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Case Study of an Acute Life-Threatening Health Conditions Assignment
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Assignment Task
Aim
The aim of this assessment is to enable students to:
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Demonstrate knowledge by analysing the information provided in the case study.
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Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework.
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Discuss nursing strategies and evidence-based rationales to manage a patient with sepsis
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Discuss the pharmacological interventions related to the management of a patient with sepsis
Details
You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past five years with at least two references from the resources provided in the vUWS site including peer-reviewed journal articles, textbook material or other appropriate evidence-based resources.
Case study
Mrs Casey Smith is a 28-year-old lady presenting to the emergency department at 1900hrs with fevers and right flank pain. Unwell for last 10 days with right loin flank pain and suprapubic pain. Developed fevers, dysuria, frank haematuria 2 days ago. Complains of myalgia, nil respiratory symptoms. Nil diarrhea. Has nausea, nil vomiting. Nil chest pain. Unsure of pregnancy status.
Received 500mL Normal Saline IV bolus on arrival.
Lab Results
|
|
Result |
Reference Range |
|
Sodium |
137 mmol/L |
135-147 mmol/L |
|
Potassium |
3.9 mmol/L |
3.5-5.2 mmol/L |
|
Chloride |
120 mmol/L |
95-107 mmol/L |
|
Haemoglobin |
109 g/L |
120-140 g/L |
|
White blood cells |
26.3x10^9/L |
4.0-11.0x10^9/L |
|
Neutrophils |
13.0x10^9/L |
2.0-7.5x10^9/L |
|
Platelets |
64x10^9/L |
150-400x10^9/L |
|
C Reactive Protein (CRP) |
116 mg/L |
<3mg> |
|
Urea nitrogen (BUN) |
10.0 mmol/L |
3.0-8.0 mmol/L |
|
Creatinine |
127 µmol/L |
64 -104 µmol/L |
Coagulation profile:
|
|
Result |
Reference range |
|
Partial thromboplastin time (PTT) |
33 sec |
30-45 sec |
|
Prothrombin time (PT) |
26 sec |
10-12 sec |
Procalcitonin:
|
|
Result |
Reference range |
|
Procalcitonin (PCT) |
37.18 ug/L |
0-10 ug/L |
Arterial blood gas analysis (at 2200hrs)
|
|
Result |
Reference Range |
|
pH |
7.12 |
7.35-7.45 |
|
PaO2 |
70 mmHg |
80-100 mmHg |
|
PaCO2 |
28 mmHg |
35-45 mmHg |
|
HCO3- |
16 mmol/L |
22-26 mmol/L |
|
SpO2 |
82% |
>95% |
|
BE |
-7.2 mmol/L |
-2 - +2mmol/L |
|
Lactate |
5.2 mmol/L |
0.5-1.6mmol/L |
Clinical Impression: Sepsis (Urosepsis)
Plan:
1) Transfer to ICU within 1 hour
2) Chase urine and blood culture results
Question 1
Explain the pathophysiology causing all the clinical manifestations with which Mrs Smith presents.
Please use information from diagnostic results where relevant.
Question 2
Mrs. Smith has been prescribed the below two interventions.
- Briefly explain/provide rationale why each of these two (both) interventions are prescribed for Mrs Smith using pathophysiological linking and appropriate evidence
- Discuss briefly the specific mechanism of action of the medication and relate the medication to the underlying pathophysiology
- Describe briefly the impact of not performing the interventions
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