University Case Study: Complex Care Patient Assessment

This case study presents an analysis of a patient, John Hayes, admitted to the emergency department with abdominal pain. It details the systematic assessment, including diagnostic tests like abdominal radiographs, CT scans, and ultrasounds, used to identify potential issues such as gallstones. The assignment emphasizes treatment priorities, such as diet and exercise, and the role of the nurse in managing the patient's condition, considering the patient's history of pulmonary embolus and ethical considerations. Discharge planning is also addressed, including patient education, self-management strategies, and application of the Social Justice Framework to ensure equitable care. The case study highlights the importance of comprehensive patient care, effective communication, and adherence to ethical principles throughout the treatment process.

Running Head: COMPLEX CARE
COMPLEX CARE
Name of the Student
Name of the University
Author Note

1COMPLEX CARE
Introduction
John Hayes is a patient who has been admitted to the emergency department due to
the pain in the right upper quadrant of the abdomen. The temperature as recorded by the
nurse at the time of admission was 36.5 and the rate of respiration was 28. The blood pressure
as recorded by the nurse was 100/60 which is a lower blood pressure. The pain score of the
patient was 9/10 that indicated the severity of the pain. The GCS or the Glassgow Coma
Score was 15 that indicated lower head injury.
Systematic Assessment
As John was suffering from pain in the upper abdomen the assessment that should be
done for the patient includes abdominal assessment, which is an indicative of the gallbladder
stone or peptic ulcer, gastritis or hepatitis and liver abscess. Thus, the required assessment for
the diagnosis of the patient’s condition involves non-imaging tests, imaging tests, and
ultrasound imaging. Thus all these diagnosis evaluation is under the abdominal assessment
(Greenberg et al. 2016).
ABDO
As the patient was suffering from right upper abdominal pain there is a multitude of
useful diagnostic tests are amylase tests, urinalysis, white blood cell count, ECG, and liver
function tests (Working and APA 2013). The liver function tests are the most useful
laboratory tests on a preliminary basis as certain abnormalities suggest that the patient is
suffering from hepatobiliary disease. Along with this, it can also point out the abnormal
functioning of the liver parenchyma or the biliary process. The renal, cardiac abnormalities
and the pancreatic abnormalities can be identified by the results of the urinalysis, serum
amylase level as well as ECG (Forsmark 2013). This can be used to detect the presence or
absence of any kind of calcifications that are present in the gallbladder. The liver function
tests should be helpful for the patient as it can help to detect the abnormalities that are
prevalent in the patient’s liver (Phillip, Steiner and Algül 2014).
RENAL
After the non-imaging tests, the imaging tests that should be done by the nurses on an
initial basis involves radiographs of the abdomen and the chest as well (Wu and Banks 2013).
These methods are very rapid and inexpensive way of evaluating the patient for the sources

2COMPLEX CARE
of pain in the abdomen and intestine. Along with this, these radiographs can help in the
detection of any kind of calcifications in the kidney, appendix, ureter, and in the pancreas.
These methods can be used in case of the abdominal pain as gallstones cause calcifications
that are radiopaque and can be detected by the use of the radiographs (Working and APA
2013). Computed Tomography is a better technique for the detection of the calcifications in
compared to the plain radiographs and hence can detect the presence of gallstones more
sensitively. It can also detect the cholesterol stones as well as the stones that contain gas.
Along with this it can locate the position of the gallstone and can also confirm whether the
stone is in the gallbladder or not (Forsmark 2013). These techniques can be used in the
treatment of the gallstones in the patient as it can help the clinicians to detect the position of
the stone and also to detect the type of the stone. This will ultimately help the doctors to
provide the right kind of intervention that is needed for John Hayes. It can also help to detect
that whether the stone is located in the John’s bladder, kidney or appendix (Phillip, Steiner
and Algül 2014).
There are a number of research that shows that the ultrasound is very effective in the
detection of gallstones. It has been seen that the sonography is highly accurate for the
detection of the gallstones. These techniques are useful because ultrasound helps in getting
the pictures of the gallbladder and the bile duct. It helps to show the signs and the symptoms
of inflammation and indicates that the flow is blocked in the bile duct (Cooper, Burden and
Molassiotis 2015). This can be used for the patient John who has the similar kind of pain in
the abdomen to identify whether the patient has gallbladder stones or not. It will also help to
know the size of the stone that will help the doctors to analyze the situations of the patient
and that can be a better treatment process for the patient (Greenberg et al. 2016).
Priorities of Treatment
The priorities of the treatment will include the necessary actions that should be taken
by the nurses for John when he has been hospitalized. This highlights the role of the
registered nurse or the RN who works and manages all the actions that has to be taken for
John.
As the primary diagnosis of the patient shows that the patient is 130 kg and lives all
alone. Thus the primary treatment for the patient that has to be taken by the nurse involves
the use of minimal exercise and the maintenance of a strict diet plan. The exercise should
help the patient to keep the weight under control and also to be healthy and active (Tenner et

3COMPLEX CARE
al. 2013). The first priority of the nurse is to advice the patient to eat healthy food and to
maintain a healthy lifestyle. As the couple stays at a high set house and it becomes difficult
for them to do regular up and down the stairs and thus, they should change the location and
should stay somewhere close to the primary healthcare center near them (Forsmark 2013).
This will be helpful as they do not have to put strain on their limbs and can also get easy
access to the medical treatment. Another intervention to manage the weight will be the intake
of food that is rich in fiber and have less calories and sodium. This will help john to feel
active all through the day. As they stay all alone thus, it is the responsibility of the nurse to
educate them about the disease and also to encourage them to learn the self-management of
the disease (Working and APA 2013).
The body temperature of John was 36.5 degrees which was normal. After John was
admitted to the hospital the P102 was also measured along with the respiratory rate and the
blood pressure that were recorded to be 28 and 100/60 respectively (Wu and Banks 2013).
Thus, the nurse should take care of the fact that the patient restores the normal breath rate that
is 12-20 breaths per minute. In order to keep the blood pressure under normal the intervention
hat should be taken by the nurse involves restricting the patient form doing certain work that
causes exhaustion in him (Greenberg et al. 2016). This will help the patient as the patient has
a history of pulmonary embolus. Pulmonary embolus that occurs when there is a clump of
blood that gets entangled in the artery of the lungs. These blood clots generally travel from
the legs that arises from a condition called Deep Vein Thrombosis or DVT due to the
excessive weight of the patient. Thus the embolus can travel from the fat droplets that are
clogged in the blood veins (Phillip, Steiner and Algül 2014). Thus, the most important step in
the intervention of the patient involves the weight management. While providing the
treatment for the abdominal pain the nurse should also keep in mind about the past disease
that has been faced by the patient. Thus, in the process of treatment the nurse should
compress the legs of the patient to prevent the clotting of the blood and will also prevent the
travelling of the blood clot (Schepers et al. 2013).
The other critical approach that has to be taken by the RN is the documentation of the
records of the patient at the time of the admission (Nesvaderani, Eslick and Cox 2015). It is
very important for the nurse to know and record the observations that are related to the
patient as it can be needed by the doctor for the proper analysis of the patient. It is very
necessary for the nurses to keep a track of the patient details as it is an important element of
providing quality, safe and evidence-based treatment to John. The nurse should also

4COMPLEX CARE
communicate effectively with the patient to know whether the treatment plan is working or
not (Portelli and Jones 2017). The communication between the nurse and the patient enables
the nurse to know that whether the patient is responding with the treatment process or is
satisfied with the services. They can also know whether the patient wants certain changes in
the treatment plan or is facing certain challenges with the healthcare services that are
provided by the healthcare staff (Karakayali 2014; Cooper, Burden and Molassiotis 2015).
The RN should also consider the ethical issues that are related with the treatment of
John. As John was an older patient then the nurse should be considerate with the process of
treatment should consider the fact that John and his wife Beryl stays all alone. The nurse
should always respect the autonomy of the patient (Kota et al. 2013). This can be done by
informing the patients about their clinical processes, line of treatment and any change in the
defined treatment process. The next ethical principle that has to be considered by the nurses
involve the maintenance of confidentiality regarding the information and the details of the
patients (O’Reilly et al. 2014). It is necessary to maintain confidentiality of the patients for
the proper treatment and evaluation of the patients.
Whenever, the clinicians have to take the decision for the patient they should make
the situation autonomous for the patient and should ask them to participate in the decision
making. The nurse should ask John to ask his son to join in the treatment process so that
whenever a situation arises when John and his wife are impaired or unable to take the
decision their son can take the decision on their behalf. This will help the patient to stay
involved and their family member will be able to take part in the decision making process of
the treatment process (Kapritsou et al. 2014; Axtner et al. 2016).
Discharge Planning
The discharge planning for John will involve the education of the patient about the
disease. This will help the patient to know the signs, symptoms, causes and the prevention
steps that are necessary for the patient to avoid the reoccurrence of the same situation. This
will help in the improvement of the patient outcome and will also help in the prevention of
the condition to some extent (Cooper, Burden and Molassiotis 2015). The next step in the
discharge planning will involve the involvement of the process of the self-management of the
disease in the patient. This will involve the consumption of meals that are small and the
restrictions of the diet that has to be followed by the patient. The nurse should also teach the

5COMPLEX CARE
patient to reduce the intake of alcohol and should ask the patients to continue their vitamin
supplements for the faster recovery (Axtner et al. 2016).
As per the Social Justice Framework the process of delivering effective and compact
healthcare services and interventions involves principles of social justice. It involves
establishment of an environment that is supportive and helps in promoting diversity. The
principles of social justice involves the management of the inequities of the work in the
healthcare services that are based on the mortality and morbidity rate along with the social,
economic, political and cultural factors. In this case, the discharge planning should be based
as per the SJF and should include the justice that should be done to John (Benfer 2015). Thus
the nurses should make the discharge plan as per the SJF so that all the rights of the patients
are conserved and preserved as well. This will encourage the patients to respond in a better
way and will also help in the better treatment of the patient. This will also give a positive
patient outcome and will build up a strong relation with the nurse and hospital.

6COMPLEX CARE
References
Axtner, J., Steele, M., Kröz, M., Spahn, G., Matthes, H. and Schad, F., 2016. Health services
research of integrative oncology in palliative care of patients with advanced
pancreatic cancer. BMC cancer, 16(1), p.579.
Cooper, C., Burden, S.T. and Molassiotis, A., 2015. An explorative study of the views and
experiences of food and weight loss in patients with operable pancreatic cancer
perioperatively and following surgical intervention. Supportive Care in Cancer, 23(4),
pp.1025-1033.
Forsmark, C.E., 2013. Management of chronic pancreatitis. Gastroenterology, 144(6),
pp.1282-1291.
Greenberg, J.A., Hsu, J., Bawazeer, M., Marshall, J., Friedrich, J.O., Nathens, A., Coburn, N.,
May, G.R., Pearsall, E. and McLeod, R.S., 2016. Clinical practice guideline:
management of acute pancreatitis. Canadian Journal of Surgery, 59(2), p.128.
Kapritsou, M., Korkolis, D.P., Giannakopoulou, M., Kaklamanos, I., Elefsiniotis, I.S.,
Mariolis-Sapsakos, T., Birbas, K. and Konstantinou, E.A., 2014. Fast-track recovery
after major liver and pancreatic resection from the nursing point of
view. Gastroenterology Nursing, 37(3), pp.228-233.
Karakayali, F.Y., 2014. Surgical and interventional management of complications caused by
acute pancreatitis. World Journal of Gastroenterology: WJG, 20(37), p.13412.
Kota, S.K., Krishna, S.V.S., Lakhtakia, S. and Modi, K.D., 2013. Metabolic pancreatitis:
etiopathogenesis and management. Indian journal of endocrinology and
metabolism, 17(5), p.799.

7COMPLEX CARE
Nesvaderani, M., Eslick, G.D. and Cox, M.R., 2015. Acute pancreatitis: update on
management. The Medical Journal of Australia, 202(8), pp.420-423.
O’Reilly, D.A., Malde, D.J., Duncan, T., Rao, M. and Filobbos, R., 2014. Review of the
diagnosis, classification and management of autoimmune pancreatitis. World journal
of gastrointestinal pathophysiology, 5(2), p.71.
Phillip, V., Steiner, J.M. and Algül, H., 2014. Early phase of acute pancreatitis: assessment
and management. World journal of gastrointestinal pathophysiology, 5(3), p.158.
Portelli, M. and Jones, C.D., 2017. Severe acute pancreatitis: pathogenesis, diagnosis and
surgical management. Hepatobiliary & Pancreatic Diseases International, 16(2),
pp.155-159.
Schepers, N.J., Besselink, M.G., van Santvoort, H.C., Bakker, O.J., Bruno, M.J. and Dutch
Pancreatitis Study Group, 2013. Early management of acute pancreatitis. Best
practice & research Clinical gastroenterology, 27(5), pp.727-743.
Tenner, S., Baillie, J., DeWitt, J. and Vege, S.S., 2013. American College of
Gastroenterology guideline: management of acute pancreatitis. The American journal
of gastroenterology, 108(9), p.1400.
Working, G.I. and APA, A.P.G., 2013. IAP/APA evidence-based guidelines for the
management of acute pancreatitis. Pancreatology: official journal of the International
Association of Pancreatology (IAP)...[et al.], 13(4 Suppl 2), p.e1.
Wu, B.U. and Banks, P.A., 2013. Clinical management of patients with acute
pancreatitis. Gastroenterology, 144(6), pp.1272-1281.
Benfer, E.A., 2015. Health Justice: A Framework (and Call to Action) for the Elimination of
Helath Inequity and Social Justice. Am. UL Rev., 65, p.275.