient. 500 words+/- 10%
The body relies on a series of complex and interactive processes to contain and eliminate infection.
Briefly discuss the components of GIT as a septic source and the required strategies needed to disrupt the sepsis cascade. Identify the inflammation and immune responses related to Mrs. Smith’s clinical presentation. 600 words+/- 10%
The sequelae of shock are systemic and detrimental to all body systems. Hence, the treatment of Mrs. Smith’s sepsis and prevention of septic shock needs to be a primary focus of managing her infective illness.
Evaluate the following treatment aspects of Mrs. Smith’s clinical management, highlighting the current evidence based practice guidelines. 600 words+/- 10%
antibiotic therapy
optimising oxygenation, fluid and electrolyte status
critical care nursing management and support to optimise health outcomes for the patient
Conclusion:
Sum up of major issues covered in the guided case analysis 150 maxTotal Word count for the Case Analysis is 2500 +/- 10%
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