Case Study

Weighting: 40%

Word count: 1600 words (every question has a specific word count, which must be adhered to)
Instructions:

Students are to choose one (1) of the case studies below and answer the associated questions. 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 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 since admission to the emergency department (ED):
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).

Case Study

Cushing’s Syndrome

Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was referred to the local hospital for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily, and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant.
On assessment, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9ºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders. Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low high-density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level measurement.
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REPRESENTATIVE TEXTS AND REFERENCES: You can use the following references as well Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., et al. (2014). Kozier and Erb’s fundamentals of nursing. (3rd Australian ed.) French’s Forest, NSW: Pearson Australia. Farrell, M., & Dempsey, J. (2014). Smeltzer and Bare’s textbook of medical-surgical nursing (3rd Australian and New Zealand ed.). Sydney: Wolters Kluwer Health/ Lippincott Williams & Wilkins. Jarvis, C. Australian Adapting Editors Forbes, H., Watt, E,. (2012). Physical Examination & Health Assessment (6th Australian and New Zealand ed.). Chatswood, NSW: Elsevier/ Saunders Martini F., Nath J & Bartholomew E. (2012). Fundamentals of anatomy and physiology. (9th edn). San Francisco: Pearson. McCance, K., & Huether, S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis: Elsevier/Mosby. McKenna, L. & Lim, A. G. (2012). Pharmacology for nursing and midwifery. (1st Australian and New Zealand Edition). Broadway: Lippincott Williams & Wilkins Nursing and Midwifery Board of Australia. (2006). National competency standards for the registered nurse. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/Codes-Guidelines.aspx Nursing and Midwifery Board of Australia. (2013). Codes and guidelines. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes- Guidelines.aspx
Perrin, R. (2012) Pocket guide to APA Style (4th ed.) Boston Massachusetts: Wadsworth/ Cengage Learning. (Highly recommended). Tiziani, A. (2013). Havard’s nursing guide to drugs. (9th edn). Sydney: Mosby/Elsevier Tollefson, J. (2012). Clinical psychomotor skills: Assessment tools for nursing students (5th ed.). South Melbourne: Cengage Learning

— DEAR WRITER PLEASE CHECK THE FOLLOWING THINGS ON THE CASE STUDY Please note the following changes, which will be updated in the assessment section: INCORRECT: Blood test results show low cortisol and ACTH levels, and high levels of low high-density lipoprotein cholesterol CORRECT VERSION: Blood test results show low cortisol and ACTH levels, and high levels of low density lipoprotein cholesterol Thank you, and apologies for the confusion Cheers

General comments: Stick to the word limit allocated. We will stop reading past this point, and the word limit helps you to be succinct and target the main concepts. You have +/-10% word limit on the entire case study. Word limit does NOT include in text citations, reference list or if you include the question Cite as you write We cannot proof read your draft, or give you specific guidance on your answers Read, read, read! Consider up to date sources – within the last 5-7 years is the recommended time frame Formatting: You can use dot points but it needs to flow and make sense. You can write in paragraphs if you wish You can use tables Refrain from using abbreviations that are not acceptable, or symbols as this can become distorted on Turnitin NO need for an introduction or conclusion Must write in third person, i.e. No “I think”, “I believe”. This is an academic piece of writing so needs to be at the right standard Q1: Cause/risks of disease needs to be focussed on what the pt has presented with The incidence of the disease needs to be as current as possible, and based in Australia. Using other stats will mean you will lose marks Impact on family MUST be linked back to the patient you have chosen. If there is no link it is not a case study Refrain from listing, as we are looking for you to provide a rationale for all your answers eg. Financial impact as evidenced by increased acuity leading to sick leave and no income etc Q2: The signs and symptoms can be taken from those listed in the case study, or you will find more relevant ones when completing your research As long as you are able to link it back to the patho of the current patient condition and explain why you have chosen it that is fine Pathophysiology needs to be in depth and at the cell level where possible Q3: The drug classes chosen can be from the case study or what you think may be used to manage the patient’s condition Need to include drug CLASSES, not specific drug names, or broad types Eg. Loop diuretics – CORRECT. Diuretics – INCORRECT. Frusemide – INCORRECT. All diuretics have a different mechanism of action, so stating diuretics is not acceptable You need to explain how each drug class works at the cell level where possible, and LINK it back to the patient in the case study. Why are these drugs indicated for the patient? Q4: PRIORITISE your care – if it helps, number it Every nursing care priority must include a rationale as to why it needs to be done This includes nursing care, not medical management. For example, if you think that a patient may need thrombolytics but are not ordered this, phrase it in a way that links it back to nursing. What are your nursing considerations in this case then? The parameters are in the first 24 hours only which will help you narrow your care We prefer less considerations with more rationale, than you including a list, i.e. 8-10 would be sufficient as long as you can rationalise your care

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