Critical Analysis of Patient Case Study

This assignment involves a critical analysis of a patient case study, focusing on the application of critical care nursing skills and evidence-based practice. The patient, Kirkman, is experiencing respiratory failure and urinary tract infection, requiring a comprehensive approach to management. The analysis highlights the importance of timely intervention, proper diagnosis, and treatment planning in preventing complications and promoting patient recovery. It also emphasizes the role of nurses in providing high-quality care through education, empowerment, and effective communication with patients and their families.

HEALTH VIRATION (NURSING)

TABLE OF CONTENTS
Analyse the pathogenesis in relation to the clinical manifestations of case study ......................1
Nursing strategy and explain the underpinning evidence base for this rational ........................2
Critically analyse the Arterial blood gas results and relate them to the underlying pathogenesis
......................................................................................................................................................3
REFERENCES................................................................................................................................4

Analyse the pathogenesis in relation to the clinical manifestations of case study
Overview of the case study: This case study is based on a 75 year old man named as Kirkman
who was admitted to the Emergency Department (ED). He was a widow and was admitted due
the diagnosis of Urinary Infection Tract (UTI). He was suffering from lower abdominal pain and
burning sensation while urinating in the right flank. The right flank includes urinary bladder,
right kidney, pancreas, gall bladder, colon and appendix and has direct impact on the patient's
medical recovery. After spending 24 hours, his conditions fell apart and led to deteriorating
levels by inserting an indwelling catheter. Moreover, this patient looked pale and unwell with
135 heart rate, 80/42 blood pressure, temperature of 39 and respiratory rate at 35. This clearly
showed his unstable medical conditions that led to admission in the hospital ward under
supervision.
Clinical Manifestation: This component is an indicative on the overall progression of a disease
with clear signs or symptoms (Finucane, 2017). With respect to the case, this manifestation shed
light on the patient, Kiekman's medical history which indicated towards the affected areas of
urethra due to burning sensation with urination and pain during discharge in the lower abdomen
part. It has also illustrated the heavy smoking habits since its teenage days and included about 2
packs a day. Along with, he was a social drinker and diagnosed with chronic bronchitis. Therein,
he was provided with Ventolin and Atrovent medications to open up the lungs airways for
treating breathing issues. There was no cardiac history, which might not be an assurance of not
having any issues related in the near future; although he was affected with the Urinary Tract
Infection earlier as well. In addition to this, this patient was given dose made up of equal amount
of IV NaCl and IV Sulfamethoxazole-trimethoprim, that is 10 mg on daily basis to minimise the
diagnostics of severe sepsis with UTI. This sepsis was refereed as severe due to prevalence of
hypotension. There is also a slight probability of organ dysfunctionality in the right kidney.
Pathogenesis: This part mainly deals with the primary survey conducted at ED to gain better
understanding of its symptoms and overall pathogenesis. It focused on patient's accessory muscle
use which was influenced heavily with high sinus rhythm of 135 bpm and low blood pressure of
80/42 mmHg. He had SpO2 at 82 % which elucidated additional supply of oxygen to attain the
saturation levels at normal pace and a clear indication of anxiety and stress. There was estimation
of 35 breaths per minute (bpm) showed that its abnormal breathing and resulted into the
hypoventilation. These clinical manifestations are directly relating to the patient's continuous
1

habit of smoking that has turned into a huge problem and is considered as the causative factor for
bladder problems. The constant respiratory related problems are increasing the patient's failing
organ functionality due to smoking and coming of UTI again.
Additionally, urosepsis acted as complication and impact adversely on the patient's body
by making the face flushed. Its urine was dark and came out in small amounts which constituted
around 40 mls. Since the patient was a senior citizen, the verbal abilities got restricted to few
single words and made the entire diagnosis more complicated. E4, V4, M5 is the abbreviation for
analyzing the Glasgow Coma Score where E is eye opening, V means verbal response and M
means motor response. Thus, Kirkman scored spontaneous eye opening, disoriented conversation
and localized pain in context to motor responses. His total score added to a total of 9 which
inferred that he was on a threshold and if not regulated properly, it might lead to any significant
medical problem. He has high levels of blood sugar. Nevertheless, Kirkman had a lower
abdominal pain 6/10 signified moderate pain and has significantly influenced the pain for
performing any daily chore or task.
The mentioned symptoms and signs defined the onset of critical conditions of Kirkman
and he must immediately stopped smoking to bring his respiratory levels, blood pressure with
SpO2 levels. There is a need to understand that proper self care practices should be incorporated
for speedy recovery and this UTI might lead to renal failure or heart related disorder, if not
treated effectually. It is important that nurses must give him assistance to control the diet and an
urge to smoke. If the conditions are not treated properly then there would be a problem of
recurring urinary tract infection and might have major danger implications in the near future.
Nursing strategy and explain the underpinning evidence base for this rational
Nurses are crucial in any recovery treatment especially for the elderly care since their
motor skills and others are not in proper functioning. Since Kirkman was placed on an
indwelling catheter, and use of medications like Ventolin and Atrovent led to a constant and
supportive palliative care by the nurses to remove any chances of unwarranted symptoms.
Herein, the nurses would have adopted qualitative improvement techniques through imparting
education and empowering them through teaching skills-set. The inconsistencies shown I the
patient's body reflected upon the casual behavioural and irresponsible attitude. The nurses would
2

have established cordial connect and led a path of mutual trust and cooperation to bring an
awareness at the service user's levels to overcome the challenges.
In regard to the above, Lewin's change of theory might be useful in underpinning the
evidences found in more proficient ways. The nurses must have brought a balance by promoting
the changes in positive order (Hayes, 2018). They must have made Kirkman to reduce smoking
cigarettes and gradually helped him through conducting consultation classes for gaining
knowledge on its overall development. This would automatically reduce his UTI led causative
agents and improve the levels of Bp, RR and more. Thus, the nurses must have implemented
daily assessment reports, continuous checks on fixed interval to push the patients like Kirkman
to follow the treatment plan with strict adherence. Henceforth, this evidence base must
incorporate bladder scanning protocol, discouraging the use of catheters and applying ProTouch
to address the methodologies with robust manner for providing appropriate clinical care.
Critically analyse the Arterial blood gas results and relate them to the underlying pathogenesis
Arterial blood gas (ABGs) is the determination of pH of the blood and the partial
pressures of carbon dioxide (CO2) and oxygen (O2) to assess the effectiveness for gaseous
exchange. This is the fundamental physiological knowledge for balancing the homoeostasis and
includes alveolar ventilation, oxygenation and acid base balance. It is a faster analysis which is
done by trained group of professionals, however, after blood sample collection, it must be done
quickly or else the sample might get degraded and should be kept on ice (Marik, 2015). From the
underlying pathogenesis of Kirkman, it has been shown that pH is 7.25 which is lower than the
normal range and additionally, the PaO2,PaCO2,HCO3 are also lower than the normal range. The
BE and Lactate levels were higher than the required range and he might be at risks to impeding
respiratory failure and has respiratory acidosis. This stated that he was a smoker with high levels
of stress and might be prone to any hypo ventilation. It affects the kidneys' response and might
lead to a failure affecting the entire abnormalities seen in the excretion or using the bicarbonate
ions found in the urethra. Additionally, it might affect the body reserves in overcoming the
complications and dis balance between the acid-base levels.
3

REFERENCES
Finucane, T. E. (2017). ‘Urinary tract infection’and the microbiome. The American journal of
medicine.130(3). e97-e98.
Hayes, J. (2018). The theory and practice of change management. Palgrave.
Marik, P. E. (2015). Evidence based critical care. In Evidence-Based Critical Care (pp. 3-6).
Springer, Cham.
4

5

6

7

8