Due Date: 3rd April at 5pm via Turnitin
?Weighting: 40%?
Word count: 1600 words (every question has a specific word count, which must be adhered to)
Instructions:
• The assignment is to be presented in a question/answer format not as an essay (i.e. no introduction or conclusion). ?
• Each answer has a word limit (1600 in total); each answer must be supported with citations. ?
• A Reference List must be provided at the end of the assignment. ?
• Please refer to the marking guide available in the unit outline for further information. ?** The following questions must be answered for your chosen case study ** ?The following questions relates to the patient within the first 24 hours:
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words) ?
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words) ?
a. This can be done in the form of a table – each point needs to be appropriately referenced
3.
Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs belong to.
4.
Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).
The case
Mr Nathan James is a 48 year old male who was admitted to the high dependency unit for investigation of jaundice and ascites. He is an interstate truck driver and is married with 2 children. Mr James is a current smoker and known to consume 2 glasses of beer per day. He has a previous (15 years ago) history of recreational drug use and was diagnosed with Hepatitis C 10 years ago.
On assessment:
Mr James is lethargic but orientated to time, place and person and slightly irritable. He is slightly tachypnoeic with moderate use of accessory muscles. His wife reported that Mr James has been spitting blood stained sputum for the last few weeks with no associated cough or shortness of breath. Mr James reports that he has lost 9 kilos in weight which he attributed simply to a lack of appetite. No changes were reported with his urine output. On examination his sclera is mildly jaundiced and has some “unexplained” bruises on his arms and legs. His abdomen is tight and distended and pitting oedema noted on his ankles.
Observations: BP: 115/60mmHg, HR: 110 bpm, RR: 24 bpm, SpO2: 88% on RA, 95% on 6L via Hudson Mask, Temp: 37.8C
Impression: Liver Cirrhosis
Laboratory Findings:
Result
Normal Values
RBC 4.0 million/mm3 2.6 to 5.9 million/mm3
WBC 3500/mm3 4300 to 10800/mm3
Platelets
75000/mm3
150000 to 350000/mm3
Serum Ammonia 110 µm/dl 35 to 65 µm/dl
Total Bilirubin
4.9 mcg/dl
0.1 to 1.0 mcg/dl
Sodium 150 mEq/L 135 to 145 mEq/L
Potassium 3.4 mEq/L 3.7 to 5.5 mEq/L
Haemoglobin 85 g/L 120-170 g/L
Albumin
24 g/L
35-50 g/L
Liver Enzymes
Slightly elevated
BUN 22 mg/dl 7-18 mg/dl
Creatinine 154 ml/min 88 to 137 ml/min
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