NURS6019 Case Study Analysis: Mr. John Walker's Nursing Interventions

This case study examines Mr. John Walker, a 64-year-old patient admitted to a high dependency ward three days after a Hartmann’s procedure. The analysis identifies potential risks including post-operative fever, urinary tract infection, acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS). The patient presents with low SpO2, high respiratory and pulse rates, fever, oliguria, and decreased air entry. The discussion highlights the importance of addressing low oxygen saturation through oxygen therapy, ensuring proper urination with diuretics or dialysis, and managing the underlying AKI. The nursing interventions prioritize restoring blood oxygen levels, ensuring proper urine output, and preventing infection, emphasizing evidence-based practices to mitigate risks of lung damage, cardiac arrest, and brain stroke. The case study underscores the necessity of continuous monitoring and prompt intervention to improve patient outcomes and prevent mortality.

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

1CASE STUDY ANALYSIS
Introduction:
The paper aims for discussing the case study involving Mr. John walker. The patient
is 64 years old and he went through a colectomy surgery three days ago, which was
performed by using Hartmann’s procedure. Colectomy is a surgical procedure that involves a
complete or a partial removal of the colon of an individual. There are many risk factors for
the health of the patient associated with this surgery. Mr. Walker is currently admitted in the
high dependency ward of the hospital. Three days ago, when he was admitted in the ward, he
was found to have a low Spo2 level (89%), a higher respiratory rate (28 breaths per minute)
and a higher pulse rate (110 beats per minute). He also had a body temperature of 38.20 C,
which suggests that he has fever. The patient is using an indwelling catheter. He is
experiencing an oliguria condition or a lower urine output than normal. There is a central
venous catheter attached to his subclavian vein. There is also a cardiac monitor attached to
his body, which is monitoring his cardiac output on a continuous basis. The paper will focus
on discussing the potential risks, which might be associated with the present condition of Mr.
John Walker at first. After that the appropriate nursing interventions for improving the health
conditions of Mr. Walker and to prevent the other potential risks will be discussed in brief.
Discussion:
Potential Risk Identification:
The above case scenario presents many clinical manifestations in Mr. Walker. He had
a colectomy surgery three days ago. After his transfer to the high dependency ward it was
found that he has high body temperature of 38. 20 C. Thus the first complication for Mr.
Walker that can be identified is the postoperative fever condition. There are many causal
factors that can be considered to be responsible for the postoperative fever condition in the
patient. One of those causal factors might be urinary tract infection or injury at the surgical

2CASE STUDY ANALYSIS
site (Abdelmaseeh & Oliver, 2019). There are mainly two facts for considering these two
possibilities. Firstly, the patient is using an indwelling catheter. There are studies that found
that the urinary tract infection is common in the patients, who use indwelling catheters in a
hospital setting (Letica-Kriegel et al., 2019). Secondly, any surgical procedure is associated
with a risk of surgical site injury, which might proceed to become an infected wound and
finally septicaemia (Tevis & Kennedy, 2016). However, the first possibility of urinary tract
infection can be cancelled for Mr. Walker. The reason behind that is that he was not
experiencing any burning sensation in the genital area, which is one of the principle
manifestation of urinary tract infection (Beahm et al., 2017). Thus the possibility of injury to
the surgical site must be considered seriously.
The patient is experiencing a decreased urine output, which can be resulting from the
inability of his kidney to manage the appropriate fluid balance in the body. The reason for the
occurrence of that phenomenon might be resulting from an injury to the kidney of Mr.
Walker (Klein, Lehner, Forni & Joannidis, 2018). An injury to kidney is associated with
various risk conditions in the patient. Kidney is an important organ of human body that is
focused on maintaining proper fluid balance in the body. It is an organ that filters all the
waste materials of the body from the blood and excretes those waste products via urine. An
injury to kidney results in the waste build up in the body. The cells of the body continues to
excrete their metabolic wastes to the blood but there is no filtering action of the kidney to
purify the blood. As a result there will be toxic reactions in the blood and also the blood
pressure will be high due to osmotic imbalance (Fuhrman et al., 2018). The oxygen carrying
capacity of blood will also decrease if proper action is not taken. The disease condition
progression is thus associated with low SpO2 level in blood and increased respiratory rate.
Mr. Walker is already displaying the symptoms of oliguria and a low SpO2 level in his blood.
Thus there is a high possibility that he has encountered an acute kidney injury (AKI)

3CASE STUDY ANALYSIS
condition (Balci, Haftaci & Kunt, 2018). If the situation is not addressed immediately there
might be various risks to his health. The acute kidney injury will result in severe fluid
imbalance in his body, which eventually lead to complete renal failure (Fuhrman et al., 2018).
Additionally his blood pressure will be excessively high and he will develop hypertension
condition. The decreased oxygen carrying capacity of blood and the hypertension condition
together will build up a strenuous condition for the other three most important organs in the
body. The lungs will be working harder to supply necessary oxygen to the body and the heart
will also face difficulties with pumping the blood properly throughout the whole body. The
decreased oxygen content in the blood will result in decreased oxygen supply to the brain.
Thus there are potential risks of lung damage, cardiac arrest and brain stroke in the patient
with acute kidney damage condition (Makris & Spanou, 2016).
Mr. Walker has been found to be experiencing a decreased air entry and a high
respiratory rate. Those symptoms match to the clinical manifestations of acute respiratory
distress syndrome (ARDS) (Rawal, Yadav & Kumar, 2018). The ARDS condition are often
associated with the acute kidney injury (AKI) conditions (Han et al., 2019). The ARDS
condition can be resulting from fluid build-up event inside the lungs mainly, which can be
resulting from the inability of the kidney to maintain the fluid balance inside the body. The
ARDS condition is associated with shortness of breath, bluish colouration of the skin and
rapid breathing, due to shortage of oxygen supply all around the body (Rawal, Yadav &
Kumar, 2018). The condition presents with mortal risks to the elderly patients (Kao et al.,
2018). The inability of lungs to perform the gas exchange event leads to short supply of the
oxygen to the brain also. Thus initially with the progression of the condition, the patient
experiences light-headedness, dizziness, fatigue or even fainting along with the above
mentioned ARDS symptoms. If the timely care is not provided to manage the situation there

4CASE STUDY ANALYSIS
is potential risk of death resulting from brain stroke in the patient(Rawal, Yadav & Kumar,
2018).
The ARDS condition in the patient might progress to pneumothorax condition, in
which there is a leakage of air between the chest wall and the lungs. A continuation of that
phenomenon results in the filling up of the air outside the lungs. Then the capacity of the
lungs to expand becomes limited and thus the patient feels a sharp pain in the chest area as
they attempts to breathe. The condition is associated with the risk of complete respiratory
failure and death of the patient. The pressure that gets created inside the chest of an
individual, also affects the activity of the heart and thus there is also an additional risk of
cardiac arrest in the patient (McKnight & Burns, 2019).
Mr. John Walker’s current health condition can be associated with another potential
risk factor. It is the risk of nosocomial infection. He had a colon cancer condition and he is
also an elderly person. The case study does not mention any significant clinical manifestation
that suggests this possibility already. However, he is using an indwelling catheter and also
experiencing respiratory problems. Thus a pneumococcal infection or a urinary tract infection
might worsen his health condition and increase the risk of mortality (Haque, Sartelli,
McKimm & Bakar, 2018).
Nursing Interventions:
Considering the above discussion, it can be decided that the health problem that
requires the most immediate attention of the healthcare staffs, is the low oxygen saturation of
the blood in Mr. Walker. The situation presents most immediate and most adverse health risk
to the patient. It is associated with the hypoxia condition or the risk of low oxygen supply to
the brain and finally the risk of brain stroke in the patient. Thus the first nursing goal for the
patient should be restoring his blood oxygen level to normal within next hour. The normal

5CASE STUDY ANALYSIS
level of SpO2 is patient should be within 95% to 100% (Torp & Simon, 2019). There should
be a constant measurement of the SpO2 level in the patient in order to track the improvement.
The action plan for the achievement of this goal will be to deliver the patient an oxygen
therapy. Mostly this intervention is carried out by administering oxygen through a face mask.
There are also other methods of delivering an oxygen therapy to the patient, such as the
application of nasal tubes or tubes that are directly connected to the trachea of the patient.
There are studies that found the oxygen therapy to be sufficiently effective in treating the
hypoxia conditions in the patients (Hou et al., 2019). This is an evidence based practice that a
nursing staff must apply to avoid the potential mortality risks in Mr. Walker.
Additionally the in the oliguria condition the patient must also be addressed with
equal importance to prevent the most adverse outcomes in the patient. His kidney is unable to
filter the blood and excrete the waste products. There is a chance of severe imbalance of the
fluids in the body along with the electrolyte imbalance and the pH imbalance. The fluid
imbalance might lead to unnatural fluid build-up in various organs, such as the lungs. The
electrolyte imbalance and pH imbalance will stimulate the process of complete renal failure
(Fuhrman et al., 2018). Thus the second nursing goal should be ensuring proper urination in
the patient. 800 ml to 2000ml urine out put on a daily basis can be considered as a normal
urine output in an individual (Klein, Lehner, Forni & Joannidis, 2018). Proper actions should
be continued until there is a normal urine output in the patient. The goal should be achieved
within one week of time period. The action plan to achieve this goal will be the application of
some medications, such as the diuretics to influence the urine output in the patient. The
outcomes of the plan should be tracked continuously. If there is no significant improvement
in the patient’s condition, other options such as different medications or dialysis should be
considered (Bell et al., 2017). These practices are also evidence based practices. The

6CASE STUDY ANALYSIS
application of diuretic medications or dialysis or other medications to improve the oliguria
conditions in the patient have been found to be effect in previous research studies.
After addressing the above immediate necessities of the patient, the root cause for all
these adverse outcomes in the patient should be addressed, which is the acute kidney injury
(AKI) in the patient. The risks associated with this condition affects all the vital organs in the
body and thus this condition must be addressed very carefully and effectively (Makris &
Spanou, 2016). There is no treatment plan that can solve this problem immediately in the
patient. Thus to treat this condition the focus of the treatment plan should be on lowering the
clinical manifestations in the patient and wait for the body to heal that injury itself (Bell et al.,
2017). Thus the nursing goal regarding this condition should be should be ensuring there is a
proper fluid balance in the patient and also preventing any possible microbial infection at the
site of the injury. In order to achieve these goals the patient must be monitored continuously
for possible imbalance or pain and swelling in the abdomen area. The pain and swelling is
often associated with the inflammation events, which is in turn associated with the infection
event. A continuous fluid chart should be maintained for tracking the fluid balance in Mr.
Walker and regular blood tests should also be performed in order to detect infection. If fluid
imbalance is detected various pharmacological and non-pharmacological interventions must
be adopted to deal with the condition immediately. In case any microbiological infection is
detected proper antibiotic treatment must be initiated.
The next nursing goal should be focused on the fever condition in the patient. The
action plan should be administering different medications in the patient. The patient must be
monitored continuously. The body temperature of the patient must be restored to normal
within four hours of administering the medications (Abdelmaseeh & Oliver, 2019).

7CASE STUDY ANALYSIS
Finally there should be a nursing goal focused on the prevention of nosocomial
infection in Mr. Walker. There should be a range of action plans to achieve these goals. There
should be a proper maintenance of the hygiene around Mr. Walker. All the healthcare staffs
must wash their hands properly, the room and the surfaces must be cleaned on a frequent
basis. The food should be properly cooked and the staffs must make sure that the patient
washes his hands properly before consuming the food. The needles, tubes or the face masks
that are being used in the patient must be properly decontaminated prior to the use. There
should be a regular blood profiling test in the patient and the level of the white blood cells
must be monitored especially to detect the possibility of microbial infection in the patient
(Khan, Baig & Mehboob, 2017).
Conclusion:
Hence it can be concluded from the above discussion that there is many potential risks
associated with the condition of 64 year old Mr. John Walker. Those risks are associated with
all the vital organs of the body, which are the heart, the lungs, the brain and the kidney. After
analysing the information obtained from the case study it can be assumed that he is suffering
from a postoperative fever. The fever is probably resulting from a damage to his kidney.
Kidney is an important organ of human body that is focused on maintaining proper fluid
balance in the body and thus an injury to kidney results in the waste build up in the body. The
disease condition progression is associated with low SpO2 level in blood and increased
respiratory rate. The acute kidney injury may result in severe fluid imbalance in his body,
which might eventually lead to a complete renal failure. Additionally his blood pressure will
be excessively high and he will develop hypertension condition, which can be associated with
the risk of cardiac arrest. A progression of the decreased oxygen supply condition in the
blood can be associated with the risks of lungs collapse and the brain stroke condition.
Additionally the patient is already experiencing the symptoms of acute respiratory distress

8CASE STUDY ANALYSIS
syndrome (ARDS), which is associated with the risks of lung collapse and brain stroke also.
The patient is also at risk of encountering nosocomial infections. The main focus of the
nursing goals for Mr. Walker will be addressing his low SpO2 condition and oliguria
condition. After that his AKI condition and postoperative fever condition should be
addressed. Finally the nursing goals must be focused on preventing the nosocomial infection
in Mr. Walker.
References:
Abdelmaseeh, T. A., & Oliver, T. I. (2019). Postoperative Fever.
Balci, C., Haftaci, E., & Kunt, A. T. (2018). Use of cerebral oxygen saturation and
hemoglobin concentration to predict acute kidney injury after cardiac
surgery. Journal of International Medical Research, 46(3), 1130-1137.
Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The
assessment and management of urinary tract infections in adults: guidelines for
pharmacists. Canadian Pharmacists Journal/Revue des Pharmaciens du
Canada, 150(5), 298-305.
Bell, S., Ross, V. C., Zealley, K. A., Millar, F., & Isles, C. (2017). Management of post-
operative acute kidney injury. QJM: An International Journal of Medicine, 110(11),
695-700.
Fuhrman, D. Y., Kane-Gill, S., Goldstein, S. L., Priyanka, P., & Kellum, J. A. (2018). Acute
kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25
years of age treated in an adult intensive care unit. Annals of intensive care, 8(1), 26.
Han, H., Li, J., Chen, D., Zhang, F., Wan, X., & Cao, C. (2019). A clinical risk scoring
system of acute respiratory distress syndrome-induced acute kidney injury. Medical

9CASE STUDY ANALYSIS
science monitor: international medical journal of experimental and clinical
research, 25, 5606.
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated
infections–an overview. Infection and drug resistance, 11, 2321.
Hou, Q., Zhang, Z., Lei, T., Gan, M., Wu, X., Yue, W., ... & Gong, H. (2019). Clinical
efficacy of high-flow nasal humidified oxygen therapy in patients with
hypoxemia. PloS one, 14(6).
Kao, K. C., Hsieh, M. J., Lin, S. W., Chuang, L. P., Chang, C. H., Hu, H. C., ... & Wu, H. P.
(2018). Survival predictors in elderly patients with acute respiratory distress
syndrome: a prospective observational cohort study. Scientific reports, 8(1), 1-9.
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology,
prevention, control and surveillance. Asian Pacific Journal of Tropical
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Klein, S. J., Lehner, G. F., Forni, L. G., & Joannidis, M. (2018). Oliguria in critically ill
patients: a narrative review. Journal of nephrology, 31(6), 855-862.
Klein, S. J., Lehner, G. F., Forni, L. G., & Joannidis, M. (2018). Oliguria in critically ill
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10CASE STUDY ANALYSIS
McKnight, C. L., & Burns, B. (2019). Pneumothorax. In StatPearls [Internet]. StatPearls
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