Nursing Case Study: Patient Care, Errors, and Future Practice

This case study analyzes the care of an 81-year-old female patient admitted to the hospital with breathing difficulties, focusing on the progression of her condition and the actions of healthcare professionals. The patient's initial symptoms included dyspnea and elevated jugular venous pressure, leading to Lasix administration. Despite this, her condition deteriorated, with the VMO ordering various tests and procedures, including a V/Q scan which resulted in dizziness and atrial fibrillation. The patient's refusal of food, abdominal pain, and deteriorating vital signs, including a high respiratory rate, low blood pressure, and eventual septicemia, are highlighted. The case examines the breaches of care, including negligence, ageism, and violations of nursing ethics and NMBA standards. The analysis also provides recommendations for future practice improvements, including the implementation of NMBA codes, patient-centered care, and addressing malpractices like ageism, with the ultimate goal of eliminating negative outcomes and promoting the well-being of elderly patients. The case concludes with references to relevant legislation and research.

Running head: NURSING ASSIGNMENT
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Name of the Student
Name of the University
Author Note

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Criteria 1
An 81 year old female patient has been diagnosed with dyspnoea at the GP clinic as
stated by the patient that she is facing breathing issues when lying flat. The GP found crepes in
both of her lungs along with elevated jugular venous pressure. The GP suggested the
administration of oral Lasix as the patient found with normal renal function and vital signs
however, her respiratory function was not normal. Next day the patient has again been admitted
to the hospital as her condition did not improved and the medication process was not effective
for her at all. With time the patient was deteriorating and the visiting medical office (VMO) has
been attending her and suggested an X-ray and blood test. The VMO have acknowledged that the
patient has diarrhea and tender abdomen. Based on this diagnosis the VMO organised a
ventilation/perfusion (V/Q) process. The patient found to be dizzy and atrial fibrillation found to
be happening in the patient’s body after the V/Q process. Thus the V/Q process was highlighted
as inter-determinate by the VMO. The patient this point found to be refusing food or liquid
intake and complaining about her abdominal pain. Next day the VMO suggested mobilization for
the patient as the patient found as depressed and also anxious at this point of the diagnosis. Based
on the discharge note of the nurse it has been found that the respiratory rte of the patient was 28
to 30 and other vital signs are normal. At this point it has been found that the patient is
deteriorating with her health condition, immobile and with time she is developing back pain and
abdominal pain is getting higher as well. The development of the condition of the patient can be
related to the absence of the responsible doctor for her and it has also been seen that the doctor
could not be contacted in this point. On the other hand the respiratory rate of the patient reached
40 which is very high and she found with a tachycardia attack as well. Her skin was getting pale
and she has been feeling woozy. At this point a RN has been involved for the investigation of the

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condition of the patient and also the issues with the patient as well. The patient found with a
rising dizziness, abdominal pain (8/10) and her blood pressure was very low (89/53) along with a
very high respiratory rate up to 44 per minute. Hence, the RN organized a locum to observe the
patient. After this condition the RN involved an En for the patient as well. Next observation
highlighted that the patient’s diarrhea was getting higher and also the vital signs were not normal
as well. At this point the clinical nursing manager arrived and stated that the patient needs some
medication and thus she told the nurse to take the medicine from the drug safe of another patient.
After this the RN conducted an ISBAR for the patient in terms of the discharge plan and also the
transportation for the patient to a rural hospital. However, before the transport the on call doctor
arrived and inserted a large bore IV cannula in the patient’s body to sustain the diarrhea of the
patient. Ultimately next morning, due to septicemia the patient tragically died when the patient
was evaluated by the air evacuation team.
Criteria 2
Based on the above case description the patient was found vulnerable to many factors of
her health condition. However, there is no proper treatment was provided to the patient. On basis
of this description it can be stated that the patient was neglected in the process of treatment.
Based on the condition it can be stated that the case is highlighted with the issues of ageism that
is the discrimination based on the age of the patient (Kydd & Fleming, 2015). Hence, the context
it can be found that the negligence and also the mal practice of ageism has been conducted by the
clinical staffs here. On the other hand the ethics of care has also been breached in different times
as there is no proper observation of the patient, medication and also the process of the diagnosis
should be considerate about of the age of the patient. Thus it can be stated that the
discrimination, negligence and the ethics of care has been breached in this case scenario. On the

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other hand the factor of the care was not considerate about the NMBA standards of care as well
as the patient centered approach was not implemented and the nursing ethics of the beneficence
and non-malificence has also been neglected here (Nursingmidwiferyboard.gov.au, 2019). On
the other hand the Aged Care Act 1997 and also the Aged Care Act 2013 has also been breached
as well (Australian Government Department of Health, 2019). Hence, based on this case analysis
it can be stated that the care policy and also the ethics of nursing has been breached as the
process of the medication and also the diagnosis has not been proper in the cases of the treatment
of the patient. In this process the nursing management, doctor attention and also the medication
management should be considered with the highest priority for the patient as these factors affect
the condition of the care of the patient mostly. Other than these the aspect of the health condition
of the patient would be done with the help of the proper observation of the patient and reporting
the changes of the patient the doctor (Lee & Jung, 2015).
Criteria 3
The improvement of the patient care would be focused with the help of the proper
implementation of the NMBA code of nursing and also the proper nursing ethics as well. On the
other hand the factor of the care should be done with the proper attention and also the
observation of the patient as well (Richards, Coulter & Wicks, 2015). On the other hand the facto
of the care plan development should be implemented with all these factors as well in order to
improve the care process of the patient. Other than this it can be found that the Aged care Act
1997 and the Aged Care Act 2013 should be implemented with the proper consideration for the
aged patients as well. Based on this discussion it can be stated that the factor of the future
practice should be eliminated with the mal practices such as the ageism and also the
consideration of the nursing ethics of the beneficence and also the non-malificence as well

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(Kangasniemi, Pakkanen & Korhonen, 2015). Hence, it can be stated that the nursing code of
conduct as stated by NMBA should be considered with the primary focus on the patient centered
care and also the aspect of the care process with the consideration of proper medication
administration along with the proper observation and interaction with the patient. It can be stated
that the proper implementation of all these factors should be helpful in the development of the
improved care facility for the elderly people and also the discrimination would be eliminated as
well (São José et al., 2017). The consideration of the patient centered approach would be the
most effective process in this kind of care procedure (Vincent et al., 2016). Other than this the
consideration of the health care ethics and well being of the patient should be considered in a
highest priority as well. Thus it can be stated that the factor of the future practice should be
considering of above mentioned factors in order to eliminate the negative outcomes such as
morbidity and death as well (Delaney, 2018).

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References
Australian Government Department of Health. (2019). Legislation we administer. Retrieved 25
August 2019, from https://www.health.gov.au/about-us/what-we-do/legislation-we-
administer
Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in Australia.
Collegian, 25(1), 119-123.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Kydd, A., & Fleming, A. (2015). Ageism and age discrimination in health care: Fact or fiction?
A narrative review of the literature. Maturitas, 81(4), 432-438.
Lee, M. K., & Jung, D. Y. (2015). A study of nursing tasks, nurses' job stress and job satisfaction
in hospitals with no guardians. Journal of Korean Academy of Nursing Administration,
21(3), 287-296.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved 25 August 2019, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx
Richards, T., Coulter, A., & Wicks, P. (2015). Time to deliver patient centred care.
São José, J. M. S., Amado, C. A. F., Ilinca, S., Buttigieg, S. C., & Taghizadeh Larsson, A.
(2017). Ageism in health care: a systematic review of operational definitions and
inductive conceptualizations. The Gerontologist, 59(2), e98-e108.

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Vincent, J. L., Shehabi, Y., Walsh, T. S., Pandharipande, P. P., Ball, J. A., Spronk, P., ... &
Badenes, R. (2016). Comfort and patient-centred care without excessive sedation: the
eCASH concept. Intensive care medicine, 42(6), 962-971.