University Nursing Case Study: Professional Practice and Implications

This report presents an analysis of a nursing case study involving an 81-year-old patient admitted with breathlessness. The case highlights several professional issues, including failure to observe medication side effects, inadequate documentation, and delayed medical intervention. The report identifies contributory factors such as medication errors and lack of adherence to patient care plans. It also discusses the implications for future practice, emphasizing the importance of proper medication administration, patient monitoring, and timely medical referrals. The analysis underscores the need for comprehensive patient care plans and adherence to professional standards to prevent adverse outcomes. The case study references relevant literature, including guidelines from the Nursing and Midwifery Board of Australia and the Australian Commission on Safety and Quality in Health Care, to support its findings and recommendations for improved nursing practice.

Running head: BEING A PROFESSIONAL NURSE 1
401021 Being a Professional Nurse or Midwife – Assessment 2
Student’s Name
University

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Criteria 1. Case Summary: Summarizes the case and presenting professional practice
issues.
The case of 81year old patient A started with a complaint of breathlessness for two nights
when lying flat where the medical examination revealed that there were fine creeps at the base of
the lungs and elevated jugular venous pressure. This led to the commencement of Oral Lasix
treatment but the justification for the drug and the dosage have not been recommended. The
patient’s condition became worse where there was need for a chest x-ray and blood tests were
done. From the case study, one professional issue that was noted is the failure of the nurse to
observe the symptoms after being given Lasix. This drug has severe side effects that can affect a
patient and thus requires close observation to monitor the symptoms that develop as a result of
the side effects that arise from this drugs. Despite the fact that there were changes that were
observed on the patient, it is evident that this was not considered. The second professional issue
is the failure to document the changes in the patient especially after admission. It is evident in the
case study that the RN failed to document the observations that he was making on the patient
even when the condition was deteriorating. The role of documentation of vital signs and
symptoms is to determine the response of the patient towards the medication. This was
compromised thus affecting the care that the patient received. This means that the locum and
even the air evacuation team did not have complete notes on the patient that could assist them to
make clear decisions. The third professional issue is the admission of the patient in a critical
condition and yet there was no locum to attend to her. The patient stayed in the hospital for four
days before the locum came to see her. Even when the registered nurse indicated that the hospital
was not well equipped to handle the situation of the patient, this advice was ignored and the

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patient was forced to wait for the locum which compromised the quality of care that she
received.
Criteria 2. Contributory factors: Identify relevant professional errors that potentially
contributed to the incident happening?
One professional error in the case study is the failure by the medical team to identify the
side effects of the drug (Lasix) that was administered to the patient. From the case study, the
medical team have not indicated if they stopped administering lasix to the patient when she was
admitted or not. According to Casu & Merella (2015) lasix can cause depletion of body water,
sodium, and chloride and thus the need for close examination of the patient when under this
medication. The ACSQHC under medication safety requires hospitals to define and verify the
scope of practice for prescribing, dispensing and administering medication. This was missing
since the side effects that the patient was experienced were ignored and not assessed to
determine the effect on the patient (Australian Commission on Safety and Quality in Health
Care, 2017). From the case study, it is noted that this was not done well since the patient was
treated and left to go home and only admitted after the condition failed to improve. Further, Won
& Sang (2015) adds that the threshold of the dose differs from patient to patient and from the
case study we have not seen where the dose was prescribed and specifically what the drug was
prescribed for in the case of the patient. In addition to that, the patient had difficulties to void
which was reported after the administration with Digoxin and Valium due to the increased heart
rate of 168/min.
Another error that was made by the medical team is the failure to document the
observations that were made on the patient properly. Oczkowski, Mazzetti, Meade, & Hamielec
(2014) argue that furosemide (Lasix) has several side effects that require monitoring and

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documentation to assist in decision making. Australian Commission on Safety and Quality in
Health Care (2017) requires proffesionals to use evidence based systems to document patient
progress and prevent infections.The fact that the registered nurse did not document all the
changes observed in the patient may have affected the decisions that were made on her. This
means that the information that the VMO, the locum and even the air evacuation team used could
have been insufficient in assessing the cause of death.
Lastly, another professional issue is the admission of the patient when it was clear that
there was no doctor to attend to the patient while at the same time the hospital seemed to ill
equipped to handle the condition of the patient. Nursing and Midwifery Board of Australia
(2016) in standard four requires the nurse to develop a plan for nursing practice to meet the
needs of the patient. This quality of care of the patient was compromised since the locum and the
VMO came to assess the patient when the symptoms had worsened and even the patient having
difficulties to void. This shows that there was clear care plan for the patient was waiting for the
VMO and the locum to attend to her. The role of the patient care plan is to have a treatment plan
that details how the condition of the patient will be managed and how the patient will be assessed
during medication (Doenges, Moorehouse, & Murr, 2014; Thorsen, Hartveit, & Baerheim,
2012). The mode of treatment for patient A was not properly planned and could be one of the
reasons why the condition worsened. From here, we can note that there was a problem in
identifying the medical needs of the patient which led to the delayed referral of the patient.
Criteria 3. Implications for future practice: Discussion that includes how your practice
might change and develop as a result of this learning. What professional behaviours may
have made a difference in this situation?

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From the case study, one implication for practice is the need to administer medications
properly and monitoring the conditions of the patient keenly. From the case study, the fact that
the nursing team failed to monitor the changes in the condition of the patient when under the
medication shows that there was a medicine administration challenge. The nurse guide to
professional boundaries by the Nursing and Midwifery Board of Australia requires the need to
minimize risk and any potential for harm and improving the quality of life of the patient. The fact
that the patient died of septicemia means that there could have been drug administration issues
that could have been addressed when the condition of the patient was worsening. Thwaites,
Lundeg, & Dondorp (2016) suggests that the nature of the patient’s condition and the
medications used need to be monitored so that blood poisoning can be avoided.
Another implication for practice is the need to identify the medical needs of the patient
and at the same time determine when to seek the services of a specialized medical professional.
As seen in the case study, patient A was waiting to be seen by a locum who came late and led to
the referral of the patient. As required by the second code of professional standards, the nurses
were supposed focus on the changing needs of the patient and respond accordingly. In this case,
the absence of the locum and the fact that the registered nurse had noted that the hospital was not
well equipped to handle the condition of the patient means that these were enough reasons for
moving the patient early to the rural referral hospital. Grace & Armstrong (2016) suggests that
patient referral needs to be done when the condition of the patient is not improving or there is a
need to seek further assistance on the patient.
Lastly, this case raises the issue that there is a need for patient care plans as a way of
guiding the nature of the treatment the patient receives. Standard five of the Nursing and
Midwifery Board of Australia (2016) requires professionals to develop a plan for practice to care

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for the patient. This plan details the planned medications and the expected indicators that will be
assessed by the practitioners (Ballantyne, 2016). This medical plan makes it easy to address
patient challenges and even side effects to avoid fatalities as seen in the case of the patient where
the septicemia was not addressed by the medical team. Plans are also relevant in developing
individualized care based on the changing needs of the patient. The implication for practice
therefor, will be to review the patient condition and ensure that the nursing plan is adjusted
based on the changing needs of the patient.

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References
Australian Commission on Safety and Quality in Health Care. (2017). National Safety and
Quality Health Service Standards. Australian Commission on Safety and Quality in
Health Care.
Ballantyne, H. (2016). Developing nursing care plans. Nursing Standard, 30(26), 51–60.
Casu, G., & Merella, P. (2015). Diuretic Therapy in Heart Failure - Current Approaches.
European cardiology, 10(1), 42–47.
doi:10.15420/ecr.2015.10.01.4210.15420/ecr.2015.10.01.42
Doenges, M., Moorehouse, M., & Murr, A. (2014). Nursing care plans: guidelines for
individualizing client care across the life span. Philadelphia: Davis Company.
GRACE, J. F., & Armstrong, D. (2016). Reasons for Referral to Hospital: Extent of Agreement
Between the Perceptions of Patients, General Practitioners and Consultants. Family
Practice, 3(3), 143-147.
Nursing and Midwifery Board of Australia. (2016). Registered nurses STANDARDS FOR
PRACTICE. Nursing and Midwifery Board of Australia.
Oczkowski, S. J., Mazzetti, I., Meade, M. O., & Hamielec, C. (2014). Furosemide and albumin
for diuresis of edema (FADE): a study protocol for a randomized controlled trial. Trials,
15(222).
Thorsen, O., Hartveit, M., & Baerheim, A. (2012). General practitioners’ reflections on referring:
An asymmetric or non-dialogical process? Scandinavian Journal of Primary Health
Care, 30(4), 241–246.
Thwaites, C. L., Lundeg, G., & Dondorp, A. (2016). Recommendations for infection
management in patients with sepsis and septic shock in resource-limited settings.

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Intensive Care Medicine, 42(12), 2040–2042.
Won, S., & Sang Youb Han. (2015). Loop Diuretics in Clinical Practice. Electrolyte Blood
Pressure, 13(1), 17-21.