Case study: Mr Jones deterioration
Give a short answer essay, based on a clinical case study about a deteriorating patient.
• The task revolves around your thinking and reflecting on various nursing topics related to critical care nursing, and you will be expected to draw together information from several of the unit topics to complete it.
• You will be asked to demonstrate your competence in analysing clinical problems, clinical diagnostic reasoning, teamwork, and documentation skills.
• You will receive more practice in preparing for all your assignment tasks during the intensive school.
Task requirements
First you need to read the case study carefully and analyse the information that is provided about a patient (Mr Jones) who has undergone surgery to repair his fractured femur.
1. Read the case information below:
Case study information
Stage 1: Mr Jones, a 66 year old male, was scheduled for theatre at 8am for an internal fixation of his femur. Prior to surgery a peri-operative assessment was carried out by the anaesthetist and surgeon to ensure he was fit enough to undergo surgery. Mr Jones was prepared for operating theatre and a pre-operative checklist was completed. Mr Jones was transferred to the operating theatre where he underwent surgery without complications and was transferred to the recovery unit prior to returning to the High Dependency unit (HDU) Mr Jones’s observations in the recovery unit were as follows:
BP: 130/80
Pulse: 80
Resps: 20
Temp: 37
Sp02 (Oxygen saturation) : 95%
Stage 2: He returns to High Dependency receiving 6 litres of oxygen via simple face mask. He has a subclavian triple lumen central venous catheter with an infusion of normal saline at 50 mL/hour and Patient Controlled Analgesia (PCA) morphine infusion at 3mg/hour with 1mg bolus dose. He has an indwelling urinary catheter and a transparent dressing to his operative site with a wound drain.When he arrives in the HDU you complete a set of observations and note the following:
BP: 100/60
Pulse: 110
Resps: 24
Temp: 37.2
Sp02 (Oxygen saturation) : 93%
Stage 3: You continue to assess Mr Jones and note there are 20 mL of urine in the catheter drainage bag, 100 mL of blood in the wound drain and his capillary return is less than 3 secs. You decide to do another set of observations and note the following:
BP: 80/50
Pulse: 120
Resps: 26
Temp: 37.2
Sp02 (Oxygen saturation) : 90%
Stage 4: You note that Mr Jones’s condition has deteriorated over the 30 minutes upon return to the HDU and you call for an Emergency reponse and review (MET). The Medical Emergency team arrive and request that Mr Jones receives 500mL of Normal saline stat. and inform you that he is in Hypovoleamic shock! Mr Jones has the bolus of Normal saline and his obervations are as follows:
BP: 110/60
Pulse: 100
Resps: 22
Temp: 37.2
Sp02 (Oxygen saturation) : 96%
2. After reading the information above please answer the following questions related to the case study scenario using a critical discussion framework.
• Define hypovoleamic shock and critically discuss the pathophysiology of hypovolaemic shock including the aetiology, pathogenesis, signs and symptoms and related compenstory mechanisms. Relate this to the case study presented.
• Outline your systematic assessment of Mr Jones upon his return to HDU (Stage 4 of this case study)
• Make sure you include primary and secondary survey
• Using the ISBAR framework outline how you would handover to the Emergency Response Team (Stage 4 of this case study).
• Discuss the evidence-based nursing actions in relation to the following:
• low urine output
• decreased oxygenation
• increased wound drainage.
Assignment instructions
• Provide an introduction and a conclusion for your assignment.
• You may use subheadings for each section, if you wish.
• Your MUST provide accurate references throughout your assignment, using the APA style.
• Include a reference list. You are expected to demonstrate evidence of the literature that informed your scope of inquiry, and your diagnostic clinical reasoning. Use not less than 8 references which are not later than 2008.
