Nursing Case Study Assignment Sample: Analysis Of Four Medical Conditions

Question

Go through the four medical cases given below and provide apt answers to the questions given in each medical case of this Nursing case study assignment.

Answer

Problem 1
Situation: Below is given the first situation in this nursing case study assignment sample.

Antasia Kyrillos, a geriatric who is 78 years old has come across with the Cerebro Vascular Accident to the left portion of the brain and was relocated to the rehabilitation department. Because of this accident to the left section of the brain, the patient underwent right-sided hemiparesis. The patient has recovered a little from the condition since the accident had happened before two weeks. For safe transportation, she is provided with a wheelie walker, which will help herself in moving from bed to chair and to walk for little distance. The interaction with the patient is a major challenge because she doesn’t have the knowledge of the English language and her condition of hemiparesis and aphasia doesn’t allow her to communicate non-verbally. According to the report given by her family, the patient is in the condition of understanding everything but don’t have the ability to express her thoughts. The patient was living along with her daughter till she had come across with CVA. Her family is hoping her to join them soon after her treatment.

The medical record of the patient demonstrates the history of hypertension which not given proper attention and eventually resulted in hemorrhagic stroke. The present state of Blood pressure of the patient is steady. The regular dose of anti-hypertensive medication is being provided to the student in order to keep BP under control. The patient is also suffering through the condition of osteoporosis which diagnosed before 10 years. In an accident, the patient had a fractured hip. The patient is also under the medication of hypoglycaemic because of Type 2 Diabetes. An incontinence pad is being provided to the patient since the patient is suffering through the condition of incontinence in passing urine. The bowel movement of the patient is in normal condition.

1. In which daily activities Anastasia need help? Give a detailed description of each task.
2. In order to communicate with the patient what should be the strategies adopted by the nurses?
3. Analyze the real and latent care needs which should be provided for Anastasia?
4. What risks are being posed to the condition of the patient because of the current condition of Anastasia?

Solution

1. The condition of Anastasia is very critical and she needs nursing aid in most of her daily activities. She needs aid to move from bed to chair and walk for small distance for her daily needs. For this purpose, Anastasia is provided with amnesties like wheelie walker. Anastasia also needs help in interpreting and translating her language into English. A help of interpreter is very important in the case of Anastasia who can help the patient to convey her problems to nurses which help in providing her with better care and medication (Code, 2012). The hospital officials should engage a multi-disciplinary team who can work cordially and effectively to make the condition of the better. The multi-disciplinary should consist of an interpreter, a social worker, physician, and a neuropsychologist.
2. The medical team can adopt different strategies for effective communication between Anastasia and them. Strategies like making clear communication in slow speed, using simple language avoiding jargons and medical terms, a better medium of communication, providing with basic instructions, and demonstration of more patience (Jirwe, Gerrish and Emami, 2010).
3. Anastasia is still in a convalescent stage and her condition should be monitored on a regular basis. Anastasia is suffering from type 2 diabetes and thus a proper and thorough analysis of her glucose level should be done. Proper medication should be given to the patient in order to keep the level of the glucose static in the body (Lammert, 2008). The patient has also a history of hypertension, so her blood pressure should be checked at a regular interval and proper report should be made. The test of BP is of significant nature in this case because she is suffering through the hemorrhagic stroke. She should be injected with antihypertensive medicines in order to keep the blood pressure under check. By proper observation done by these procedures, the nurses can mitigate the risk faced by the patient. Although the patient is provided with wheelie walker, the patient needs great supervision because her body is suffering through osteoporosis and have a fracture in her hip. Proper support and help should be given by the nurses to the patient in transportation. The body of the patient is not in a condition to bear another fall or fracture. Anastasia is going through incontinence in her urine flow so she has to use an incontinence pad. Improper use of pad may result in the infection of the urinary tract. So the special focus should be given on the patient’s hygiene.
4. Since Anastasia is suffering through various medical conditions, her body is susceptible to many health risks. Type 2 diabetes and hypertension had made the condition very dangerous and critical for the patient (LeMone and Burke, 2008). Any variation in glucose level or blood pressure of the student will be very dangerous for the patient. If the blood pressure will increase further, it may result in another hemorrhage stroke or CVA. The bones of the patients are very weak because of the osteoporosis and she is having the elevated risks of fractures and even in a worse case, vertebrae fractures. The present condition of bones may result in having a stooping position of her vertebrae i.e., the condition of kyphosis. In extreme condition of osteoporosis, the patient may lose the ability of motion. If the current condition of urinary hesitancy is not treated, it may affect the functioning of kidney, infection in the urinary tract, urethra, and urinary bladder. The patient currently had the attack of aphasia which should be treated otherwise she may lose the ability to speak permanently.

Problem 2: Below is given the second situation in this nursing case study assignment sample

Situation: James Moorland, a 22-year-old fellow has suffered an accident 3 weeks ago and bearing a compound fracture on his right femur. The patient was admitted in the orthopedic department soon after the accident and 2 surgical operations were conducted on his legs. The first operation was conducted for the internal fixation, i.e. using plates and screws and the second one to scrub the wound by the method of delayed closure.

After two weeks the closure and bandages of the patients were removed but now the wound has started to dissever and is oozing with foul-smelling pus from the stitched area. After conducting the tests on the sample of the pus, it was confirmed that there is a presence of pathogen which is methicillin-resistant Staphylococcus aureus. The patient was moved to isolation and the matter was informed to the infection control department. The patient is not going through other condition or comorbidities, and there is no previous record of surgery conducted. The body mass index of the patient is only 18 and he comes in the category of underweight. The history of the patient depicts the significant case of malnourishment, chain-smoking, and heavy intake of alcohol on a continuous basis. It is the third consecutive case from last month that a patient has developed this condition of MRSA.

1. . Find out what may be the reasons which caused the spread of MRSA in the ward of the hospital. Provide the preventive measures which should be taken by the management and health team to avoid this sort of condition from now on.
2. Evaluate the aspects which caused the patient to end up with the present nosocomial infection?
3. What preventive measures should be taken by the health team and the management to stop further cases of nosocomial infection?
4. In the case of nosocomial infection, describe what is the process for documenting and reporting, keeping workplace policies and procedures in mind?
5. Keeping in mind that the patient is malnourished and need dietary supplements, what strategies should be adopted by the nursing team to enhance the nutritional status of the patient?

Solution

1. There are various reasons which may result in the spread of MRSA in a health care institute. The infection can transfer from one patient to another patient by the means of the healthcare team. The members of the health care team and nurses have to deal with many patients in a short span of time and there is a great possibility of infection in this process. The staffs may show carelessness in changing their gloves while handling different patients and the pathogens from one patient can be transferred from patient to another by the infected gloves or the devices like a thermometer and intravenous tubing. There is a strong possibility of being contaminated with MRSA if the patient has a very low immunity (Nimmo and Coombs, 2008). The vicinity of a patient to an infected patient will also increase the chance of MRSA infection. The extending and persistent stay of the patient in a hospital will also increase the risk of infection. If there is an accumulation of waste and waste disposal is not done in a periodic and systematic way, it will lead to contamination among the patients. The waste materials like the used syringes, surgical blades, body fluids of patients, etc. will pose danger to the patients if they come into contact with them. Proper sanitation should be maintained by the staff of the hospital in order to avoid this condition. Several policies like using separate gloves for different patients and disposing of the needles and body fluids as soon as possible should be adopted by the staffs in order to reduce the risk of contamination.
2. In the orthopedic department, the patient has undergone two operations which were the internal closure of the multiple fractures using screws and sheets and the second was primary closure of the wound by stitching it. It is a high probability that James, the patient has been the victim of nosocomial infection (Bennett et al., 2005). It may have been occurred because of using unhygienic instruments in the operation of the patients.
3. The condition of spreading MRSA is a very dangerous thing to happen in a hospital and urgent strategic steps should be taken to avoid this scenario. Proper scrutiny and medical audit should be conducted among the patients, their environment, staffs, condition of instruments, etc. in order to reduce the risk of MSRA. The staffs should take the responsibility to maintain hygiene and the management should devise various ways to maintain proper hygiene and discipline in the hospital. The most probable way of the transmission of the MSRA infection is by the hands of staff, hence the staff should be given special awareness class regarding the sanitation of the hand. The nurses should take extreme caution while entering and leaving some critical care wards like intensive care units, isolation rooms.
4. While the case of infection and its control policy is being considered, the documentation and reporting requirement plays a very significant role. Here should be a proper documentation process followed in the hospital so that the proper record of used equipment and fresh equipment should be kept under the track. By the proper documentation, the risk of the infection from the unsterilized used equipment can be reduced. The documentation should not be limited only to this; every case of nosocomial infection should be recorded in the hospital records (Gosbell et al., 2006). Each MSRA infection should be reported to the infection control department and while reporting the case the recorded report will help the team accurately in a more accurate way because of the accurately recorded consists of all the pieces of evidence of medications, actions taken by the staff, guidelines by the families, etc. By referring to the documented records and medical chart the patient can be given the appropriate vaccine and medical assistance.
5. It has been observed that James has poor nutrition and is underweight. The medical history and comments of family members had made it clear that the patient is a chain smoker and used to take heavy intake of alcohol. This is a very critical stage and the nurses should make it sure that he is getting proper supplements and nutrition so that his nourishment and sustenance can keep at the desired level. Since the patent has shown reluctance in the intake of a balanced diet and nourishment a proper nutritionist should be allocated for him. The psychologist and nurses should make him aware of the evil after-effects of consuming nicotine and alcohol. Since the patient is suffering through a compound fracture, his diet should consist of calcium and phosphorous.

Problem 3: Below is given the third situation in this nursing case study assignment sample.

Situation: Gordon Freemason, 53 years old mid aged person, fell into a gutter from a ladder while working at home. The person has got his L4 and an L5 vertebra fractured and has sustained an occipital fracture in his skull. Apart from the fracture in the skull, the patient is suffering through epidural hematoma. In order to drain the bleeding occurred in the skull, he went for a surgery and the condition of occipital fracture was elevated surgically. He was kept under observation for 12 hours in the Intensive Care Unit after his surgery.

The patient is now strictly suggested for bed rest and is provided with log rolls for efficient management if the pressure areas. The Coma Scale of Gordon shows the reading of 14/15 and he is under very precise observation. The patient is suffering from great pain because of the fracture to his lumbar area. Because of this, he is injected with the dose of morphine by following the method of patient-controlled analgesia. Apart from this, the patient is provided the periodical dose of paracetamol every 6 hours. The patient has also developed a condition of fluid flowing through is the intravenous system. He is provided with preventive inhalers since he is having asthma attacks. The patient had an infection in his respiratory system way before the accident had happened and was taking antibiotics on a regular basis as medication for this condition. The body mass index of the patient is 32 which indicate that the patient’s body is obese. The patient has a further condition of depression and he is not taking medication for this condition. The patient has just tried to make the depression under control by attending counseling classes. According to the family record, the patient has shown the signs of suicidal mentality and negative thoughts in dejected conditions. The family of the patient consists of his wife and 3 children. He is under the observation of orthopedic and neurosurgical team.

1. Explain how the medical condition of the patient prior to the fall will be affected by the current medical condition and hospital care?
2. Evaluate what may be the probable risks that Gordon may face after the surgery?
3. There are no lift policies provided by the health care companies if the workplace health, security, and physical treatment are considered. Investigate what may be the ways which can be utilized by the medical team to provide back care and bed change to the patient?
4. It is the policies and the legislation of the administration which controls and governs the medical team. In this case, the supply of morphine and saline for the student is shrinking. The patient should be provided with a new supply of morphine and saline. Give instructions on what schedule should be adopted by the team to provide a divisive drug like morphine while keeping in mind the seven rights of drug administration?
5. In this case, there is a strong possibility that the patient needs a frame up until he regains his mobility or his motor function become normal. What should be the plans adopted in the discharge of Gordon if he is opting to go home?

Solution

1. From the medical history of Gordon, it was confirmed that the patient has a condition of asthma. Erstwhile the accident had happened the patient was suffering through infection in his respiratory system. Because of his condition of asthma are having preventive inhalers. It is most probable that this accident will affect the present condition of asthma. The misery of Gordon in respiration will further intensify since he is having great pain in his lumbar region. Another affecting factor in his respiration will be his obesity. Since the patient has gone through a severe accident he is suggested for strict bed rest thus he should be subjected to proper pressure area management. The increased weight of the patient will cause difficulty in conducting log rolls in as it may cause more damage to his spine. Gordon is a depression patient. He used to control it by attending the counseling sessions. But the present condition of the patient is not allowing him to attend the session which may result in severe depression and rise of negative thoughts.
2. . After the surgery, there is a great likelihood of brain herniation to Gordon. This brain herniation will lead to an increase in pressure inside the skull. This increased pressure in the intracranial region will result in the formation of the intracranial hemorrhage which will limit the supply of blood to the brain and destroy some delicate and elusive tissues. If the pressure area of Gordon is not given proper attention, he may end up with a pressure ulcer because of his obesity. Since the occipital fracture of the patient was removed using surgery, there is a great risk of infection in his surgical sutures (Lintzeris, 2006). The depressed condition of the patient can be mitigated by the use of background infusion.
3. In order to lift the patient from his bed, the medical team should subject him to log roll. The special care should be taken in maintaining the spine alignment as the patient is obese. To aid him in the process of sitting, the bed should be attached with bed stick on its side. An overhead bar should be utilized to lift him and reposition his posture.
4. Under the law, morphine is considered as contentious and schedule 2 medicines. According to medication administration, the seven rights in the section of drug administration are right medication, right route, right patient, right dose, right reason, right time and right documentation. In the right medication proper checking of labels and expiry date is checked, right route consists of the review whether the patient is provided with medication in an ordered and periodical way, right patient includes the verification of the patient’s name and his medical history, right dose includes the usage of dose in required quantity referring to good sources, right time consists of referring when the last dosage was given (Dubut de Laforest and FarreÌ€re, 2010).
5. If Gordon is planning to discharge from the hospital, he should be provided with the aid of a nurse at his home. In the house, Gordon will be using the frame to walk around and there is a great likelihood of him slipping or losing his balance which will result in further damage to his spine. The nurse should take care of him until he regains his mobility and motor functions. The service of a physiotherapist should also be provided to the patient, who will engage him in light aerobic exercises and help him in reducing his weight. He should also be provided with regular counseling in the house to cope with the condition of depression.

Problem:4: Below is given the fourth situation in this nursing case study assignment sample

Situation: Louise Young, a mid-aged woman of 30 years has gone through a laparoscopic surgery because of a ruptured appendix and have been returned to the ward. Later her readings were observed and the denominations were BP 140/75, respiration 28, pulse-112 and the temperature- 38.96°C. Louise has underground four incisions in the abdominal area which is being concealed with transparent occlusive bandages. The wounds are still intact and each of the surgical sutures is discharging fluid.

The Abdomen area of the patient is swelling and she is having the ache of 8/10 in the pain scale. The patient is having a line in the intravenous region inside the elbow i.e. the left cubital fossa. The patient is being provided with the saline fluids and maintenance dextrose at the rate of 125ml/hr. Louise is not taking any medication orally hence she is mounted with a nasogastric tube which is facilitating the free drainage. The patient was provided with the dose of intravenous fentanyl in the convalescent stage and an additional order of intravenous morphine is done for the patient.

After the befalling of half hours in the ward, the condition of the patient worsened and deteriorated. Her medical readings after the worsening of the situation are pulse 160, temperature 40.1 °C, BP100/55 and respiration 36. The abdominal area of the patient is now more bloated and stretched. The patient has lost her consciousness and regains the awareness only after she is shaken.

1. Explain what should have been the priorities for care when the patient was returned to the ward while considering the factors like her dressing, observations, analgesia, etc.
2. What should have been the actions and the interventions taken when the patient’s health deteriorated?
3. What is occurring to Louise?
4. Explain the precautions and other interventions to be done when the condition of Louis worsens.

Solution

1. When the patient was returned to the ward after surgery, her dressing, medical observation, and analgesia should have given more importance. After the half hour of the entry of patient the pulse, temperature and the respiration rate of the patient increased to an abnormal level. Making the situation worse her blood pressure fell to a dangerous level. Form the surgical sutures of the patient there was a discharge and the wound posed a great risk of infection. Additional care and attention should have been given to the surgical incision. Since the patient was going through extreme agony and severe pain the intake of intravenous analgesics should have been elevated through the saline intake. While conducting the surgery her blood pressure was comparatively very high but it reduced to a considerable level when she was admitted to the ward. The BP of the patient should have been monitored on a regular basis.
2. When the health of the patient faded she should have been mounted with an oxygen mask to aid her respiration. Her abnormal rate of heartbeat i.e. the tachycardia condition may have been because of her medical condition and should have been medicated with the injection of proper drugs. The accumulation of gas in the abdomen area should have resulted in the distending i.e. the situation of necrotizing fasciitis and resulted in the tight abdomen.
3. As mentioned above the patient shows the strong symptoms of Necrotising Fasciitis which occurred after the operation of the vermiform appendix by the process of laparoscopic appendectomy (Raghavendra, Mills and Carr, 2010). In this situation, the patient suffers great pain in his abdominal area with tightness and bloating. The condition of Necrotising Fasciitis can facilitate an increased pace of infection in the connective tissue of the fascial planes.
4. The team nurses should consult the doctor if the condition of the patient worsens further. The medical condition of the patient should be confirmed and it should be checked whether a change in medication is needed. Previously the patient had received the dose of fentanyl and the additional requirement of morphine was informed to the hospital. The current condition should be informed to the doctor by the team of nurses and it should be confirmed whether the patient should be given the dose of morphine in this condition. A regular observation should be undertaken in the case of Louis since she had lost her consciousness.

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References
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Code, C. (2012). Apportioning time for aphasia rehabilitation. Aphasiology, 26(5), pp.729-735.

Dubut de Laforest, J. and Farrère, C. (2010). Morphine. New York: Harper Perennial.

Gosbell, I., Barbagiannakos, T., Neville, S., Mercer, J., Vickery, A., OʼBrien, F., Coombs, G., Malkowski, M. and Pearson, J. (2006). Non-multiresistant methicillin-resistant Staphylococcus aureus bacteraemia in Sydney, Australia: emergence of EMRSA-15, Oceania, Queensland and Western Australian MRSA strains. Pathology, 38(3), pp.239-244.

Jirwe, M., Gerrish, K. and Emami, A. (2010). Student nurses’ experiences of communication in cross-cultural care encounters. Scandinavian Journal of Caring Sciences, 24(3), pp.436-444.

Lammert, E. (2008). The Vascular Trigger of Type II Diabetes Mellitus. Exp Clin Endocrinol Diabetes, 116(S 01), pp.S21-S25.

LeMone, P. and Burke, K. (2008). Medical-surgical nursing. Upper Saddle River, N.J.: Pearson/Prentice Hall

Smith, L. S. (2010). Write a nursing resignation letter without burning your bridges. Nursing2019, 40(6), 51-52.