401021 Nursing Case Study: Patient A - Professional Practice Review

This case study examines the care of Patient A, an 81-year-old admitted to the hospital with symptoms including apnoea, high blood pressure, and crackles in her lungs. The case details the patient's deteriorating condition, including persistent abdominal pain, diarrhoea, and elevated respiratory rates, leading to a misdiagnosis of depression and anxiety. The analysis highlights several professional errors, such as the initial prescription of oral Lasix without monitoring, inconclusive test results, and the failure to recognize the severity of the patient's condition, leading to the administration of inappropriate medication and delayed intervention. The study explores the implications for future practice, emphasizing the crucial role of nurses in preventing medical errors, promoting safe transitions from health centers, and the importance of effective communication and documentation among healthcare professionals. The case underscores the need for nurses to take responsibility for their actions, advocate for patients, and maintain moral courage in challenging situations to improve patient outcomes and uphold professional standards.

Running head: CASE STUDY
Case Study: Patient A
Student Name
Institution

CASE STUDY 2
401021 Being a Professional Nurse or Midwife – Assessment 2
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Criteria 1. Case Summary: Summarises the case and presenting professional practice issues.
Patient A was presented to a General Practitioner, and on 8th January 2013 was
admitted to the hospital on account of apnoea, slight high blood pressure and crackles
detected from the bottom of both her lungs.
Her pre-admission prescription was oral Lasix, which failed to remedy her diagnostics
and due to such consequences was scheduled for a blood tests and a chest x-ray, and later a
ventilation/perfusion (V/Q) scan, all which resulted in inter-determinate results.
More symptoms started to show, including persistent severe abdominal pain,
diarrhoea and elevated respiratory rates, rising from 28/minute to 44/minute. Other treatment
attempted include introduction of a large bore intravenous cannula-tube to deliver fluids.
During her stay, the patient complained to be feeling dizzy, had no energy and
reported her back pain was critical. She had an unsteady heartbeat of 120/min pulse rate. The
patient’s also refused to consume any meals or liquids, the reason she was looking to be very
weak.
Upon examination by the Visiting Medical Officer’s, the patient was diagnosed with
depressed and anxiety was set to be discharged from the hospital after treatment for the same.
The patient was then given Digoxin and Valium medicine. Her vital signs were normal
despite increased heart pulse rate of 122/min, and elevated blood sugar levels of
16.1mmmol/l.

CASE STUDY 3
At the time of her death, her pulse rate had seceded. Last minute attempts to treat her
loss of body fluid from severe diarrhoea had been tried to no avail. Patient A suffered blood
poisoning sepsis
Various professional errors were made since the patient visited the general
practitioners clinic. The first day patient A visited and received a medical examination, she
was commenced on oral Lasix treatment. The administering doctor should have periodically
checked the patient’s progress and reaction to the drug since the drug takes a considerable
amount of time to be fully taken into the blood.
On 7th January, patient A had already been admitted to the hospital for over a day, and
only the VMO reviewed her clinical presentations after spending a day hospitalised. On 11th
January, RN John said that at her handover, patient A’s doctor was gone
On the 9th of January, the VMO tests and diagnosis were inconclusive but in spite of
his doctor judgment, the VMO, Dr Haron noted that the patient was the problem, that she
refused to eat or drink any liquids and that she has been complaining of feeling weak. Instead
the doctor should have carried out more conclusive tests to a certain her ailment (Cherry &
Jacob, 2018, p. 19). He later dismissed her case as mere depression and anxiety even though
her heart rate had remained high.
The staff in the hospital continually ignored patient’s A medical condition and history
(Daly, Speedy, & Jackson, 2017, p. 65). The patient received Valium and Digoxin for the
wrong diagnosis. They failed to administer the proper medication and even mark-out patent A
for hospital discharge on 11 January, as soon as her condition worsened. At 2020 hours, John
the Registered Nurse telephoned the Clinical Nurse Manager to organise drugs for a patient,
other than patient A.
Criteria 2 Contributory factors Identify relevant professional errors that potentially
contributed to the incident happening

CASE STUDY 4
Registered Nurse (RN) John, in her evidence before the committee she states that she was
straightaway troubled with patient A’s situation (Cranmer & Nhemachena, 2013, p. 47).
These is not the case because on 11th January at 1810 hours, the Registered Nurse, John was
informed of patent A’s deterioration by a co-nurse. At first she her colleague by telling her
that the locum would reanalyse the patient’s condition once he arrives. She then goes on to
review patient A but fails to document her observations.
The locum arrives on Friday at 2100 hours but RN John failed to inform him of the
worsening condition of patient A. Patient A succumbed to septicaemia, most probably
contracted within the hospital even though she came in for different non-life threatening
condition. The hospital cleanliness is therefore not up-to standards.
Criteria 3. Implications for future pratice: Discussion thatincludes how to practice
might change and develop as a result of this learning. What professional behaviours
may have made a difference in this situation
Nurses play a major role in preventing medical errors, the reduction of hospital
acquired infection rates and safe transition from health centre to home (Schuster, 2010,
p. 106). Nursing leadership and management are crucial to providing patients with safe,
patient centred and effective quality care, involving the patient’s family in all health care
decisions. Other good practices include a personal baseline of the depth of observation and
recording in whichever scenario..
A nurse’s prime commitment is to the patient (Gross & Kinnison, 2014, p. 43). As a
registered nurse, one must always take responsibility for any nursing judgement and actions
while practicing accountability. A patient should always retain autonomy over their body. A
nurse can only make useful suggestions, but not coerce or intentionally deny a patient service.

CASE STUDY 5
As a nurse, moral courage is essential to overcome fear head on, even when the issue
is a conflict with a fellow nurse or doctor, and especially when a nurse’s core beliefs and
values are threatened (Fisher & Kiernan, 2019, p. 28). Moral courage turns principle into
deeds and involves upholding quality patient results and standards of professionalism while
being answerable to those who rank above (Paula DiMeo Grant; BSN; & Diana Ballard,
2013, p. 73).
Communication between the various healthcare professionals working together, needs
to be precise and accurate. Nurses have the expert responsibility to document care planning,
the actual care delivered and patient’s results (Malone, Fletcher, & Martin-Plank, 2014,
p. 59). Effective documentation is vital for essential intrapersonal and interpersonal
communication. Hence, clear, accurate and accessible documentation is an indispensable
element of quality and evidence based practice.
Recognizing the crucial dignity of oneself and of each patient must also remain a
basic value of nursing. Being a Registered Nurse considerably gives a nurse power (Black,
2019, p. 12). However, this power should not be abused. A senior nurse should foster
collaboration with his/her juniors, while maintaining boundaries and moral self-respect, to
preserve integrity of character while achieving professional growth and maintaining
competence and cohesion in the work place (D'Avanzo, 2018, p. 32)

CASE STUDY 6
References
Black, B. (2019). Professional Nursing E-Book: Concepts & Challenges. St. Louis, MO:
Elsevier Health Sciences.
Cherry, B., & Jacob, S. R. (2018). Contemporary Nursing: Issues, Trends, & Management.
St. Louis, MO: Elsevier Health Sciences.
Cranmer, P., & Nhemachena, J. (2013). Ethics for Nurses: Theory and Practice. Milton
Keynes, United Kingdom: McGraw-Hill Education (UK).
Daly, J., Speedy, S., & Jackson, D. (2017). Contexts of Nursing: An Introduction. St. Louis,
MO: Elsevier Health Sciences.
D'Avanzo, C. (2018). Mosby's Pocket Guide to Cultural Health Assessment - E-Book. St.
Louis, MO: Elsevier Health Sciences.
Fisher, M., & Kiernan, M. (2019). Student nurses' lived experience of patient safety and
raising concerns. Nurse Education Today, 77, 1-5. doi:10.1016/j.nedt.2019.02.015
Gross, R., & Kinnison, N. (2014). Psychology for Nurses and Allied Health Professionals:
Applying Theory to Practice. London, England: Routledge.
Kennedy-Malone, L., Fletcher, K. R., & Martin-Plank, L. (2014). Advanced Practice
Nursing in the Care of Older Adults. Philadelphia, PA: F.A. Davis.
Paula DiMeo Grant; RN; BSN; MA; JD, & Diana Ballard, J. (2013). Fast Facts About
Nursing and the Law: Law for Nurses in a Nutshell. New York, NY: Springer
Publishing Company.
Schuster, P. M. (2010). Communication for Nurses: How to Prevent Harmful Events and
Promote Patient Safety. Philadelphia, PA: F.A. Davis.