Submission Details:
1250 words handed in through Turnitin
Aim of assessment
The purpose of the assessment is to enable students to demonstrate knowledge by accurately analysing information in a case study of complex critical care patient.
Read the case study attached and answer the following questions-
1. analyse the pathogenesis in relation to the clinical manifestations in the case study (15 marks).
2. Select ONE (1) appropriate nursing strategy, and explain the underpinning evidence base for this rational (5 marks) ( NON PHARMACOLOGICAL NURSING STRATEGIES Eg: fluid resuscitation, OXYGEN THERAPY, WITH RATIONALE WHY YOU USING IT AND HOW DOES IT HELPS ?
Critically analyse the Arterial blood gas results, and relate them to the underlying pathogenesis (10 marks) DISCUSS ALL THE FACTORS OF ARTERIAL BLOOD GAS IN DETAIL. Eg: why is the pH is low ?
3.
4. Academic Writing (5 marks).

Case Study Details: Mr Kirkman a 75-year-old male, presented to ED complaining of burning sensation upon urination and lower abdominal pain radiating into the right flank. Mr Kirkman was admitted to the ward with a diagnosis of Urinary tract infection. He was placed on IV NaCl and IV Sulfamethoxazole-trimethoprim 10 mg/kg/day IV in 2 equally divided doses daily and an Indwelling catheter was inserted.
Twenty-four hours later, his condition deteriorates HR135, BP 80/42, RR 35, TEMP 39 and looks generally unwell.
History from ED notes
• Wife died 12 months ago
• Social drinker
• Heavy smoker 2 packs a day since commencing as a teenager.
• Chronic bronchitis on Ventolin and Atrovent.
• Previous UTI
• No cardiac history
Diagnosis 24 hours later
• UTI with severe sepsis
PRIMARY SURVEY O/E
explain the pathogenesis of the below mentioned A-G clinical manifestations and relate it to the case study 15Marks OR
analyse the pathogenesis in relation to the clinical manifestations in the case study (15 marks).
1.
clues: (Q V MISMATCH, INFLAMMATORY SYSTEM, OXYHAEMOGLOBIN CURVE, RAAS SYSTEM )
why he’s respiratory rate is 35?
WHAT COMPENSATION IS RESULT OF DECREASED RR?
Why he’s saturation low?
why is bp DROPING AS A RESULT OF SIRS ?
AS A Result of low bp what other system is initiating (RAAS SYSTEM) TO TRYING TO CONSERVE THE FLUID ? WHY HE IS HAVING DECREASE URINE OUT PUT?
WHATS HAPPENING TO HIM TO INCREASE HIS TEMP ?
Why he’s using accessory muscles ?,
WHY HE IS TACHYCARDIC? WHILE HIS SATURATION IS LOW AND RR HIGH.
AND WRITE FULL BLOOD COUNT IN QUESTION 1?
how UTI leads to severe sepsis within 24 hrs ~ WHAT DOES IT DO TO OUR BODY MECHANISM ~ WHAT COMPENSATES
A – Patient speaking in single words
B – RR 35bpm, accessory muscle use. SPO2 82%, in obvious distress.
C – Sinus rhythm 135bpm, Blood pressure 80/42mmHg, Temperature 39°C
D – E4, V4, M5
E- Use of accessory muscles, lower abdominal pain 6/10, flushed face
F- IVC insitu, IDC- Dark urine passed small amounts approximately 40mls in last 8 hours
G- 8.4mmol/L

Diagnostics
3 Critically analyse the Arterial blood gas results, and relate them to the underlying pathogenesis (10 marks)
Urinalysis
Positive – nitrite, leukocytes & blood.
Arterial blood gases (ABGs) DISCUSS ALL THE FACTORS OF ARTERIAL BLOOD GAS IN DETAIL. Eg: why is the pH is low ? AND RELATE TO THE UNDERLYING PATHOGENESIS
ABGs Result Normal range
pH 7.25 7.35-7.45
PaO2 75 mmHg 80-100 mmHg
PaCO2 32 mmHg 35-45 mmHg
HCO3 15 mmol/L 22-32 mmol/L
BE -6 mmol/L -2 - +2mmol/L
Lactate 3.2 mmol/L 0.3-0.8 mmol/L
Full blood count (FBC)
FBC Result Normal range
Haemoglobin (Hb) 140g/L 130-180 g/L
Red cell count (RCC) 5.0 x 1012/L 4.5-6.5 1012/L
Packed cell volume (PCV) 0.42 0.40-0.54
Total white cell count (WCC) 15.2 x 109/L 4.0-10.0 x 109/L
Platelets 290 x 10 9/L 150-400 x 109/L
Coagulation (‘Coags’)
Coags Result Normal range
APTT 30 25-35
PT 15 11-15
INR 2.2 2.0-3.0
Electrolytes, urea & creatinine (EUC)
EUC Result Normal range
Na+ 148 mmol/L 135-145mmol/L
K+ 5.2 mmol/L 3.8-4.9 mmol/L
Cl- 111 mmol/L 95-110 mmol/L
Mg2+ 0.82 mmol/L 0.8-1.0 mmol/L
Urea 15 mmol/L 3.0-8.0 mmol/L
Creatinine 130 µmol/L 60-120 µmol/L
Marking criteria and standards: Assessment 2: Short Answer Questions
Criteria Mark High Distinction Distinction Credit Pass Fail
Criteria 1 – Using the case study analyse the pathogenesis in relation to the clinical manifestations. /15 Provides an accurate, clear and comprehensive analysis of the pathogenesis in relation to the clinical manifestations. Provides an accurate analysis of the pathogenesis in relation to the clinical manifestations. Provides an accurate analysis of the pathogenesis in relation to the clinical manifestations. However, the information may be incomplete or lack clarity. Provides a basic analysis of the pathogenesis in relation to the clinical manifestations.
There may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow. Superficial analysis of the pathogenesis in relation to the clinical manifestations.
There are major inaccuracies, omissions or repetition of information, lack of clarity or logical flow.
13-15 11.5-12.5 10-11 7.5-9.5 =7.0
Select ONE (1) appropriate nursing strategy, including the rationale. /5 Provides an appropriate, accurate, clear and comprehensive nursing strategy and rationale. Provides an appropriate and accurate nursing strategy and rationale. Provides an appropriate and accurate nursing strategy and rationale. However, the information may be incomplete or lack clarity. Provides an appropriate but basic nursing strategy and rationale. There may be minor inaccuracies, omissions and lack of clarity. Incorrect prioritisation.
Does not accurately identify the nursing strategy OR identifies the strategy but does not accurately explain the rationale.
4.5-5 4 3.5 2.5-3 =2
Criteria 2 – Critically analyse diagnostic result Arterial blood gas, and relate to the underlying pathogenesis
/10 Critically analyses ABG diagnostic result, and comprehensively and accurately relates to the underlying pathogenesis. Critically analyses ABG diagnostic result, and accurately relates to the underlying pathogenesis. Analyses ABG diagnostic result, and accurately relate to the underlying pathogenesis
However, response may lack some relevant information or clarity in relating to pathogenesis. Discusses ABG diagnostic result with little analysis. Some inaccuracies in relating to the underlying pathogenesis. refers to ABG diagnostic result with inaccuracies in relating to the underlying pathogenesis
Inaccurately discusses ABG diagnostic results with little/no relating to the underlying pathogenesis.
8.5-10 7.5-8 6.5-7.0 5-6
=4.5
Academic Writing Style. /5 Writes in an advanced style exhibiting highly coherent and logical flow of ideas.
No errors in referencing, spelling, grammar, punctuation or sentence structure. Writes clearly and succinctly with a coherent, logical flow of ideas exhibiting advanced clarity.
No errors in spelling, referencing grammar, punctuation or sentence structure. Ideas are clearly documented
Use of written word enables effective flow of ideas.
Minor errors in spelling, grammar, referencing punctuation or sentence structure that do not impede the logical flow of ideas and meaning. Writes in a reasonably clear, but limited use of language sometimes hinders the effective flow of ideas and meaning.
Minor, frequent errors in spelling, referencing grammar, punctuation or sentence structure sometimes impede meaning and the flow of ideas. Writes in an elementary style with basic use of language and poor articulation of ideas.
Organisation of material and main points are unclear, confused or disorganised
Multiple errors in spelling, referencing grammar, punctuation and sentence structure.
4.5-5 4 3.5 2.5-3 =2