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NRSG370 Clinical Integration Speciality Practice

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NRSG370 Clinical Integration Speciality Practice

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NRSG370 Clinical Integration Speciality Practice

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Course Code: NRSG370
University: Australian Catholic University is not sponsored or endorsed by this college or university

Country: Australia


Students will complete a case study, which discusses the provision of ethical, legal, evidence based, holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle (Levett-Jones, 2013).
Ms. Melody King presented to the Emergency department with 2-3 days of severe Right Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix.
She has a past medical history of asthma and depression, with her current prescribed and compliant medications list which includes:


Melody’s observations were as follows:

BP 95/45mmHg
HR 120
Temp 38.3°Celcius
RR 22/min and shallow
SpO295% on room air

She complained of increasing nausea and centralised abdominal pain 7-8 on a scale of 0 to10. Physical assessment showed a distended abdomen and generalised abdominal guarding. To investigate her condition further, pathology results reveal a raised white blood cell (WBC) count and CRP.


The management of the healthcare as per the client’s demands and requirements as in Melody’s case is a challenging situation. Nurses are accountable for providing high quality care to the patients. Thus, the experiences and the expectations of the patients are to be explored progressively using the survey in between the focused group meetings, patients, outcomes and the interviews which are applied to encourage and for motivation in the healthcare delivery. For example, Ms. Melody King is suffering from peritonitis and needs much attention of a nurse. Melody’s condition could worsen if the nurse doesn’t give keen attention to her. Nurses are faced with healthcare task which requires the application of ethical codes of conduct and basis of ethics in decision making. The legal, ethical and the overall professional code of conduct pertains to the nurses’ occupation and nursing problems. Also realistic and relevant goals have been set towards the required client’s care to be analyzed, evaluated and discussed in this essay. The description and the overview of this essay are evaluated in accordance with the clinical reasoning cycle.
(a). patient’s situation consideration
As per Melody’s situation, it is necessary to measure quantitatively, elaborate and evaluate her disease status through chemical and physical examination of the main cause of her pain. The Melody’s measurable information that was recorded includes; respiratory rate, skin color, white blood cells count, the peritoneal membrane status, moisture, blood pressure and the temperature pulse rate (Longmore, Wilkinson, Baldwin, & Wallin, 2014).
(b). collection of the data
When Melody was admitted to the emergency department, she presented the following complains; severe abdominal pain in her lower right quadrant, which called for the appendix removal through laparoscopic surgery (DeWit, Stromberg, & Dallred, 2016). Melody’s current complains related to the medications such as the sertraline, Seretide and the Ventolin which were appropriate to anticipate the status of her health (Belkina, 2017). She presented central abdominal pain (7-8) which was 0- 10 from the medical scale. The client’s history of medication were depression and asthma disorders. physical assessment results show that she had general abdominal guarding and swelling in the abdomen. It was also noted that there were several body changes; Sp02 95% at room’s atmosphere, 38.3 degrees Celsius in body temperature, HR 120, shallow RR22/ min and BP 95/45 mmHg. Further treatment examination showed that her white blood cells count had increased. All the observed result was recorded, and it was due for determining the most appropriate treatment to be used after the surgery.
(c). processing of the gathered information
After thorough analysis and interpretation of the patient’s history, assessment observation, current patient’s symptoms, and her complaint’s information, the pathologist determined that peritonitis was the disease that Melody’s was suffering from due to ruptured appendix. The peritonitis disease is described as an acute or a chronic swelling in the peritoneum membrane that holds the abdominal cavity and the other splanchnic. This infection lowers the intestinal mortality and leads to the distention of the intestine with gas. The death due to this disease could result when the individual’s bowel is obstructed and the intestinal mortality reaches 10%. The frequent monitoring and taking measure are some of the crucial nursing care to prevent the further spread of the illness.
There are six nursing care plans that a registered nurse has to prioritize on while handling peritoneal patients includes; fear and anxiety, acute pain, dangers of an unbalanced diet, appropriate fluid volume, sufficient knowledge and the risk of the infection. Some of the risk infection are immunosuppression, invasive procedures and the inadequate primary defense. The patient’s history of diagnosis revealed that the peritonitis signs and symptoms are unpredictable and the most likely recommended strategy of preventing the disease in through quality nursing interventions (Dains, Baumann, & Scheibel, 2015).
(d). The problem
The examination and the experimentation of the wound culture specimen, the urine and the serial blood to monitor the cause of the infection was carried out. The experiment was meant to identify and determine microorganism responsible for the disease and assist in the efficiency of the antimicrobial treatment. The registered nurse dealing with the peritonitis patient like Melody is entitled to ensure a sterile technique while providing catheter care and ensure the cleaning of the peritoneal every day to avert the bacterial growth within the urinary path. The caregiver is supposed to regulate the number of visitors such as the family members or the staffs, so that to reduce the risk of exposure to the secondary infection on the immunocompromised peritonitis patient (Urden, & Dineen, 2015). The microorganisms responsible for the infection were recognized to be amikacin, clindamycin, and gentamicin via the peritoneal membrane.
The treatment via the information and the data collected showed that the gram-negative bacteria known as the bacilli which are aerobic is the causative agent of the disease. The lavage process is used to remove the necrotic debris and to treat the swelling of the ailing diffused membrane. The cause of the pain in Melody was due to postoperative laparotomy surgery (LeMone et al, 2015). The client’s needs nursing care interventions due to hyperglycemia condition that could be as a result of inadequate knowledge of the infection and poor diet.
(e). The nursing goals
The first goal to set when handling a peritonitis patient is to reduce the level of pain. Ms. Melody King required pain assessment for she was experiencing lower abdominal pain which the nurse to prioritize on in relieving the pain through the administration of the intravenous antibiotics. The antibiotics such as analgesics could be infused directly to the peritoneum membrane which is much more effective.
The second goal that a nurse has to set is restoring and regulation of both the fluid and the electrolyte of the patient. Here the nurse’s priority is to administer and monitor the Ms. Melody’s fluids to ensure that they are balanced.
The third goal that a nurse has to set is to prevent further complications which could occur within the course of the illness. Also, the nurse has to prioritize on restoring the normal gastrointestinal (GI) functions for the client to confirm its normal operations.
Issues/Problems that arose and nurse had to prioritize on;
The balancing between the fluids and the electrolytes was one of the nursing issues that arose while conducting the interventions to the patient.
The assessment in response to the functioning of the gastrointestinal and controlling the increased level of pain in the patient were some of the major challenges (Miller, 2018).
The other significant issue was the secondary infection and the risk to shock that was related to septicemia and hypovolemia. It was not an easy case to monitor and control the number of visitors who came to see the Ms. Melody king as their family members were radical to convince about the disease condition (Mashlan et al, 2015).
(f). The nursing interventions for the set goals
The nursing intervention for the peritonitis patient was based on the following measures; pain management interventions include the administration of the antibiotics, body positioning and use of analgesics. The nurse has to ensure that the patient acquires an aseptic method while dealing with the abdominal drains (Williams, & Hopper, 2015). Use of the appropriate solution while cleansing. Monitoring of the fluid and urine output taken by the patient. There should be an accurate and proper recording of all the fluid assessment and replacement by the clients. This assessment will enable the fluid balance in the patient’s body and maintain the required levels. The nurse contributes in administering and carefully monitoring the fluids. In abdominal drainage, the nurse has to note and record the draining characters postoperatively. Monitoring the patient’s blood pressure levels is a nurse’s role. The nurse should perform, show and demonstrate to the patient proper hand washing technique to reduce the risk of spreading of infection and also the cross-contamination. The patient’s blood pressure has to be frequently monitored through the arterial line and if there is shock signal, it should be noted keenly to prevent further complications as it was indicated in melody’s diagnosis history (Dekker, 2016).
(g). Reflection and Evaluation
Through the individual’s common risk factors like acute appendicitis, peritoneal dialysis and the abdominal trauma can assist in increasing the effectiveness of medication to the patient. The application of efficient and quality nursing ethics and experience in the sterilizing the medical procedures of the patients are the most appropriate choices in such an emergency condition (Corner et al, 2013). Frequent checking and monitoring the vital alterations in the symptoms and signs of the patient are very crucial. Taking measures and recording the blood pressure levels, tachypnea, fever, and the low pulse pressure were some of the important signs of the immediate septic shock. When promoting the insufficient body fluid volume, the interventions involved the use of the endotoxins circulations that lead to the vasodilation which results to the low output state through ensuring that the airways are functioning.
It is always important to note the changes in the patient’s mental health on the clients such as cognitive sense, stupor and discombobulation. The acidosis, hypoxemia and the hypotension are the crucial changes pay attention to as they are responsible for impairing the psychological health. Oliguria disease that results from decreased perfusion on the renal, as the results of the antibiotics and due to toxins circulation could be prevented through monitoring the urine output (Rawles, Griffiths, & Alexander, 2015).
The easy has elaborated on how to apply the efficient quality nursing care goals both at before and postoperative interventions in the emergency department of laparoscopic surgery during the treatment a peritonitis infection. The has demonstrated the procedural involved in the medical techniques to handle the cultural, pathology, pharmacology, physiology, and ethical measures of a registered nurse within the surgical department. The paper shows the establishment of goals, legal-ethical, logical sequence, evidence-based and quality nursing care interventions to a client who is in severe condition.
Belkina, T. (2017). Non-prescribed antibiotic use in some developing countries and its association with drug resistance.
Corner, E. J., Manderson, E., Gard, J., Corner, E., Atrill, K., Thomas, F., … & Arawwawala, D. Clinical Practice Poster Presentations. In E-supplement: Abstract and poster presentations from the State of the Art 2013 meeting (p. 23).
Dains, J. E., Baumann, L. C., & Scheibel, P. (2015). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.
Dekker, S. (2016). Patient safety: a human factors approach. CRC Press.
DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015). Medical-surgical nursing. Pearson Higher Education AU.
Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford Handbook of Clinical Medicine-Mini Edition. OUP Oxford.
Mashlan, W., Hayes, J., Wakefield-Newberry, S., Hutchings, P., Roberts, L., Bissmire, S., … & Whittingham, J. (2015). Advanced assessment and clinical decision making. Advanced Nursing Practice: Changing Healthcare in a Changing World, 139.
Miller, A. J. (2018). Gender Disparities in Diagnosis and Pain Management (Doctoral dissertation, Temple University).
Rawles, Z., Griffiths, B., & Alexander, T. (Eds.). (2015). Physical examination procedures for advanced practitioners and non-medical prescribers: Evidence and rationale. CRC Press.
Urden, L. D., & Dineen, K. K. (2015). Ethical and Legal Issues. Priorities in Critical Care Nursing-E-Book, 10.
Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical nursing. FA Davis.

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