Case Study

Case study

Assessment Task 1: Essay
27/04 50%

This assessment task enables you to deeply engage with the literature around the health status of an acutely ill patient. You must select a case for analysis who has experienced either shock, or acute respiratory or cardiac failure. We are looking for demonstration of a deep understanding of the applied pathophysiology that underpins the key problem experienced by the patient, and explanation of at least one management strategy provided.
Please note, that we are not looking for a great deal of detail about the patient. The information can be conveyed in one or two sentences (see the example). Institutional approval is not required as no patient details are to be included in the paper. If you wish to include test results, then you must present them in the form of your analysis, it is not sufficient to list them, as a list does not convey your interpretation and therefore does not add to the grading. For example, you could say:
The patient presented with hypotension with a mean arterial pressure of 48, hypoxic as evidenced by low oxygen saturations, acidotic as indicated by a pH value of 7.16 and carbon dioxide levels of 55.
In terms of case selection, if you believe that you cannot think of a suitable case for review, please contact your tutor to discuss your options. Cardiovascular students may not select heart failure as a topic. Intensive care students may not discuss positive pressure ventilation.
This assessment task enables you to deeply engage with the literature around the management of an acutely ill patient. You must select a patient for the case study who has experienced either shock, acute respiratory or cardiac dysfunction; if in doubt as to your case, it will be useful to discuss your choice with your tutor prior to commencing writing. Please review the Echo360 lecture for examples of suitable cases.
Write a brief summary of the patient’s current health problem, relevant history and any specific early management provided to address the primary problem prior to arriving in your ward/department if relevant. This should be sufficient to set the scene for the reader and the introduction should take up no more than one (1) to one and a half (1 1⁄2) pages.
At all times you must maintain patient confidentiality by assigning the person a pseudonym and not disclosing personal identifying information. Please note that no patient details are required, and it is your interpretation of the management of the patient’s physiological status that is examined. There is no need to include patient’s test results unless significant to the case.
Please do not include diagrams, pictures or tables in the essay, it is your role to interpret the information, not reproduce data. Ethics approval from health care institutions are not required as you are not providing any identifying information, nor patient specifics.
To facilitate demonstrating depth of knowledge related to acutely ill patients, critically analyse the related health problem (shock, or acute respiratory or cardiac dysfunction) using evidence-based findings, limit your paper to an explanation of the physiology underlying the problem and the management provided. The management should be restricted to the key elements used to address the problem and should be linked back to the altered physiology.
Include a conclusion to the paper that draws the key elements together. Use a minimum of 10 scholarly references to support your discussion themes ensuring that you correctly reference your work. You must clearly demonstrate the related pathophysiology in the body of your paper. References in the main should be no more than five years since publication.

Assessment Criteria Measures Intended Learning Outcome:

Criterion 1 Selects a patient with the required health related acuity and presents work that shows critical analysis of the selected topics 1,3
Criterion 2
Demonstrates the ability to describe relevant aspects of the case abiding by ethical requirements

Criterion 3 Comprehensively describes and relates the relevant pathophysiology to the patient’s clinical condition, assessment findings and the management of the problem
Criterion 4 Demonstrates critical engagement with the relevant evidence based research
1
Criterion 5 Writes clearly in an appropriate academic style and structure and backs up claims by referring to academic literature and references appropriately using modified Harvard style as required by the School of Nursing. Utilizes correct English conventions (spelling, grammar and punctuation)
Task length 2000 words
Due by date 27/04 before 0900hrs

Patient A was a 61 year old man with a past history of hypertension, Coronary artery disease, Peripheral vascular disease, stroke, Insulin dependent Type 2 Diabetic, end stage renal failure on haemodialysis 3 days a week
Patient present for dialysis with SOB, grey in colour, nauseas, dizzy and very weak in the legs and anxious, no chest pain.
Vital signs Attended Resp 24, O2 Sat 94%, T36, P30 bpm regular rhythm, BP108/60, chest listened to creps on expiration.
ECG and U&E and FBC taken, blood gas taken, O2 6LPM Hudson mask, patent sat up right position.
Results of ECG showed bradycardia and 1st degree heart block, peaked T waves, prolonged PR interval, widened QRS and amplified R wave. Potassium came back as 8.0mE/L, all other blood results were normal. Pads applied incase of deteriation. Blood gasses pH 7.38, PCO2 29(32-48), PO2 155(83-108), HCO3 17.3(22-32) TCO2 18 (24-29).
Treatment – Involves stabilising the myocardium to prevent further arrhythmias, and to shift K back into extracellular space and remove excess K from body.
Mr A was given Calcium Gluconate 10% 10ml over 3-10minutes– this stabilises the myocardium and
Insulin and Glucose – IV fast acting insulin actrapid 10 units and glucose 50% in 50ml – over 5min, insulin moves K into cells and glucose prevents hypoglycaemia.
After 1hr patient feeling better P 60bpm, BP 135/80, R 16, O2 sat 98% and K6.5, patient was stable enough to have haemodialysis to further eliminate K and return it to normal levels.
Explain pathophysiology of how high K affects heart – cardiac action potential and cardiac conduction system. Then how it affects cardiac output.
Also pathophysiology of the compensatory mechanisms such as SOB due hypoxia and an increase O2 demand to heart due to decreased cardiac output, weak legs from decreased Cardiac output and decreased BP and therefore less blood flow and perfusion to skeletal muscles causing weakness etc

Harvard Referencing

At least 10-15 references no older than 8yrs 2012-2020