NRSG370 - Clinical Integration Case Study: Bianca Lane's Care

This case study analyzes the clinical integration and nursing care of Ms. Bianca Lane, a 20-year-old patient who presented to the emergency department with severe abdominal pain, ultimately diagnosed with peritonitis following a ruptured appendix. The assignment applies the clinical reasoning cycle to assess Bianca's condition, considering her medical history of asthma and depression, and current medications. It involves collecting and processing information from the patient's symptoms, physical examination findings, and pathology reports to identify key nursing problems, including acute pain, risk for infection, and fluid volume deficit. The case study then outlines the establishment of nursing goals aimed at preventing complications, promoting comfort, and providing information. It details the nursing interventions implemented, such as surgery, wound dressing, pain management, and measures to prevent infection. The case study also includes an evaluation of the interventions' effectiveness and reflects on areas for improvement, such as patient education and the use of advanced wound care products. The paper concludes by summarizing the key aspects of Bianca's care and the importance of clinical reasoning in nursing practice.

Running head: NRSG370-CLINICAL INTERGRATION-SPECIALITY PRACTICE 1
Nrsg370-clinical integration -specialty practice
Name
Institution

NRSG370-CLINICAL INTERGRATION-SPECIALITY PRACTICE 2
Nrsg370-clinical integration -specialty practice
Introduction
Nurses with effective clinical skills usually meet their objective of giving quality care
whereas those without end up disappointing their clients. According to Crystal (2010), there are
three reasons which prevents patients form receiving quality services in most health facilities.
These reasons includes, misdiagnosing of illness, poor treatment procedures and lack of
knowledge on best medication for the patients. All these reasons are related to poor clinical
reasoning. Alan (2015) argues that, through education, correct strategies can be implemented to
ensure patients receive quality care. Nursing practitioners must be in a position to utilize
communication skills and collaborate with other teams to achieve quality care. One of the ways
of doing this is by implementing clinical reasoning cycle. This paper will apply clinical
reasoning cycle by reviewing and planning care for a patient named Ms. Bianca. She was
presented in the hospital due to severe abdominal pain in the right side of her abdomen. This
showed that Bianca had an appendicitis. This is an inflammation that occurs on the appendix and
it’s usually finger-shaped. It protrudes in a colon hence causing pain in the right side of the
abdominal part.
Consider the patient
According to David & Sabrina (2019), nurses in this stage collect information through
talking to the patient and performing some tests. Nurses then approaches Bianca who is the
recipient of care and began to gain first impression. Ms. Bianca was brought into an emergency
room because she had a severe right lower quadrant abdominal pain for 2-3 days. She also had
nausea, fever and lack of appetite. Physical examination and the ultra sound performed on her

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abdomen revealed that Bianca had a perforated appendix which required emergency laparoscopic
surgery. She had a Bp of 94/45mmhg, hr 136 and temperature 38.5c. She had also been
complaining of increased nausea, feeling bloated and increased centralized abdominal pain. The
pathology outcomes revealed that Bianca had a rise in white blood cells count CRP and blood
cultures were pending.
Collection of information
From the reports collected, Bianca is under medications such as salbutamol, seretide and
sertraline. According to Jaykaran & Deepak (2012), these medicines used by Bianca are used to
treat asthma. With this type of medication, it is clearly that Bianca had a history of asthma.
Salbutamol is used to treat and prevent bronchospasm in patients with asthma. Additionally,
seretide is used to treat asthma and obstructive pulmonary diseases (Danielle, 2016). Therefore
nurses should perform some tests to see whether Bianca has obstructive pulmonary diseases.
Apart from this data collected from Bianca, She had a BP of 94/45mmhg, hr 136 and temperature
38.5c. She also complained of increased nausea, feeling bloated and increased centralized
abdominal pain. The pathology results showed that Bianca had a rise in white blood cells count,
CRP and blood cultures were pending. In the room where Bianca is hosted, an x-ray is done and
the nurses identifies edematous distention of the small and large bowels. Before anything was
done, the nurses read the consent file to Bianca and asked her whether she agrees with the
procedures they have chosen for her care.
Process information
All signs and Bianca’s data collected are being analyzed. She is suffering from
appendicitis and nursing practitioners should pay attention in assisting her to cure the illness.

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Appendicitis is a dangerous illness and if proper care fail to be taken can lead to more problems
(Michal & Nadav, 2011). Appendicitis is an inflammation of the appendix and it makes one to
feel pain in the lower abdomen. Some of the symptoms associated with appendicitis is nausea,
lack of appetite and abdominal pain. Since Bianca was experiencing increased abdominal pain,
nurses recommended a small surgery because it can bring more health issues. Surgery is the only
course of action which can be taken on Bianca to reduce the ever increasing pain in her lower
abdomen.
Identify the problem
Ms. Bianca was complaining of severe abdominal pain. According to Amal (2016), lower
abdominal pain is mostly caused by inflammation, abnormal growths, obstructions and intestinal
disorders. In this case, Bianca had inflammation which caused appendicitis. Appendicitis,
usually protrudes and forms something like a sack hence causing abdominal pain. She also had a
loss of appetite. Pain can make someone to lose appetite. Moreover, she also experienced nausea
which can also be caused by pain. Additionally, Bianca had a temperature of 38.5c which is
slightly above normal. According to Catherine (2016), normal body temperatures should be 37c.
In this case, Bianca had fever which made her body temperatures rise above normal. Lastly, she
had a spo2 of 95% which is normal. This means that the asthma she had was not severe because
it could have affected the amount of oxygen in the blood. Nursing practitioners should
concentrate their care plan on appendicitis because it the one causing much pain to Bianca.
Establish goals.
Nursing goals are important because they help in focusing what is necessary to improve
health of the patient (Shannon & David, 2010). In Bianca’s case, nursing goals would involve

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preventing complications, promoting comfort and providing information. One of the nursing
problem identified in the Bianca’s case is acute pain. This pain is brought by the perforated
appendix and the operated wound. In this case nurses should come up with measures to reduce
this pain. It will also stop other symptoms brought by acute pain like loss of appetite, nausea and
fever.
Additionally, risk for infection is another nursing problem identified in the Bianca’s case.
This risk for infection is related to the rapture of the appendix. Also, the open wound after
operation is prone to infection so nurses should come up with ways to prevent transferring
infections to it. Lastly, fluid volume deficit is another nursing issue in the Bianca’s case, loss of
fluids is brought by nausea with is usually accompanied by vomiting. This is making Bianca to
lose a lot of fluids hence causing nausea to her. They should therefore help her in reducing pain
which causes nausea.
Take action
After discovering the main problems facing Bianca, nurses came up with measures on
how to help her reduce the pain. In order to reduce the acute pain, the nurses had to first do a
surgery on her. The increasing pain she had showed that the appendix had really outgrown and
the only option was doing a surgery. Surgery will help to remove the raptured appendix hence
reducing pain. Moreover, after an operation the open wound left can also bring pain to Bianca.
To reduce the pain, nurses should do a wound dressing on her (Karen, 2015). They should be
careful because poor wound dressing can bring more discomfort to her. They should first wash
their hands, pour saline on the wound and squeeze it with a gauge pad until it’s not dripping.
After squeezing the gauge pad, they should then cover the wound with a clean dressing pad. The

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saline helps the wound to always keep dry hence preventing loss of fluids (Judy, 2010). It also
assist in reducing pain.
In order to prevent the risk of infection, nurses should observe high level of cleanliness.
This includes washing their hands before attending Bianca, sterilizing equipment and ensuring
she is not exposed to environment which can worsen her conditions. Hospitals are prone to
infections and failure to take due measures can transfer infections to her. Lastly, to ensure that
Bianca is not subjected to situations which can make her lose a lot of fluids like nausea, nurses
should give her pain killers to reduce the pain. They should also advise her to take a lot of water.
Evaluation and reflection
The interventions carried out on Bianca’s case were effective because they helped in
reducing the pain. However, there are areas which needed more reasoning to achieve effective
results. When Bianca was presented in the hospital, nurses did not advise her to place herself in
semi-flowers position because this would have prevented pain as she awaits for surgery.
Therefore she could not have experienced things like nausea and fever which are brought by
acute pain. Nurses should consider educating patients because some of these symptoms they
experience can control by themselves. Also, during wound dressing nurses should have used
Acquacel Ag silver. This is more effective than saline because it contains silver irons which not
only makes the wound to dry but also minimizes risks for infection (Carolyn, 2016).
Conclusion
Ms. Bianca was suffering from appendicitis because she was experiencing pain in her
lower abdomen. Due to the increasing pain, the only option which could have helped in reducing
it was through surgery. After the surgery, nurses did a wound dressing to prevent transferring

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hospital infections to Bianca. During wound dressing they applied saline which helped the
wound to dry quickly. They then gave her pain killers which helped to reduce the pain after
surgery.

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