Responding to the Deteriorating Patient: A Case study

Assignment Task

Case study Scenario

Mrs P., a 38-yo Caucasian female, with no pre-existing health conditions, experienced some significant headaches, reported stiffness in her neck and fatigue, presented to an Emergency Department (ED) at a tertiary hospital in the Perth Metropolitan area on Wednesday the 2nd of August ’23 in the evening with worsening symptoms.

She was placed in the observation area and assessed by an ED nurse at 18:00 hours. Her initial observation parameters were Temp 37.8 C (oral), BP 140/90 mmHg, HR 92, RR 17/minute. Observations were repeated half-hourly by the nurse, with no further variable /unstable values observed; her vital signs remained stable. After 4 hours of waiting and no further changes of her symptoms, she was diagnosed with a migraine, although she reported that she never had experienced any migraine before and still being unwell, she was sent home, with some oral pain medication to treat the headaches.

Three days later, on the 5th of August, the symptoms worsened, she felt nauseated and started vomiting. After no further improvement, she then presented again to the same ED with the same symptoms including stiffness to her neck, but was now experiencing, slurred speech, a substantial headache and further deterioration. Observation parameters were as follows: Temp 37.9 C (oral), BP 150/90 mmHg, HR 99, RR 18/min.

The ED doctor decided to perform a lumbar puncture and a magnetic resonance imaging (MRI) to obtain a diagnosis, as it was suspected she may have had an intracerebral bleed. At 10 pm, after waiting 4 hours the MRI revealed there were no signs for a haemorrhagic stroke, and the nurses prepared her for discharge again. Then, as she was just about to leave the ED area with another dose of pain medication, the ED doctor received the lab results from the lumbar puncture, which revealed a high level of protein and a low level of glucose.

Instructions

In this assignment you should create an essay relating to the aforementioned case study.

You are required to analyse and critically review this case. Using your analytical skills, explore what you may have learnt from this case, and how this will change your practice moving forward. Support your ideas with references derived from the appropriate literature. In a conclusion, come up with a potential cause for the symptoms experienced by Mrs. P. and what may have been overlooked by the HCPs, although essential.

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