Case Study: Bert

You are the RN working on the medical ward.

Presenting complaint

Bert is a 93-year-old man with end stage CCF, he presented to the ED with shortness of breath. CXR shows a pleural and pericardial effusion. PMH AF, on apixaban. He was reviewed by cardiology in the ED and they advised he was not an appropriate for a chest drain or pericardial drain. They also requested a 1.2L fluid restriction, daily weights, TTE, BD furosemide, and to change the NOAC due to his poor renal function.

Bert is now on the ward and you are the nurse looking after him. He had been in ED for the past 12 hours. No fluid balance documented, unsure if he has eaten. He is still in his clothes which he said he has had on for four days and he’d like a shower.

Bert is from home and has carers and meals on wheels 3 times a week. His daughter checks in on

him every day. Bert’s Daughters have expressed they want ‘everything’ to be done for him should he deteriorate but Bert told you that he doesn’t want to all the bells and whistles, and just wants to die with a little dignity. He tells you that he’s had a good life and wants to be with his wife again who passed 10 years ago. ‘just keep me comfortable’, ‘if I can’t wipe my own my own bum or enjoy a cold beer in the sun then I don’t want to be here’.

Observations:

-      BP167/70,

• HR 98 irregular,
• RR 26
• SPO2 91% on room air, increasing to 98% on
• Talking in short sentences. Bert currently sleeps upright with 3 pillows. He feels too short of breath when he lies down.

Medications:

• Furosemide 40mg OD
• Apixaban 5mg BD
• Ramipril 5mg BD
• Bisoprolol 5mg OD

The lab call to inform you that his PCR was positive for COVID.

What are you priorities for Bert?

TASK Tutoring

This assessment maps to the following Unit Learning Outcomes:

ULO 1 - Demonstrate critical thinking to analyse nursing practice

ULO 2 - Determine safe, appropriate, and responsive nursing practice to a variety of patient conditions and settings

ULO 4 - Reflect on systematic assessment, and relevant data, to determine priorities of care in a holistic and culturally responsive and respectful manner

Rationale

This assessment aims to consolidate your nursing knowledge and experiences and provides you with the opportunity to develop and refine your clinical reasoning skills by presenting you with real-world scenarios that require you to consider multiple factors and make complex decisions.

Task Description

You will critically analyse patient information from a case study, and provide an overview of appropriate nursing care, which is safe, responsive and supported by high quality evidence. You will reflect on the systematic assessment you have chosen, and relevant data that will determine priorities of care in a holistic and culturally responsive and respectful manner.

In your report, you will demonstrate your understanding of how your decisions are informed by the NMBA professional standards NMBA standards for practice and the National Safety Quality Health Service (NSQHS) standards NSQHS standards.

Task Instructions

Case study – 1500 words

Choose ONE of the case studies provided (under Assessment 3 folder in Assessment Task and Submission section) and using the template below, demonstrate your understanding of the priorities of care, and the most appropriate nursing practices that should be taken to ensure it is delivered safely and appropriately. Support your proposed interventions/actions

with the best available evidence and reflect on how your choices are informed by the NMBA professional standards and the National Safety Quality Health Service (NSQHS) standards.