NRSG378 - Principles of Nursing - Extended Clinical Reasoning

Assignment Task

Case Study

Kate Sansbury is a 22-year-old female who presented to the emergency department (ED) with abdominal pain, nausea and vomiting, and general malaise. She stated that the pain appeared 3 days ago but was dull and localised to the right lower quadrant only, and resolved when she applied a heat pack and took some paracetamol.

She assumed the pain was due to her upcoming period. Last night at 3am she woke when the abdominal pain became sharp and was so “intolerable” she vomited. She has since had 2 further vomits, and states she feels ongoing nausea. She has not been able to eat or drink her usual amounts for the past day. She states she has only voided once yesterday and it was “very dark yellow” in colour.

On assessment:

• Kate appears pale, cool and clammy. Her lips appear dry

• She is lying in a semi-Fowler’s position and has her hands across her stomach (guarding). Kate appears reluctant to move

• Her abdomen is distended and tender, and there are minimal abdominal sounds on auscultation

• On abdominal palpation, she states the pain is 8/10 on the right lower quadrant, but the pain also occurs across her abdomen, and it is becoming worse

Task

Students will assess, prioritise and plan the care of the case study patient using a clinical reasoning framework. Sections you need to respond to include:

1. Disease pathophysiology and patient assessment:

 i) Provide an initial impression of the patient and identify relevant and significant features from the patient presentation;

 ii) Discuss in detail, the pathophysiology of the disease and how Kate’s presenting signs and symptoms reflect the underlying pathophysiology;

iii) Identify further elements of a comprehensive nursing assessment (this can be presented as a list)

2. Identify nursing and patient issues:

1. Identify and prioritise 3 nursing issues you must address for Kate and justify why they are priorities and support your discussion with evidence and data from the case study. These can be actual or at-risk issues.

2. Discuss the potential impact of this admission on Kate’s 2 most important activities of living (can be biological, psychosocial, spiritual or cultural factors)

3. Discuss the pharmacological management:

i) Identify and discuss two (2) common classes of drugs used for Kate, including the drug mechanism of action, indication and nursing considerations. This does not mean specific drugs but rather the class that these drugs belong to.

4. Nursing interventions:

1) Identify, rationalise and explain, in order of priority, the nursing care strategies you should use within the first 24 hours post-surgery for Kate.

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