Sarah Agarwal a 20-year-old university student has been transferred to the medical admissions ward from the accident and emergency department. Her mother reports that she has a 3- day history of flu like symptoms, a productive cough and fever. She has been transferred to the high dependency unit with type 1 respiratory failure due to bacterial pneumonia. She is restless and confused. Sarah weighs 60kgs. Her doctor diagnosed her with sepsis.
Initial Observations
Airway –Sarah is talking in complete sentences
Breathing: Respiratory rate of 30 breaths per minute.
Self -ventilating on 40% of Oxygen with a normal face mask
SPO2 is 92%
Crackles sound is heard in the base of lung on examination
Circulation
Heart rate of 118 beats per minute, sinus tachycardia
Blood pressure of 102/50 mmHg
C-reactive protein (CRP) 150 mg/dl
White cell count is raised
Urine output – 25 ml/hr, 18 ml/hr and 10mh/hr for the last three hours
Capillary refil time (CRT) is >2
Disability: Temperature 38.8o C
She is lethargic and disoriented
Exposure: She has a dry mouth and cracked tongue
Type 1 respiratory failure due to bacterial pneumonia, which leads to hypovolemic shock and sepsis.
Introduction (max 200 words).
Summarise the scenario linking to the learning outcomes
Provide context such as prevalence, mortality and morbidity figures
Present a summary at the end of the introduction as to what is to follow in the rest of the essay
Part 1: Analyse the findings of the ABCDE assessment (LO 1-2) 600 words
Analyse the patient’s signs and symptoms assessment
Describe what the normal values are and how these deviates from the norm.
Ensure you use professional terminology so for example if the heart rate is elevated refer to this as tachycardia
Calculate an accurate NEWS2 score and explain the severity of the patient condition.
Explain escalation and the method you would use to communicate this to
Include whom you would escalate to and why?
Part 2: Critically discuss the underlying pathophysiology (LO 1) 600 words.
This should include discussion of the cause of admission
physiological responses (compensatory mechanisms)
the effects of the underlying pathophysiology on organ function
Part 3: Critically discuss the nursing and medical interventions required to manage the condition (LO 1) 600 words.
Identify the:
priorities of care
key interventions this is to follow the ABCDE approach
Make recommendations based on evidence to manage the priorities of care
Critically discuss the holistic care needs of the patients and their families. ( LO 3) 600 words.
Demonstrate awareness of:
patient-centred care incorporating the role of the family, psychosocial impact of acute illness on patients and their families.
Compassion in practice and holistic care.
MDT working
implications of the ethical and legal issues that surround the care of the acutely ill patient.
