NRSG378 - Critical Care Management for Shaun Morley Case Study

Assignment Task

Case study

Shaun Morely is a 35-year-old male who was taken by ambulance to the emergency department (ED) this evening due to worsening cough, shortness of breath, fever, and general weakness, and was accompanied by his husband George. Shaun is only able to speak a few words at a time, before becoming fatigued. George stated that they both tested positive for SARS-CoV-2 virus (tested on PCR) 4 weeks ago, but Shaun has been struggling to recover from his symptoms since then. George noticed that his symptoms were progressively getting worse over the last two (2) days, but they have not been able to make an appointment with their local GP due to a lack of availability

Shaun states that he has not had an appetite for weeks now, and feels he has lost weight since being unwell (although he hasn’t weighed himself)

A CT scan was ordered which showed bilateral consolidation most likely due to pneumonia, secondary to his initial SARS-CoV-2 infection.

On assessment:

• Shaun appears pale, cool and clammy. His lips appear dry and his tongue is cracked
• He appears lethargic and George states he “just wants to sleep all the time”
• He is lying in a semi-Fowler’s position but keeps pushing himself upright, while holding his chest
• He has a frequent productive cough, with purulent green phlegm
• Bilateral crackles in the lower and middle lobes are audible on auscultation. Occasional expiratory wheeze noted across all lung fields

Patient history

Shaun lives with his husband in an outer suburb in Sydney. He is currently studying civil engineering at university full-time, while working at his local café as a barista on the weekends.

Shaun does not smoke and only drinks alcohol on special occasions, but uses a vape daily, although he has stopped since becoming unwell with COVID-19

Family history

Parents live overseas and are both well with no medical concerns

Medical history

Asthma, diagnosed as a child although now well controlled

Management

• Administer IV bolus NaCl 0.9P0ml over less than 15 minutes
• Commence IV NaCl 0.9% at 100ml/hr 
• Administer IV ceftriaxone 1g BD
• 30/60 vital obs and 1/24 respiratory assessment
• Administer high flow oxygen

Purpose

This assessment enables students to apply knowledge from unit learnings to an issue requiring extended clinical reasoning. The assessment will engage students with the application of theory to practice, and is designed to facilitate an understanding of the impact of illness on the patient. It is also intended to give students the opportunity to demonstrate the ability to use a clinical reasoning framework to plan the care of an acutely unwell patient.

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