Clinical Incident of Patient A: Lessons for Professional Practice

This case study discusses the clinical incident of Patient A, who died due to lack of adequate care. It analyzes the activities that the nurse or midwife needed to complete in the immediate situation and the professional behaviors that could have made a difference. The case study also highlights the importance of vital sign assessment, initial care, effective communication, and documentation in nursing practice. It also emphasizes the consequences of lack of care and not fulfilling duty in healthcare settings by health professionals. The subject is Being a Professional Nurse or Midwife and the course code is 401021.

401021 Being a Professional Nurse or Midwife – Assessment 2
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Q1. What happened in this clinical incident?
The clinical incident is about patient A, an 81 years old woman who has died due to
septicaemia. She has visited a GP when suffering from breathlessness. She was recommended
to have oral Lasix and further clinical review after 2 days. Meanwhile the patient has visited a
local hospital as her health condition did not improved. During hospitalization VMO has
reviewed the condition of the patient. The vital assessment has shown increase in the heart
rate, respiratory rate, atrial fibrillation and tachycardiac measure. She has refused to take food
and liquid and reported about her abdominal pain and weakness. After observing the patent
the VMO has concluded that the patient was suffering from depression and anxiety. Further
assessment was done as the patient has refused to take dinner. The patient has administered
medication recommended by the VMO. The patient condition became more critical and pale
clammy skin, nausea, immobilization due to pain, increase in WBC and infection in urinary
tract have been reported. Next day registered nurse has attended the patient and identify
dizziness, abdominal pain, low blood pressure and high respiratory and heart rate.
Furthermore continual diarrhoea has been reported. However, the registered nurse did not
documented such condition. The registered nurse has called Clinical Nurse Manager but did
not discuss about the sever condition of patient A. ISBAR was performed and deteriorating
health condition have been marked. In such emergency, doctor has attended the patient and
use IV cannula to treat dehydration. However, due to lack of interventions regarding initial
care the patient has died.

Q2. What activities did the nurse or midwife need to complete in the immediate situation?
As the patient was admitted due to severe breathlessness it was important to assess the
vital signs properly to identify the problems of the patient. In this situation the nurse should
have been assess the vital signs such as blood pressure, respiratory rate, heart rate and body
temperature. The nurse should have been ask the patient about past history of health and abut
her current medication (nursingmidwiferyboard.gov.au, 2018). It could help the nurse to
identify if the increase in the breathlessness is due to the side effect of any drug such as Lasix
(Mickelson, Willis & Holden, 2015). As the patient was reported high respiratory rate and
shortness of breath it was important to assess the air way and provide adequate oxygen
therapy to the patient to relief the patient. In this regards the nurse should have tell the patient
regarding the importance of oxygen therapy as it could help the nurse to make patient
comfortable with the treatment and reduce depression and anxiety (You et al., 2013).
Adequate medication should have been provided to the patient. However, digoxin and valium
have been recommended to reduce the breathlessness and anxiety. In addition the nurse
should have tell the patient to use relaxation technique to reduce rapid heart and respiratory
rate and could help to manage pain and help the patient to improve mobilisation (Karlen et
al., 2013). As the health condition of the patient was deteriorated it was important to provide
proper diagnosis such as chest x-ray, MRI, ECG and blood test. It could help the health
professional to identify the underpinning health issues such as any infection in lungs or
bloodstream (You et al., 2013).
Nursing care means not only provide treatment but also encourage the patient to
involve in the treatment in an effective manner. In this case the patient has refused to take
food and fluids. Such condition has affected her health thus her blood pressure became low

and she was suffering from weakness and nausea as well. In this situation the nurse should
have provide mental support and tell her about the importance of healthy diet to recover
faster (You et al., 2013). It could help the nurse to convince the patient to take food and
fluids. Furthermore, the nurse should have incorporate IV fluids to provide adequate nutrition
to the patient. It could help to reduce the risk of diarrhoea and dehydration as well. In order to
reduce the pain the nurse should have provide medication. Increase in the WBC sometimes
related with infection. As pathogen increases in the body the number of WBC also increases
to protect the body from the pathogens (Erba et al., 2013). In this case the nurses should have
taken proper infection control interventions and medications. Such immediate actions taken
by the nurse could have reduce the risk of septicaemia and save the life of the patient.
Q3. What professional behaviours may have made a difference in this situation?
Enormous mistakes in the behaviour of the registered nurse have been found in case
of patient A. The registered nurse did not documented the health condition of the patient
which was a major mistake and ignorance of responsibility of a registered nurse. Such
activity could lead to miscommunication regarding the health information of the patient. On
the other hand the registered nurse has called the clinical nurse manager for the medication of
other patients but did not discuss about the severe health condition of patient A, which was
another irresponsible action. Furthermore, the registered has failed to establish effective
relationship with the patient thus has failed to convince the patient to have food. Such poor

quality of service has contributed to the severe health condition and death of the patient. The
nurse should know how to take care of a critical patient and should comply with the standard
of NMBA to provide quality service and ensure patient safety
(nursingmidwiferyboard.gov.au, 2018).
In this case at first the registered nurse should have assessed the patient properly and
document each minor to severe details about the health condition of the patient. The NMBA
standard of practice has mentioned in the standard 4 that it is important to introduce holistic
assessment to identify the severity of the patient (nursingmidwiferyboard.gov.au, 2018).
Documentation of health condition is another important duty that the registered nurse should
have maintain properly. The standard 5 of NMBA has indicated the importance of prepare
proper care plan (nursingmidwiferyboard.gov.au, 2018). Documentation is a vital part of
nursing care plan as it helps to identify the area of priority and helps to introduce proper
treatment. The standard 2 of NMBA recommended to establish effective therapeutic and
professional relationship (nursingmidwiferyboard.gov.au, 2018). The registered nurse should
have discuss with the clinical nurse manager about the severe health condition of the patient.
In this case the clinical nurse manager could have provide effective medicines that could help
to relief the pain, diarrhoea or dehydration. Such collaboration would help to improve the
quality of care and patient safety (safetyandquality.gov.au, 2018). Furthermore, the nurse
should have inform the patient about the treatment process and its effectiveness. It could help
the nurse to involve the patient in treatment and convince her to eat food (Faden et al., 2014).
Such behaviour could help the nurse to improve the service and save the life of the patient.

401021 Being a Professional Nurse or Midwife – Assessment 2
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Q4. What do you learn from this case study about your own preparedness for professional
practice?
The clinical situation was about Patient A, who has died due to lack of adequate care.
I have identified the consequence of lack of care and not fulfilling duty in the health care
settings by health professionals. I feel that there is lack of awareness regarding the
importance of patient safety. The nurses learned about the standard of practice but they fail to
apply such standards in the nursing practice. Thus fail to achieve expected outcomes. I have
learned about the importance of vital sign assessment and initial care from the case. The case
has helped me to identify the importance of establishing effective relationship with the
patients and other health workers. I have learned about the management of a patient
breathlessness and primary care that need to do in such critical cases. It has helped me to
understand how documentation could help to introduce effective care plan. I have identified
that the culture of safety and communicate effectively with patient and other health
professional is interlinked with each other. I have realised how the irresponsible activity of
one person leads to harmful outcomes and death as well. After learning from this experience I
would like to utilise all the guidelines provided by NMBA in my clinical practice.
Maintaining such guidelines could help me to improve my skill, provide quality service and
ensure patient safety.

Reference List
Erba, P. A., Sollini, M., Conti, U., Bandera, F., Tascini, C., De Tommasi, S. M., ... & Lazzeri,
E. (2013). Radiolabeled WBC scintigraphy in the diagnostic workup of patients with
suspected device-related infections. JACC: Cardiovascular Imaging, 6(10), 1075-
1086.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative
effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Karlen, W., Raman, S., Ansermino, J. M., & Dumont, G. A. (2013). Multiparameter
respiratory rate estimation from the photoplethysmogram. IEEE Transactions on
Biomedical Engineering, 60(7), 1946-1953.
Mickelson, R. S., Willis, M., & Holden, R. J. (2015). Medication-related cognitive artifacts
used by older adults with heart failure. Health policy and technology, 4(4), 387-398.
nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia -
Registered nurse standards for practice. Retrieved from
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards/registered-nurse-standards-for-practice.aspx
safetyandquality.gov.au (2018). NSQHS Standards (second edition) | Safety and Quality.
Retrieved from https://www.safetyandquality.gov.au/our-work/assessment-to-the-
nsqhs-standards/nsqhs-standards-second-edition/
You, L. M., Aiken, L. H., Sloane, D. M., Liu, K., He, G. P., Hu, Y., ... & Shang, S. M.
(2013). Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys
of nurses and patients in hospitals in China and Europe. International journal of
nursing studies, 50(2), 154-161.