NURS3002: Inquiry for Complex Care - Josephine Mitchell Case Study - Nursing Assignment Help

Assignment Task:

Case study

Patient: Josephine Mitchell 27-year-old DOB 31/03/1993 Admitted via ED yesterday morning at 07.00am. ED Notes- Bought in by ambulance, following bicycle versus car accident whilst riding to work. No loss of consciousness, GCS 15 at scene and maintained throughout transfer to ED. Complaints of pain to lower abdomen, ribs, and Right lower leg. Significant abdominal bruising present. Pain score 9/10. Laceration to Right leg- dressing soaked with blood on arrival to hospital. IV analgesia given en-route to hospital. 

On arrival to ED, patient asked for her mother and father to be called to be informed of the situation but asked for them to be told to not attend the hospital. In ED primary and secondary surveys were performed. Results of Right lower leg, Cervical, Thoracic and lumbar x-rays and Abdominal and Pelvic computed tomography (CT) scans are as follows: 

• Fractures to right ribs # 4,5,6 – no displacement noted. Plan - Conservative management, pain relief as required and rest in bed.
• Right Tibia and Fibula fractures. Orthopaedic team consulted. Plan – for Open reduction internal fixation (ORIF) of Right tibia and fibula fractures. Consent for theatre and blood transfusion if required obtained on Theatre consent form.
• Abdominal and Pelvic CT scans revealed a giant right lateral abdominal wall hematoma. Keep patient nil by mouth and administer IVT as charted.
• HB – 103. Plan – repeat Hb in 24hrs. All other bloods noted as Nil abnormalities detected (NAD).
• IV ab’s commenced - QID Flucloxacillin 1g. 

HDU notes: Pt transferred to HDU at 11.30am. Admission paperwork completed. Patient is in a same sex relationship. Her next of kin (NOK) is noted as fiancée Fiona Smith, who had arrived at ED after the patient phoned her post-accident and she has accompanied the patient to HDU. Patient did not identify as any religion. Theatre checklist completed and patient prepped for theatre. Josephine’s parents arrived at HDU to see the patient but she was already in theatre. 

Patient returned from theatre at 18.30pm post ORIF right Tibia/fibula fracture. Large blood loss noted in theatre. Blood pressure low (ranging between 89-102 systolic) post theatre. 1000mls fluid challenge ordered over 2 hrs when reviewed by Dr for ADDS score caused by low BP, modifications noted for BP. Patient is to remain nil by mouth postoperatively. Administer IV therapy and monitor the patient’s abdomen regularly through focussed abdominal assessment. 

Current situation: You are caring for the below patient on this morning’s am shift. Handover by RN- Pain in abdomen, ribs and right leg has been hard to manage overnight, required review by Anaesthetist – further IV analgesia ordered. Given with good effect. Neurovascular status –some tingling noted in toes of right foot (RN states that is from the nerve block used in theatre). NVS intact R leg, DP and PT pulses palpable. Right leg raised with pillows. Systolic BP remains low but within modifications. Bloods taken at 06.00am. Abdominal bruising significant with abdominal distension noted. Rib fractures are limiting patient’s movement in bed and pressure area care required every 2 hrs. 

Patient’s mother phoned overnight to check on patient – no information disclosed as not listed as next of kin (NOK). Her mother became upset and told nursing staff that the patient should not be given any blood products as she is a Jehovah’s Witness. The RN questioned the patient about the mother’s information and the patient stated that she no longer identifies with that religion and is estranged from her parents due to their religious beliefs and her sexuality, as the patient is in a same sex relationship. The patient’s fiancée Fiona arrived at 06.45am and is currently with the patient. 

Following handover at 7.15am you introduce yourself to the patient she complains of intense abdominal pain. Patient also complains of feeling short of breath and light headed and just generally ‘off’. As you are about to take patient’s observations, the shift coordinator enters the room and informs you that the FBC is back and Haemoglobin is 78g/L. The Consultant is coming to review the patient to gain consent for a blood transfusion. The coordinator also informs you that the patient’s mother and father are waiting at the nurse’s station. The patient immediately starts telling you that her parents are not to come into this room and especially when Fiona (fiancée) is there. Whilst telling you this, the bedside monitor starts to alarm with a Sa02 of 92% on Room Air. Fiona starts to comfort Josephine who is now visibly upset. The alarm stops and Sa02 rises to 95%. Josephine asks you to go and tell her parents to leave and not return until she requests them to do so. 

You excuse yourself and go to the Nurses station where the shift coordinator introduces you to Josephine’s parents. Immediately her mother informs you that Josephine going through a bit of a crisis and that she has left her faith (Jehovah’s Witness), moved out and become engaged to Fiona to spite her mother and father. She asks you to ensure that her religion is noted in the medical paperwork. She tells you that if Josephine receives any blood products then she will be excommunicated by the family and they will never see her again. At this time you are called away by the coordinator as the consultant is here to review the patient. 

You try to excuse yourself from the patient’s parents and tell them that they are currently unable to see the patient. The mother ignores you and starts walking down the ward towards the patient’s room. 

CASE STUDY QUESTIONS: 

1. Identify two most relevant and significant Acts or Laws relevant to the case study that guide care of this patient. Ensure you focus on the current time frame and situation and that identified legislation is current and valid in Western Australia. 

2. Choose one of the Acts or Laws you have identified above and explain why and how it applies to Ms Josephine Mitchell’s current care and situation. Ensure the Act/Law itself is used to discuss and analyse its relevance and significance. 

3. a) Identify one ethical issue that you, as a student Registered Nurse, faces when caring for Ms Josephine Mitchell during the morning shift. Explain your viewpoint.

b) Outline and discuss one strategy that you may utilise to deal with this ethically challenging situation. You can choose either a type of communication strategy or a conflict resolution technique.

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