Case Study Analysis Assignment 2022

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author Note

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CASE STUDY ANALYSIS
Criteria 1
Patient A is an 81 year old woman and diagnosed with shortness breath at the GP
clinic with the complaint of breathing issues when lying flat. After examination it has been
found that the patient have crepes in both the lungs along with the elevated venous pressure
in the neck. Primarily her renal function and vital signs excluding the respiratory condition
was normal and thus the GP recommended oral administration of Lasix. However, the patient
was again admitted to the hospital as her condition had not been improved by the
implementation of the medicine. As time proceeds the patient showed no improvement and
the visiting medical officer (VMO) planned an X-ray and blood test. The VMO found that the
patient is having diarrhea and tenderness in the right abdomen. Hence, the VMO organized a
ventilation/perfusion (V/Q) after which the patient found to be in dizzy condition and also
having an atrial fibrillation. At this moment the VMO stated that the V/Q scan was inter-
determinate. On the other hand the patient at this point was refusing food or liquid intake and
complaining that she is feeling week and having abdominal pain. Next day the VMO stated
that the patient is depressed and anxious and needs mobilization. After which the patient’s
discharge planning was done however, the nursing note stated that the patient was feeling
unwell, having a 28-30 respiration rate whereas other vital signs were normal. With time it
has been seen that the patient was deteriorating with times and she was getting immobile with
time and also having back pain. The patient was not diagnosed by her responsible doctor as
the doctor gone away and was not contactable. With time her respiratory rate reached to 40
and she found to have a tachycardia and her skin was pale and feeling woozy. Hence, the RN
engaged for the investigation for the case. The RN organized a locum who can be able to
attend the patient. Her dizziness increased along with the abdominal pain (8/10). Her blood
pressure was getting low up to 89/53 and the respiratory rate was 40 to 44. The patient was
reviewed by the locum, RN and the RN provided an En for the patient. This observation

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CASE STUDY ANALYSIS
found that the patient have increasing diarrhea and the vital signs were not normal as well.
After this condition the clinical nursing manager came and advised to take medication from
the drug safe of another patient. The RN conducted an ISBAR in next observation however,
the condition of the patient has been deteriorating and it should be observed and reviewed as
soon as possible (Kitney et al., 2016). After this the on call doctor came and reviewed the
patient and inserted a large bore IV cannula to treat the dehydration of the patient. At night a
transport facility has been organized to transfer the patient to a rural referral hospital. Next
morning the patient tragically died due to septicemia when the evaluation of the patient done
by the air evacuation team.
Criteria 2
In this case there has been seen many ethical breaches which can be highlighted as the
cause of the tragic outcome. Firstly the improper observation process and the absence of the
doctor leads to the deterioration of the patient in a severe condition. There has been no
indication of the oxygen supplementation or medication providence to the patient for
addressing the breathlessness or dehydration of the patient (Sanford et al., 2015). On the
other hand the abdominal or back pain of the patient was not properly evaluated by the VMO
as well. When the RN was involved for the investigation it was already very late for the
patient (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). Secondly it has been seen that the
clinical nursing manager provided medication to the patient without the doctor’s prescription
and the medication was taken from another patient’s drug safe. Thus it can be stated that the
patient’s medication management process has been breached and the nursing care has not
followed the NMBA standards which includes the patient centered care, common good for
the patient and the nursing ethics of the beneficence, non-malificence have also been
breached in this case (Nursingmidwiferyboard.gov.au, 2019). Hence, it can be stated that the
process of the care was not adequate and also the patient was attended by the doctor and also

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CASE STUDY ANALYSIS
the VMO showed negligence when attending the student. On this context it can also be stated
that the factor of the elderly care regulations has not been followed in this case scenario.
Hence, on this context it can be seen that the factor of the care here comprised with
negligence, ethical and nursing care breaches. Thus in this context it can be stated that the
process of the transportation and also the observation of the patient went wrong which lead to
the death of the patient. However, the primary concern of the patient was shortness of breath
and diarrhea which was not addressed properly. However, the RN has ran the ISBAR
procedure the condition of the patient never progressed to a positive direction. Hence, it can
be stated that the process of the care has not been properly addressed in accordance with the
patient’s concern. Other than all these the breach of the legislation can be seen such as Aged
Care Act 1997 and Aged Care Act 2013 (Australian Government Department of Health,
2019).
Criteria 3
Based on the above case it can be stated that the factor of the attention to the patient
was inadequate and also the process of the patient care was inadequate. On this context it can
also be stated that the process lacks the patient centered approach, nursing ethics and the
common good maintenance of the patient’s health condition (Bähler et al., 2015). On this
context it can be stated that the context of the improvement should be focusing on the
implementation of the NMBA standards and thus training of the nurses about the
maintenance of the nursing standards such as the patient centered care approach
implementation (Nursingmidwiferyboard.gov.au, 2019). On the other hand the proper
diagnosis of the patient and working on the basis of the proper factors of the care procedure
of the patient (Mathuray, 2017). Thus it can be stated that the implementation of the patient
centered approach and the evidence based nursing practice would be required for better
outcome of the patient (Kangasniemi, Pakkanen & Korhonen, 2015). Hence, it can be stated

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CASE STUDY ANALYSIS
that the factor of the improvement can be achieved by the proper consideration of Aged Care
Act 1997 and Aged Care Act 2013 (Australian Government Department of Health, 2019). On
this context it has also been seen that the factor of the care process can be improved if all
these aspects can be maintained by the nurses and the doctors as well. On the other hand the
proper attention to the patient would be required by the VMO or other doctors. The context of
the negligence should be eliminated as well for the improved care providence and better
outcome for the patient as well. Other than this factor of the elimination of the discrimination
based on the age of the patient in the health care providence procedure should be also be
consider for the future practice development of the nurses (Kajonius & Kazemi, 2016). Other
than all these the implementation of ISBAR should be improved during the handover process
so that the patient outcome can be improved as well and the negative outcomes such as death
of the patient or other co-morbidities would be eliminated (Kitney et al., 2016).

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CASE STUDY ANALYSIS
References
Australian Government Department of Health. (2019). Legislation we administer. Retrieved
20 August 2019, from https://www.health.gov.au/about-us/what-we-do/legislation-
we-administer
Bähler, C., Huber, C. A., Brüngger, B., & Reich, O. (2015). Multimorbidity, health care
utilization and costs in an elderly community-dwelling population: a claims data
based observational study. BMC health services research, 15(1), 23.
Dehghani, A., Mosalanejad, L., & Dehghan-Nayeri, N. (2015). Factors affecting professional
ethics in nursing practice in Iran: a qualitative study. BMC medical ethics, 16(1), 61.
Kajonius, P. J., & Kazemi, A. (2016). Structure and process quality as predictors of
satisfaction with elderly care. Health & social care in the community, 24(6), 699-707.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Kitney, P., Tam, R., Bennett, P., Buttigieg, D., Bramley, D., & Wang, W. (2016). Handover
between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR
principles: A quality improvement study. ACORN: The Journal of Perioperative
Nursing in Australia, 29(1), 30.
Mathuray, M. (2017). A critical evaluation of nurse’s legal knowledge and its impact in
preventing nursing malpractice in South Africa (Doctoral dissertation).
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved 20 August 2019, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards.aspx

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CASE STUDY ANALYSIS
Sanford, A. M., Orrell, M., Tolson, D., Abbatecola, A. M., Arai, H., Bauer, J. M., ... &
Hajjar, R. (2015). An international definition for “nursing home”. Journal of the
American Medical Directors Association, 16(3), 181-184.