Nursing Assignment: Case Study Analysis of Patient A's Healthcare

This case study analyzes the healthcare journey of Patient A, an 81-year-old patient admitted to the hospital with shortness of breath and later diagnosed with sepsis. The assignment critically examines the professional errors, including inadequate assessment, delayed diagnostic tests, and poor documentation, which contributed to the patient's adverse outcome. It highlights issues such as the failure to recognize early signs of sepsis, mismanagement of arterial fibrillation, and deficiencies in communication and organizational support. The analysis further explores the implications of these errors for future nursing practice, emphasizing the importance of thorough patient assessment, accurate documentation, timely intervention, and the ethical and legal responsibilities of healthcare professionals. The case underscores the need for improved infrastructure, better communication, and a focus on patient safety to prevent similar incidents and ensure optimal patient outcomes. The study also references several scholarly articles to support the analysis and recommendations.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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SUMMARY OF THE CASE AND PRESENTING PROFESSIONAL PRACTICE
ISSUES
This case study is about patient A, who is 81 years and has been presented in the
emergency department. The day before the admission, the patient had visited the GP clinic with
shortness of breath. He was prescribed with the Lasix and was sent home. However, the
condition of the patients did not improve. He was reported to be having a diarrhea and right sided
tenderness. He was ordered with a chest x-ray and a blood tests. On the next day, the patients
reported dizziness and was refusing food and drinks and complain of having abdominal pain and
feeling extremely fatigued. An arterial fibrillation was noted at a rate of 120/min. after the VMO
had assessed the patients, the nurses were ordered to mobilize patient A. Even after this, the
patient ordered for a discharge the next day. During that time the respiratory rate of the patients
was found to be quite low than the normal value. Patient A continuously refused dinner and
complained of having severe back pain with high heart rate. When patient A needed extra care,
his doctor could not be contacted and was instead seen by a locum. However, the patient died of
septicemia.
In this paper, the presenting professional issues are the lack of proper infrastructure
facilities and the negligence of the health care professionals, starting from the visiting doctors to
the nurses attending the patient (Grant, 2017). Since, the patients are the consumers, an unequal
power relationship exists between the receivers and the health care providers. The recipients are
always on the vulnerable side to get an unequal access to health care facilities. A large number of

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concern can be found from this case study, including error in documentation, missing out the
health and inability to initiate emergency services or a MET call.
Professional errors that potentially contributed to the incident
happening?
A considerable number of professional errors can be noticed throughout the case study.
On 6th January, two days after the patient had been admitted in to the hospital, the patient was
planned for a chest x-ray and blood tests. But the tests were not performed right after they had
been ordered. Even after there were incidences of diarrhea and tenderness and abdominal pain,
nothing was done to check the risk factors of any infection. Abdominal tenderness and
abdominal pain is a generally manifestation of acute inflammation in one or more organs
(Walters, 2018). Abdominal abscesses can form a pocket of infected fluid and puss inside the
belly that can cause abdominal pain. In that case an assessment was necessary for the patient.
The patient was reported with a dizziness. Coincided by arterial fibrillation. Arterial fibrillation
can lead to serious issue like stroke. In few of the cases, a patient who had developed sepsis
might display arterial fibrillation. It has been found that most of the patients who suffer from
arterial fibrillation at the time of sepsis are less likely survive till discharge (Walters, 2018).
Following an arterial fibrillation, an assessment should have been followed since the patients had
been showing signs of infection from the very beginning. Hence, it can be said that the doctors
involved actually could not note these clues of infection. In spite, of all these symptoms. Dr.
Haron referred the patients to discharge and before that the nurses were ordered to mobilize the
patient. The respiratory rate of the patient was also noted to be higher than the standard value and

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Heart rate and respiratory rate in patients suffering from septicemia might show an
increased value, due to the presence of an inflammation (Walters, 2018). As the sepsis worsens
the patients tends to feel nauseous and might become less alert. Later on the temperature of the
body might fall than the normal value and the skin will become cool and clammy (Walters,
2018). The physician failed to understand the blood flow has been reduced due to an infection.
On blood test, it was noticed that his white blood cell count is more but the patient is afebrile. An
acute malpractice can be noticed here when the registered nurse stated that the doctor who was
attending patient A had gone away and cannot be contacted. This shows gross organizational
mismanagement and lack of staffs. The registered nurse had admitted that the hospital was not
equipped enough to handle such complicated cases. In such case the decision of shifting the
patient to a better care facilities on time could have saved the patient. A proper transition of care
not only saves time but also produces better outcomes. A respondent reviewed patients vital
signs but missed to document his vital signs. Documentation in health care is not only important
for patients, but also acts as a legal document in case any lawsuit is pursued (Kerr et al., 2016).
Another breaching of health care standard can be seen from the fact that the respondent called
the clinical nurse manager to arrange for medications for a patient, but did not do the same for
patient A. The emergency doctor was called upon at the last moment. No MET call was
established, although it was an emergency condition.
IMPLICATION FOR FUTURE PRACTICE
I have learnt from this experience that even a smallest negligence can lead to serious
conditions s mortality. After a thorough analysis of the case study, I have realized how proper
physical assessment can be helpful in finding out important health care cues. Collecting
important clues and thinking on them critically might help health care professionals to prioritize

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and make key decisions that can be helpful to save lives. Furthermore, this incident has also
taught me the importance of documentation. The purpose of an accurate patient documentation is
to foster quality and continuity of care (Piesch & Lee, 2015). It is a way of communication
created between the patients and the caregivers, caregivers and the other staffs. It not only
protects the patients but also the provider. As per the Australian Nursing and Midwifery board,
nurses are accountable to use a range of assessment techniques for the collection of relevant and
accurate data to inform practice (Gurney et al., 2018).
Prioritization of care is extremely important in nursing. Health care professionals
compare different ways of setting the properties amongst the managers, medical doctors and the
nurses (Skirbekk, Hem & Nortvedt, 2018). The doctor who was caring for patient did not take
any initiative to find out the actual concern of the patient. There was a point in the case study,
where the concerned doctor could not be found, actually when he was needed the most. Again, in
one of the cases it was mentioned that the registered nurse contacted the clinical manager for
ordering medicines for the patient but forgot to order medicines for the concerned patients,
which clearly indicates towards an indifferent attitude towards patients (Piesch & Lee, 2015). It
is necessary to remember, that health care professionals are ethically and legally obligated to
care for the safety of the patient.
The patient would have survived, had the incidence of septicemia diagnosed earlier and
the antibiotic treatment was initiated earlier. A transitional care was necessary ensuring the
continuity of the treatment and avoid preventable and poor outcomes (Betz et al., 2018). Proper
documentation and timely care would have prevented this adverse event.

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REFERENCES
Betz, C. L., O'Kane, L. S., Nehring, W. M., & Lobo, M. L. (2016). Systematic review: health
care transition practice service models. Nursing outlook, 64(3), 229-243.
Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The
Online Journal of Issues in Nursing, 20(2), 1-10.
Grant, P. D. (2017). Nursing Malpractice/Negligence and Liability. Law for Nurse Leaders, 51.
Gurney, D., Gillespie, G. L., McMahon, M. P., & Kolbuk, M. E. (2017). Nursing Code of Ethics:
Provisions and Interpretative Statements for Emergency Nurses. Journal of Emergency
Nursing, 43(6), 497-503.
Kerr, D., Klim, S., Kelly, A. M., & McCann, T. (2016). Impact of a modified nursing handover
model for improving nursing care and documentation in the emergency department: A
pre‐and post‐implementation study. International journal of nursing practice, 22(1), 89-
97.
Piesch, L., & Lee, E. (2015). Quality Assurance of Emergency Management Operation
Processes through Statistical Process Control (No. DP-283).
Skirbekk, H., Hem, M. H., & Nortvedt, P. (2018). Prioritising patient care: The different views
of clinicians and managers. Nursing ethics, 25(6), 746-759.
Walters, E. (2018). Raising awareness for sepsis, sepsis screening, early recognition, and
treatment in the emergency department. Journal of Emergency Nursing, 44(3), 224-227.