Clinical Integration Specialty Practice - NRSG370 | Case Study


Added on  2020-03-07

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Disease and DisordersNutrition and WellnessHealthcare and Research
Running Head: CLINICAL INTEGRATION SPECIALTY PRACTICEClinical integration specialty practiceName of the StudentName of the UniversityAuthor Note
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1CLINICAL INTEGRATION SPECIALTY PRACTICEIntroductionThe paper deals with case study of the Ms Melody King suffering from peritonitisfollowing the ruptured appendix. As a nurse, I have been assigned to Ms Melody forpostoperative care. The nursing goal is to utiliseLevett-Jone’s Clinical Reasoning Cycle, toexamine, establish relevant nursing goals for the case study, plan and evaluate patient centredcare. The Clinical Reasoning Cycle developed by Levett Jone is the cycle of linked and ongoingclinical situations. This cycle acts as a decision-making framework to consider the patient’scondition, prioritise the key nursing issues and establish goals. It is difficult to improve thepatient’s health condition without effective clinical reasoning skills (Dalton, Gee & Levett-Jones, 2015). Patient’s situation, and process of related health informationData collection The case history of Ms Melody informs that she is 36 year old and was presented to theemergency department for Left Lower Quadrant abdominal pain. The pain was severe and waspersistent for 2-3 days. The case reports of immediate laparoscopic surgery requirement forremoving the ruptured appendix. As per the admission history, the patient has history of asthmaand depression. Her current prescribed and complaint medications include seretide, ventolin, andsertraline. Her clinical handover shows presents blood pressure to be 95/45mmHg, HR 120,Temperature 38.3°Celcius, respiratory rate 22/minute and shallow and SpO2 95% on room air.The case reports informs that currently the patient is facing increased nausea. Her centralisedabdominal pain assessment score showed 8 on 10. Physical assessment data showed a distended
Clinical Integration Specialty Practice - NRSG370 | Case Study_2

2CLINICAL INTEGRATION SPECIALTY PRACTICEabdomen and generalised abdominal guarding. Further pathology tests were conducted toinvestigate her condition and a raised white blood cell count and CRP was observed. The patientis diagnosed with peritonitis following ruptured appendix Ms. Melody has been shifted tosurgical ward post operation. Process of information According to Brambillasca et al. (2017) peritonitis is the inflammation of the peritoneumsurrounding abdominal organs. It is known as grave complication of the surgical intervention,appendectomy (surgical removal of ruptured appendix). It is due to the tactical or technical errorsrarely made during the operation. In majority of the cases, the condition occurs due toperforation of the appendix. Spread of infection from the digestive organs is the principlecondition causing Peritinotis. When the bacterial invasion from the appendicitis into peritoneumoccurs, it results in inflammation. White blood cells and CRPs are blood inflammatory makers and when applied to lowerquadrant abdominal pain is indicative of infections or inflammatory disease process. CRP is theC-reactive protein secreted by liver when the bacterial infections occur. This is the underlyingreason for increased White blood cells and CRP level in the patient (Preto-Zamperlini et al.,2014). Fever, nausea, abdominal distension, tenderness and continued abdominal pain are thecommon signs and symptoms of this condition, also observed in the patient (fever- 38.3°Celciusand pain score of 8 on 10). Further patient’s infective breathing pattern is evident from her lowblood pressure, rapid heart beating and shallow breathing (Chaudhary et al., 2015).Ms Melody has increased risk of depression due to history of asthma and presentexacerbation of abdominal pain. If the pain is not treated she might have poor physical and
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3CLINICAL INTEGRATION SPECIALTY PRACTICEmental health. Depression and anxiety due to pain is common during peritonitis and situationalcrisis. It may decrease the functional and emotional status of the patient. Depression may also beadded by the financial constraints and the expensive treatment (Lutz et al., 2015). Nursing problems/issues based on the health assessment dataIssues identified based on the health assessment data are-Increase in pain levelAnxiety and depression due to untreated pain Exacerbation of peritonitis and complications due to reduced GI functionsRisk of infection and risk of shock due to septicaemia or hypovolemiaElevated pain levels are the prime concern in this case. This first priority area needs to beaddressed immediately. Patients with peritonitis have reduced GI functions and hence it must berestored. Hence GI function restoration is the second priority area. If the infection is untreated, itmay further exacerbate the complications. Additional complications may include reboundtenderness with guarding in abdomen, bowel sounds may decrease, rigid and distended abdomen.In addition, next to shallow breathing, the breath sounds may decrease and diminished secondaryto shallow breathing. If the fever persist the pulse may be bounding. The patient also has the riskof deficient fluid volume that may be caused due to shifting of fluids to intestinal lumen. It maylead to fluid depletion in the vascular space. Thus, it is the third priority area that needsintervention. The patient may also be at the risk for shock related to septicaemia or hypovolemia(Sachs et al., 2017). Thus, intensive care is to be delivered to the patient to reduce infection. It isthe fourth priority area.
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