Case Analysis- Case Study of an Acute Life-Threatening Condition Word Count There is a word limit of 1000 words. Aim of assessment The aim of this assessment is to enable students to: 1. Demonstrate knowledge by analysing the information provided in the case study. 2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework. 3. Discuss nursing strategies and evidence-based rationales to manage a patient with sepsis 4. Discuss the pharmacological interventions related to the management of a patient with sepsis Details You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. Case study Mrs Casey Smith is a 28-year-old lady presenting to the emergency department at 1900hrs with fevers and right flank pain. Unwell for last 10 days with right loin flank pain and suprapubic pain. Developed fevers, dysuria, frank haematuria 2 days ago. Complains of myalgia, nil respiratory symptoms. Nil diarrhea. Has nausea, nil vomiting. Nil chest pain. Unsure of pregnancy status. Received 500mL Normal Saline IV bolus on arrival. Past Medical History: Nil Current Medications: Elevit Nursing Assessment at 2000hrs: A. Patent, own B. RR-18/mt, SPO2-99%RA. Spontaneous, no increased work of breathing, chest clear, good air entry B/L, no added sounds. C. Heart Rate Regular- 124/mt, tachycardic. BP- 90/58 mmHg. Capillary Refill Time D. GCS-14/15 E4V4M6 (was GCS-15/15 on arrival). E. Febrile T: 38.9 C. No peripheral edema. No rashes. Abdo: Suprapubic tenderness, not peritonitic, bilateral flank tenderness R>L, bowel sounds Present. IVCx2 Rand L antecubital fossa in situ. F. No IV fluids in progress. G. BSL-4.8 mmol/L Weight: 58 kg Bedside Urinalysis: Leucocytes ++, nitrites ++, blood +++, BHCG +ve Midstream Urine sent to lab for culture Lab Results:

	Result	Reference Range
Sodium	137 mmol/L	135-147 mmol/L
Potassium	3.9 mmol/L	3.5-5.2 mmol/L
Chloride	120 mmol/L	95-107 mmol/L
Haemoglobin	109 g/L	120-140 g/L
White blood cells	26.3x10^9/L	4.0-11.0x10^9/L
Neutrophils	13.0x10^9/L	2.0-7.5x10^9/L
Platelets	64x10^9/L	150-400x10^9/L
C Reactive Protein (CRP)	116 mg/L
Urea nitrogen (BUN)	10.0 mmol/L	3.0-8.0 mmol/L
Creatinine	127 mol/L	64 -104 mol/L

Coagulation profile:

	Result	Reference range
Partial thromboplastin time (PTT)	33 sec	30-45 sec
Prothrombin time (PT)	26 sec	10-12 sec

Procalcitonin:

	Result	Reference range
Procalcitonin (PCT)	37.18 ug/L	0-10 ug/L

Arterial blood gas analysis (at 2200hrs)

	Result	Reference Range
pH	7.12	7.35-7.45
PaO2	70 mmHg	80-100 mmHg
PaCO2	28 mmHg	35-45 mmHg
HCO3-	16 mmol/L	22-26 mmol/L
SpO2	82%	>95%
BE	-7.2 mmol/L	-2 - +2mmol/L
Lactate	5.2 mmol/L	0.5-1.6mmol/L

Clinical Impression: Sepsis (Urosepsis) Plan: 1) Transfer to ICU within 1 hour 2) Chase urine and blood culture results Question 1 (600 words) Explain the pathophysiology causing all the clinical manifestations with which Mrs Smith presents. Please use information from diagnostic results where relevant. Analyses information from a discerning selection of sources and provides an accurate, clear and comprehensive explanation of the pathophysiology causing the clinical manifestation of the patient in case study. The explanation is developed in a logical sequence and incorporates all clinical manifestations presented in the case study. The discussion is clearly and accurately supported by appropriate source. Question 2 (400 words) Mrs. Smith has been prescribed the below two interventions.

• Briefly explain/provide rationale why each of these two (both) interventions are prescribed for Mrs Smith using pathophysiological linking and appropriate evidence
• Discuss briefly the specific mechanism of action of the medication and relate the medication to the underlying pathophysiology
• Describe briefly the impact of not performing the interventions

• Inj. Ceftriaxone 1gm IV stat (Relate with sepsis only) 200 words
• Normal Saline 1000mL IV stat (relate with sepsis only) 200 words

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Case-Study-An....docx