Case Study – Written Assignment

REQUIREMENTS

Final Due

You have been granted an extension. Your final is now due on Thu 20th Apr at 11:59 PM.

Weighting

It’s worth 40% of the unit

Word limit

2000 words; including references

Referencing

You’re required to follow APA

TASK

Purpose 🎯
 

This assessment is designed to develop your skills in:

Evaluating the pathophysiological, pharmacotherapy and non-pharmacological management of acute exacerbation of illness, chronic diseases, and complex conditions. 

Applying critical thinking, reasoning, Code of Conduct and Standards of Practice for nurses, clinical decision making, that govern nursing practice, including ethico-legal and cultural considerations, and applying evidence for patient care assessment, planning, nursing management and evaluation of safe effective nursing care. 

Integrating principles of teamwork, and inter-professional teamwork, communication and evidence-based practice into safe, ethical and compassionate family centred care. 

 

Task Details ✏️
 

This assignment requires you to consider the case scenario of Ebony White.  You are required to write a 2000-word analysis of the case scenario. Your answer will examine a case of a patient cholelithiasis/cholecystitis and who has undergone an open cholecystectomy.  

 

Applying your knowledge and understanding of gastrointestinal function, hypertension, hypercholesterolaemia, associated pathophysiology and aetiology including surgery you will write an academic essay applying the following principles throughout your discussion:

 

Question 1 (500- 600 words)

 

Examining the pre-operative assessment data and clinical signs and symptoms, outline the collaborative assessment data that would support the patient’s probable diagnosis of cholelithiasis/cholecystitis in the context of the patient episode.

 

Your response will provide an articulate, insightful discussion relating to the pathophysiology, aetiology and prevalence of cholelithiasis/cholecystitis. You will support your answer by explaining how the clinical assessment data and clinical signs and symptoms indicate cholecystitis.  As an example, you may explain why the patient with cholecystitis presents with shoulder tip pain and respond by demonstrating an understanding of the linkages with pathophysiology and objective and subjective clinical signs of cholecystitis. Evidence provided from the case study explicitly supports and relates to your analysis of the clinical data and diagnosis and links with the underlying pathophysiology and symptomatology (clinical signs and symptoms) the patient would experience.

 

Question 2

Examine the case to identify actual clinical issues, nursing interventions and rationales (1100-1200 words)

This section will focus on the post-surgical care for the patient.  Consider Ebony’s co-morbidities including obstructive sleep apnoea (OSA), hypertension, and hypercholesterolaemia in the context of recovering from surgery. Importantly, consider the postoperative clinical data such as increased pain, to determine the priority issues and how you will monitor and manage the issue.   Justify each problem based on Ebony’s clinical assessment data.

 

Identify THREE (3) PRIORITY clinical issues (for example, based on the patient’s current condition, the nurse recognises that the patient’s priority needs will be to prevent ____________.

Choose NURSING INTERVENTIONS for each of the three clinical issues e.g., monitor urine output hourly.  

 

Your response will require you to refer to pathophysiology to explain why you are encouraging hourly deep breathing and  a synthesis and an analysis of the evidence-based literature to support your answer.

 

Suggestion: Intervention: Encourage deep breathing exercises including use of the spirometry, hourly; Rationale: Smith (2019) surmises that deep breathing promotes normal lung expansion increases oxygen levels and is useful in preventing pneumonia and atelectasis. 

 

Provide RATIONALES for each nursing intervention. Rationales justify your interventions, are referenced. e.g. explain the pathophysiology of why you are monitoring Ebony’s urine output hourly

Case 🔎

Ebony White a 60-year-old obese female is being seen in her general practitioner’s (GP’s) office with a possible history of gallstones and now with a possible diagnosis of cholecystitis. Ebony works full time as a ward medical receptionist in a busy Brisbane hospital.  

 

Her daily medications include Lisinopril for a 5-year history of hypertension, Simvastatin and a multivitamin.  

 

When asked about exercise and diet, the patient reports that due to both her and her husband working long hours, they frequently eat take away food. She occasionally goes bush walking with her husband and two dogs. 

  

The patient reports that in the past month she has experienced progressively worse indigestion and upper right quadrant pain occurring several hours after eating meals high in fat and is especially severe when going to bed. Using a pain intensity scale, the patient reports the intermittent pain to be 6/10 to 8/10 with the pain radiating to the right shoulder tip. Her urine has also recently been dark coloured.

 

The pain subsides after a few hours, but the patient reports that her right upper quadrant always feels tender. Ebony is mildly jaundiced, and recent blood results revealed an elevated white blood count.  

Pre-operative clinical data

Objective Data	Past Medical History	Social History
Current Medication Multivitamin  Lisinopril 40mg mane  Simvastatin 40mg nocte   Amber coloured urine Mildly jaundice  Urinalysis – normal  Temperature 37.2â—¦ C  RR 18  HR 88  BP 155/100  Height 168 cm  Weight 120kgs	Obstructive sleep apnoea (OSA) confirmed with sleep study January 2011  Hypertension  Hypercholesterolemia	Family history Mother 84 years of age: myocardial infarction: 52 years of age and gall stones with cholecystectomy:32 years of age Father deceased: myocardial infarction   Smokes 10 cigarettes/day  Independent with daily cares   Medical receptionist  Married with 2 grown children

Scenario Continued: Ebony had an open cholecystectomy 24 hours ago for cholecystitis. As the RN, you are caring for Ebony on the day shift and at 0700, have received a handover from the night RN. Ebony reports feeling nauseous for the past 24 hours and has not been able to eat or drink without vomiting. She also has an intravenous infusion (IV) Normal Saline (NaCl) 0.9% infusing at 60mL/hour in her right basilic vein. Using the pain intensity scale, she reports that the pain medication she received 1 hour ago decreased her pain level from an 8/10 to 6/10. She is unable to deep breath and cough due to the pain and she appears mildly drowsy. She has a T-tube draining a moderate amount of bile. The dressing on her right upper quadrant is clean and dry.

Observations 0600	Medications	Post-operative orders
-BP 90/55mmHg  -Pulse: 88   -Respiratory rate: 14/min shallow   -SpO2 95% 2 litres via nasal prongs  -Temperature -37.2°C   -Sedation score = 0-1  -T tube draining a moderate amount of bile -Urine output via a Foley -IDC: 10-15 mls/hour <1mL/kg/hour (last 4 hours)  Pain score: 6 (on a scale of 0-10)	IV Cefoxitin 2gms TDS  Normal Saline 0.9% 60mL/hour  Intravenous infusion:  Oxygen 2L via nasal prongs  Tapentadol SR 100mg b.d.  Regular paracetamol 1G QID (PO/IV)  Fentanyl PCA 20mcg bolus: 5-minute lockout  Lisinopril 40mg/day  Simvastatin 40mg nocte	Outpatient appointment 2/52 in the surgical out-patients department   DVT prophylaxis –TED stockings    Remove IDC 0800, day 1  Clear fluid diet (upgrade diet after surgical review) Cease PCA 0800, day 1.  Change to PRN oxycodone   Mobilise as able    Dressing in-situ until review

 

Additional Information 📚

To help you complete this task successfully, the following resources are provided:

Cadmus Manual — refer to this for information about academic skills (click the ? icon in the bottom right to access the manual)

 

Checklist: How to write a Case Study ✅

Copy + paste this checklist into the Notes section in Cadmus and tick off items as you complete them.

 

Step 1: Task Understanding

 

Step 2: Analyse Case

 

Step 3: Topic Research

 

Step 4: Plan

Based on your analysis and research, plan how you will answer the questions. Use the guide below to structure your plan:

 

Step 5: Write

 

Step 6: Review

 

Step 7: Submit Final

 

** These instructions were released on 12th Apr at 1:36 P

Once graded, review feedback in Cadmus

Check your email for a submission confirmation email

Submit your completed Case Study before the final due date

Read the Marking Rubric again to check that you have met the criteria

Check that citations and references match

Check your work for paraphrasing and/or citation errors.

Submit your work to generate a Turnitin Similarity Report (you can submit your work as many times as you like before the due date)

When you have completed your Case Study, review your work carefully for spelling, grammar or other errors

TIP: to avoid plagiarism, you must give credit if you use the work of others (see Referencing section in Cadmus Manual)

Things to remember:

Clear writing: use short simple sentences and familiar terms

Objective writing: be unbiased and unemotional, presenting facts or evidence for your argument

Accurate writing: present accurate and complete information

Use APA 7th formatting style. The first line of each paragraph is indented. The reference list starts on a new page with the heading References. References are listed alphabetically and have the second and subsequent lines indented  https://usq.pressbooks.pub/apa7/

Use subheadings for each section 

Bullet points, numbering, use of tables or figures must not to be used 

Academic writing: Present your assignment in a scholarly fashion i.e., academic writing conventions and written in the third person 

Building on your plan, write your assignment.

Conclusion (approx. 100 words)

Provide a critical review and summarise the main findings of the assignment. 

Question 2: Identifying clinical issues, nursing interventions and rationales (1100-1200 words)

Clinical issues

Consider pathophysiology and aetiology of Ebony’s co-morbidities, current medications, surgery, and response to general anaesthesia 

Consider the clinical assessment data you have been given in the case and other assessment and clinical data you will need to collect to care for Ebony 

Choose three (3) prioritised clinical issues related to caring for Ebony in the post-operative period. Clinical issues will be supported with contemporary published literature

Consider the subjective and objective clinical data that is necessary to develop a nursing plan of care for Ebony relevant to the context of the case scenario (be specific to the case scenario)

It is expected that the information in this section will be referenced (Academic sources 4-6 would be reasonable for this section) 

Prioritised interventions supported with researched rationales

Evidenced based nursing interventions and rationales should relate to pathophysiological processes and aim to improve clinical outcomes. This includes interventions that will aim to detect and prevent patient deterioration and improve patient clinical outcomes.

The rationales support your interventions and justify the reasons for your chosen clinical issues and explain why they are a priority.  Rationales need to be referenced. (Academic sources 4-6 would be reasonable for this section

Question 1: Assessment findings and diagnosis (500-600 words)

Determine which collaborative assessment findings that includes subjective and objective data which supports a diagnosis of cholecystitis  

Describe (succinctly and briefly) the underlying pathophysiology, aetiology and symptomatology (clinical signs and symptoms) the person may experience. This will require you to research cholecystitis and cholelithiasis and sequelae of the disease to explain the symptomatology (clinical signs and symptoms) the person is experiencing

Introduction (approx. 100 words)

An introduction will provide clear scope about the direction of your assignment.  This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.

Provide an overview of the structure of the assignment. Provide a brief overview of how you will approach each section. Outline examples in your essay that will be used to respond to the assignment question.  Avoid restating the case study.

You should aim to find at least 10-12 articles in total

Locate a selection of peer-reviewed journal articles that support your analysis and will help you to answer the questions

To help you understand the situation, investigate all areas of The Case, including:

How the assessment findings are linked to the pathophysiology of disease

Potential complications

Prioritised nursing issues

Nursing interventions and rationales

Read The Case carefully and thoroughly

Carefully analyse the assignment questions to understand what you need to do.

Read the Guide: Rubrics in Cadmus Manual and then your Marking Rubric

Read the Instructions and Checklist carefully

The Case — read this to understand the details of the case

Checklist: How to write a Case Study — use this to help you complete the task

Marking Rubric — refer to this to understand how you will be assessed