Nursing Case Study: Analysis of Patient A Incident and Implications

This case study analyzes a clinical incident involving an 81-year-old patient, Patient A, admitted to a GP clinic and subsequently a local hospital. The patient's condition deteriorated after being administered Oral Lasix, leading to a cascade of medical errors, including misdiagnosis, lack of effective medication, and professional negligence. The analysis identifies key professional errors, such as improper medication administration, failure to conduct comprehensive assessments, and the unavailability of the treating doctor, which ultimately contributed to the patient's death from septicaemia. The study emphasizes the importance of thorough patient history documentation, comprehensive assessments, appropriate medication management, and adherence to professional standards. The report highlights the need for improved monitoring, efficient nursing plans, and ethical decision-making in critical care settings. The case underscores the implications for future nursing practice, emphasizing the significance of systematic assessments, timely interventions, and the crucial role of communication and collaboration among healthcare professionals to prevent similar incidents.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author note

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Criteria 1
Patient A, who was 81 years old was admitted to a GP clinic with fine creps at
the base of both lungs and slightly elevated jugular venous pressure. The patient had no
renal issues. For this, she had been given Oral Lasix which resulted in deterioration of
the patient’s condition. Due to the oral Lasix given to her, after chest x-ray and blood
tests, it was detected that she was suffering from diarrhoea and tenderness in the right
abdomen. A Ventilation/Perfusion (V/Q) lung scan was conducted that found to be
“interdeterminate”. The patient refused to take food and liquid at this time and reported
to be feeling weak. The next day, The VMO concluded her to be suffering from
depression and anxiety. The doctor planned to discharge him however deterioration in
the heath of the patient was noticed. The respiratory rate of the patient started
decreasing and she eventually refused to intake any food items. Her Blood Sugar level
and heart rate were high. All the symptoms indicated that the patient was suffering from
dehydration. Along with this her abdominal pain got alleviated and her white cell count
had risen to 17.5. However, she had no fever. A urinary tract infection was diagnosed
subsequently as well as intravenous antibiotics were commenced at approximately 1430
hours.
The Registered Nurse who commenced patient A that afternoon reported that the
hospital was not equipped properly to provide her with appropriate medication. Along
with this, he stated that the doctor, when needed, was unavailable and could not be
conducted. A good number of hours following the condition were used for further
diagnosis of the patients condition. She was detected with continual diarrheraia.
However, the respondent did not arrange medication for her in spite of the fact that her

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condition kept on deteriorating. While patient A got critically unwell, she was given
saline and attempts to make her transfer to a rural hospital was done. However, no
medicine for her UTI was given. Finally, the patient died from septicaemia.
Criteria 2
The relevant professional errors that have potentially contributed to the happening
of the incident are as follows:
1. The patient was provided with the Oral Lasix while she was suffering from creps
at the base of both the lungs and slightly elevated jugular venous pressure. The
mentioned medication is provided to the patients in order to reduce the extra
fluid in the body that is caused by conditions like liver disease, heart failure as
well as kidney diseases like renal impairment. Since the patient did not have any
of the above, provision of Furosemide has resulted in dehydration. This can be
considered as a major medical error. As per the Nursing and Midwifery Board of
Australia (NMBA) Standard 1, it is highly crucial for Registered Nurses (RN) to
access, analyse as well as use the best available evidence in order to provide the
health care service users with the best medication available (Nagle & Vogt,
2018). However, this standard was not abided by the healthcare professionals
while treating patient A.
2. No documentation of history was conducted by the healthcare professionals
which is highly required in order to assess the current stage of the patient.
3. The second professional issue conducted by the VMO of the local hospital was a
lack of attention to the physical diseases. Considering the fact that the patient
was detected with diarrhoea it was highly crucial for the healthcare professionals

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to treat her on the basis of his disease. But no medication for diarrhoea was
provided to the patient.
4. Thirdly, when the V/Q test report came to be “interdeterminate”, no further test
was conducted. As per Jember et al., (2018), it highly crucial to conduct further
investigation while the V/Q test result shows “interdeterminate”.
5. While the patient was reporting right side tenderness in her abdomen, a test for
UTI needed to be conducted. Instead of the same, the VMO had given the
patient medication for anxiety and depression and asked the nursing staff to
mobilize her. According to Samsiah et al., (2016), excessive movement can
enhance any kind of Urinary Tract infection. Thus lack of effective and
systematic assessment can be evidenced. As per the NMBA standard 4, it is
highly crucial for the healthcare service providers to conduct comprehensive as
well as systematic assessment (nursing midwiferyboard.gov.au., 2019) .
However this standard has not been abided in the above mentioned scenario.
This in turn has resulted in deterioration of the condition of the patient.
6. The fifth professional error includes unavailability of the treating doctor. While
the condition of patient A got critical, the RN reported that she was not able to
contact the training doctor which in turn resulted in delay of the treatment.
Along with this, the condition of the patient was not documented by the RN
(Feleke et al., 2015). Unavaiability of the doctor resulted in delay in the
treatment that in turned caused further deterioration of the health of the patient
7. While it was clear that patient A was suffering from diarrhoea and UTI, no
medication has been provided to her. Even when medicines were arranged for
other patients. No mention of the medicines was conducted by the respondent

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during that time (Dyab et al., 2018). This action of the respondent demonstrates
professional negligence that eventually contributed to the death of patent A.
8. While the condition of the patent was critical, the management tried to transfer
the patient to a rural hospital. This decision of the mentioned healthcare home
was unethical since transferring patient in vulnerable condition can cause the
death of the patient.
Criteria 3
From the above discussed scenario, wrong diagnosis, lack of effective
medication, negligence and wrong provision of medicine has resulted in the death of
patient A. The first step that needs to be incorporated in the local hospital is
documentation of the patient’s history. This step will help the healthcare professional to
understand the reason behind the illness of the patient. Documentation of the patient’s
history could have enabled the VMO of the patient (nursing midwiferyboard.gov.au.,
2019). A to understand that the patient is suffering from dehydration due to the
consumption of oral Lasix.
The next professional behaviuor change that needs to perform is a
comprehensive assessment of the patient and provision of medication on the basis of the
assessment. While the patient was detected with diarrhoea effective medications for the
mentioned disease should have be provided to the patient. Along with this, since the
patient had reported abdominal pain, effective detection of the reason behind abdominal
pain should have been conducted when the V/Q test came interdeterminate. Tests like
Uranology and should be conducted in such cases.
Thirdly, since the patient was not intaking any kinds of solid or liquid food
items, it was necessary to provide her with nutrients intravenously. This could have

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enhance her heath to an extent and prevent her condition from getting more critical.
Lack of appropriate monitoring was evidenced clearly in the given scenario. Hence it
has become highly crucial to monitor the condition of the patient and provide
medication on the basis of the condition of the same. As per the NMBA code of
conducts, standard 7, it is highly crucial to take the responsibility of the practice based
on the goals and agreed priorities (nursing midwiferyboard.gov.au., 2019). Along with
this, it is highly crucial for the management to develop a highly efficient nursing plan in
order to ensure effective care for the patient.

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Reference List
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Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). Proportion of
medication error reporting and associated factors among nurses: a cross sectional
study. BMC nursing, 17(1), 9.
Nagle, C., & Vogt, T. (2018). Midwife standards for practice: one size does fit
all. Women and Birth, 31, S51.
nursingmidwiferyboard.gov.au (2019). Nursing and Midwifery Board of Australia -
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Professional-standards/registered-nurse-standards-for-practice.aspx [Accessed
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Samsiah, A., Othman, N., Jamshed, S., & Hassali, M. A. (2016). Perceptions and
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