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NURS1001 Foundations to Nursing

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NURS1001 Foundations to Nursing

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Case study: The clinically deteriorating patient

  • Demonstrate structured decision making and clinical reasoning to review a range of health situations, synthesise evidence and date, determine priorities and formulate plans of care and interventions in line with timeframes and agreed goals

Situation

  • You are rostered to work the morning shift (7am -15:30pm) and are allocated to care for Adam
  • Adam is 17 years old recently admitted to the respiratory ward from ICU with a diagnosis of a hypoxic brain injury.
  • Adam has had a tracheostomy inserted whilst in ICU to assist with the clearance of secretions due to poor cough strength and increased secretions, and to facilitate weaning from mechanical ventilation.

Background

  • Adam was admitted to the respiratory ward 6 days ago after a three-week admission in ICU secondary to an acute asthma attack
  • During his ICU admission, he was diagnosed with non-focal seizures caused by hypoxia and which is currently controlled with sodium valproate
  • He had a size 8 portex tracheostomy inserted to facilitate weaning from mechanical ventilation and aid in securing his airway

Past medical history

  • Adam’s past medical history includes brittle asthma, and he has had a number of hospital admissions related to his asthma
  • He also has complications related to asthma treatment which includes steroid induced diabetes mellitus secondary to prolonged and repeated used of corticosteroids

On assessment

  • On assessment, Adam is positioned supine in bed, you elevate his head to 45 degree, his NGT feeds are running at 83ml/hr and needs to be changed in the next hour
  • The external length of his NGT is at 40cm at the tip of nose
  • On auscultation he has course crackles, tactile fremitus, you suction his tracheostomy and cleared some creamy secretions.

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