Assessment 2: Patient A Case Study and Professional Practice Issues

This report presents an analysis of a patient case study, focusing on the care provided to an 81-year-old patient, Patient A, who was admitted to the hospital with breathlessness. The report summarizes the case, highlighting the patient's deteriorating condition and the medical team's response, including medication administration and diagnostic tests. The analysis identifies several professional errors, including failures to adhere to nursing standards, codes of ethics, and professional conduct. Specifically, the report discusses inconsistencies in patient assessment, the failure to recognize and address the side effects of medication (Furosemide), and a lack of individualized care. The report then explores the implications of these errors for future nursing practice, emphasizing the need for improved adherence to standards, codes, and professional boundaries to enhance patient safety and quality of life. The analysis draws on key references such as the Nursing and Midwifery Board of Australia's standards for practice, code of ethics, and guide to professional boundaries to support its conclusions and recommendations. The report concludes with a call for healthcare professionals to learn from these errors and improve their practice.

Running head: ASSESSMENT 2 1
Assessment 2
Student’s Name
University

ASSESSMENT 2 2
Assessment 2
Criteria 1. Case Summary: Summarizes the case and presenting professional practice
issues.
This is a case of patient A, who is 81years and had come to the hospital on day one
complaining of feeling breathlessness for two nights when she lied flat. When examined she was
discovered to have fine creeps at the base of her lungs and an elevated jugular venous pressure.
She was immediately put on an oral Lasix dose to control the condition. The following day she
came back complaining of worsened symptoms where an x-ray and blood test were done. Since
the condition had worsened, she was admitted to the facility for further observation and
treatment. On the 4th day, a VMO reviewed the patient and observed that she was having
diarrhea and tenderness in the right abdomen. Her atrial fibrillation had also changed and she
reported feeling dizzy. She started refusing food where the VMO was forced to recommend for a
V/Q scan whose justification has not been given and the findings not justified. The following
day, 0830hrs the VMO assessed the patient and reported that she was depressed and anxious due
to failure to it which led to the need for the nurse to mobilize her. The patient continued
worsening where she became tachycardic, woozy, cold and feeling back pain. On the following
day, the patient became pale, grey, felt nausea, had a clammy skin and was unable to void. At
1330hrs on the sixth day, an assessment revealed that her white cell count had increased to 17.5
and no fever had been reported. When the registered nurse John reported on duty she reviewed
the medical notes and observed that the hospital was unequipped to take care of the condition of
the patient. Dizziness, low blood pressure and abdominal pain increased as time went on. During
1810hrs the RN reviewed the patient and performed an ECG on the patient although this was not
documented. An ISBAR form was filled at 2100hrs in preparation for the locum who came later

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and requested for a large IV cannula to be used to treat dehydration. Since the condition had
worsened the locum and RN started the process of referring the patient to the nearest rural
hospital where the patient died while being transported. The patient later died the following day
with the cause of death being septicemia.
Criteria 2. Contributory factors: Identify relevant professional errors that potentially
contributed to the incident happening?
The Nursing and Midwifery Board of Australia (2016) in standard five suggests that the
professional is supposed to develop a plan for practice that will be used in caring for the patient.
This means that there is a need to think critically and analyze information to use in nursing
practice. The challenge faced by patient A is the fact that most of the information collected from
the patient was not used in informing the care process that was done on the patient. This is why
there were delays in referring to the patient even after the registered nurse had clearly stated that
the hospital was not well equipped to handle the patient. Finnell, Thomas, Nehring, McLoughlin,
& Bickford (2015) addds that when standards are not followed, proffesionals are prone to make
mistakes and even risk the life of the pateint. The fourth standard also requires healthcare
professionals to comprehensively conduct an assessment on the patient to inform decision
making. This standard was not followed since errors were made as seen in the inconsistencies in
collecting and assessing patient information. Every sign and symptom that the patient showed
during the assessment was used not used in informing the care that the patient receives. This
means that the practitioners failed to observe the standards of practice and even the code of
ethics for practice.
From the case study, it is evident that the medical team failed to diagnose the changing
condition of the patient from the second day onwards. Furosemide (Lasix) as a drug has side

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effects that require the patient to be monitored closely checking vital signs and any other
symptoms that reflect the side effects of the drug (Waskiw-Ford, et al., 2018). Since the patient
reported dizziness, diarrhea, back pain and even tenderness in the lower abdomen, this could
have been pointing to the side effects of the drug. From the first standard of practice, the nurse is
supposed to think critically using patient information for decision making (Nursing and
Midwifery Board of Australia, 2016). This is was not applied in this case because most of the
signs and information that was collected about the patient was not utilized.
From the case of patient A, the code of ethics was not applied where the role of the nurse
is to value the quality of life by putting measures in place to improve the patient’s condition.
This was not evident in the case of patient A since no effort was made to make the patient enjoy
the quality of life by controlling the abdominal pain, dizziness and even nausea that the patient
was undergoing. In this situation, individualized care was required to ensure that the patient
receives the quality of care. This led to the failure to identify the side effects of the laxis drug.
According to the case study, the patient not responding and the side effects of the drug seemed to
increase and yet nothing was done about it. Qavi, Kamal, & Schrie (2015) argue that
Furosemide (Lasix) is a sensitive drug that needs to be used keenly while monitoring the side
effects to avoid fatalities. The nurse guide to professional boundaries by the Nursing and
Midwifery Board of Australia requires professionals to minimize risks where there is potential
for harm. In this case, no effort was made to minimize the risk since the symptoms that the
patient displayed were not identified and treated.
Criteria 3. Implications for future practice: Discussion that includes how your practice
might change and develop as a result of this learning. What professional behaviors may
have made a difference in this situation?

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From the case of patient A, it is evident that the nursing standards for practice, the code
of professional conduct for nurses, and the code of ethics for nurses were not observed since
there were errors and inconsistencies in meeting the needs of the patient. The need to administer
medications properly is guided by nursing standards and professional boundaries. Since the
nursing team failed to monitor the changing condition of the patient and using the assessment
information to make, then it is clear that the patient’s life could have been saved. Poorchangizi,
Farokhzadian, Abbaszadeh, Mirzaee, & Borhani (2017) suggests that the role of nursing
standards is to reflect the desired competent level of care which directs professionals to maintain
a safe and clinically competent practice. If the standards were observed, they could have guided
in assessing the patient and dealing with complications that she was developing. This calls for
the need to assess and collect patient information that can be used in determining the type of care
that will be administered.
According to Olsson, Ung, Swedberg, & Ekman (2013) patient-centered approaches have
been regarded as the best way for tailoring nursing care to patient’s needs. As seen in the case
study, most efforts were primary care and not individualized to reflect the condition of the
patient. After admission, there was the need to apply the second code of professional conduct for
nurses where nurses are supposed to practice in accordance to the professional standards by
focusing on the changing needs of the patient. This relates to the fifth registered nurse standards
for practice which requires professionals to develop a plan for nursing practice that puts the
needs of the patient first. This leads to informed decision making as required by the code of
ethics since it builds on the information gathered from the patient. The role of nursing plans is to
achieve patient-centered care through tailoring the care process to meet the changing needs of the
patient. This was missing for the case of patient A since the care process was not designed to

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reflect her changing condition. Despite the fact that she was feeling abdominal pain, dizzy,
woozy, experiencing nausea and not eating, there was a little attempt made to incorporate
mechanisms to improve the quality of life for the patient. Thus in future practice, there is a need
for professionals to work using the set standards, codes, boundaries and regulations to improve
quality of life.

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References
Finnell, D. S., Thomas, E. L., Nehring, W. M., McLoughlin, K. A., & Bickford, C. J. (2015).
Best Practices for Developing Specialty Nursing Scope and Standards of Practice. The
Online Journal of Issues in Nursing, 20(2).
NursingandMidwiferyBoardofAustralia. (2016). Registered nurses Standards for Practice.
Nursing and Midwifery Board of Australia.
Olsson, L.-E., Ung, J., Swedberg, K., & Ekman, I. (2013). (). Efficacy of person-centred care as
an intervention in controlled trials - a systematic review. Journal of Clinical Nursing,,
22(3), 456-465.
Poorchangizi, B., Farokhzadian, J., Abbaszadeh, A., Mirzaee, M., & Borhani, F. (2017). The
importance of professional values from clinical nurses’ perspective in hospitals of a
medical university in Iran. BMC Medical Ethics, 18(20).
Qavi, A. H., Kamal, R., & Schrie, R. W. (2015). Clinical Use of Diuretics in Heart Failure,
Cirrhosis, and Nephrotic Syndrome. International journal of nephrology, 10(5).
Waskiw-Ford, M., Wu, A., Mainra, A., Marchand, N., Alhuzaim, A., Bourbeau, J., . . . Jensen,
D. (2018). Effect of Inhaled Nebulized Furosemide (40 and 120 mg) on Breathlessness
during Exercise in the Presence of External Thoracic Restriction in Healthy Men.
Frontiers in Physiology, 9(86).