Sarita Case Study - Lateral Chest Pain - Neurotransmitters - Cardiovascular Systems - Nursing Assessment Answer

Assessment Task:

Sarita Case Study Nursing Assessment Answer

Case study: Sarita

Sarita is a 22-year-old overseas student from India, who has been living in Australia for 18 months. She has been very fit, continuing to participate in many athletic events since childhood. Except for glandular fever as a teenager, Sarita has an unremarkable medical history. Over the past two weeks, she has experienced significant lethargy, anorexia, general aches and pains and non-specific bruising. She was admitted yesterday via her GP for further investigation of an abnormal blood count.
Sarita has been given the diagnosis of leukaemia and is awaiting further results and a management plan. Today she is anxious and has developed nose bleeds, a cough and a fever 38.2ºC. She is also suffering from an upper respiratory tract infection. Her mother has arrived from India to be with her.
Clinical assessment reveals:
 
HR 95 beats/minute
BP 100/60 mmHg
RR 18 breaths/minute
Temperature 38.2ºC
SpO2 92%
Blood pathology Suggested normal range
WBC 40 000 (4800–10 800 cells/μl [mm3] of blood)
Hb 8.5 g/dL
Platelets 120 (150 000–400 000 cells/μl [mm3] of blood)
Management includes:
 
IV Hartmann’s 82 mL/hour
3 units of packed cells
PANADEINE FORTE®
CXR
 

Part A 
Physical examination shows that Sarita has pain and tenderness consistent with an enlarged spleen. She also states that she is experiencing right lateral chest pain; exacerbated on inspiration. Panadeine forte has been prescribed.
•     Explain the types of pain Sarita is experiencing: outlining the pain pathways and the associated neurotransmitters.
•     Discuss the positive and negative consequences of her prescribed analgesic medication on her clinical status and the impact this medication may have on her existing comorbidities.

Part B 
As a result of her hospitalisation and symptoms, Sarita is experiencing physical and psychological stress or the “alarm stage” of the stress response.
•     Analyse the effects of the stress response on Sarita’s immune and cardiovascular systems in the ensuing resistance stage
•     Explain how prolonged stress response could lead to exhaustion phase and irreversible systemic dysfunction such overwhelming sepsis 

Part C 
Sarita’s diagnosis of leukaemia, the presence of infection as well her clinical findings shows that the disease is severe and potentially life-threatening. 
•     Discuss the immune aspects and cellular changes associated with leukaemia
•     Outline Sarita’s risk of bleeding and the potential sites (eg mucous membranes) that need to be assessed if her heart rate continues to rise
•     Explain how the prescribed intravascular fluids and pack cells will stabilise Sarita and prevent further deterioration in her condition.

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