Assignment Task
Task
Read the case studies below, choose only one of the following case studies to discuss, and answer all 4 of the questions listed below. You do not need an introduction or conclusion and headings are advised. You must use academic writing and reference your work using APA referencing. Your ISBAR may be presented in table format. Please do not use bullet points, instead use well-structured paragraphs.
Case Study
As the RN you arrive at the remote clinic at Wilcannia for your fortnightly visit, the population here is mainly Indigenous Australians and there is a high percentage of children in this community. It is normally quite a busy day.
The next patient you see is Ashanti, a 3 year old indigenous girl. Ashanti presents in the arms of her Mother with her Grandmother present. When asked about Ashanti’s chief complaint, her mother explains she has ‘had the runs for a few days and whatever I give her just goes straight through’. Ashanti is lethargic and unable to walk. On examination you observe Ashanti to be speaking quietly to her Grandmother, you notice there is no accessory muscle usage but there is an increase in her work of breathing (WOB). She has normal breath sounds on auscultation, is pale and cool to touch, she has cracked lips, a dry tongue, sunken eyes and looks very unwell. There is no sign of any wounds or lesions which could indicate an infection as the cause of her deterioration. On further questioning Ashanti’s Mother tells you she has had about 2 cups of juice today you work this out to equate to approximately 400mls. You also ask about her urine output, Ashanti’s Mother is unsure about this as she just states that it is just her bowels that are working, as far as she knows she has not passed urine and has not noticed any urine in her nappies. You ask when she last passed urine and you are told ‘it has not been for a day or so’.
You take her observations and record the following
Ashanti is fully immunised and has no medical history she weighs 13kg.
Questions:
Discuss your assessments on this patient, identify signs of deterioration and clearly state if the patient requires a clinical review or rapid response as per Between the Flags (BTF). Justify your decision with data from the case and relevant support.Document a succinct and accurate ISBAR handover in verbal script format (eg. Hello, my name is…)Considering the assessment findings, prioritise and discuss the immediate nursing management of the patientSuccinctly discuss the ongoing management of this case and integrate the relevant members of the interdisciplinary team.
Case Study 2 (Mental Health Facility)
Alex is a 23 year who was admitted to the acute ward at the mental health facility, he has been admitted to the locked ward due to his his acute psychosis. Alex was recently diagnosed with a drug induced schizophrenia caused by the use of marijuana. Alex has been in the ward for the past two weeks, over the past couple of days it has been discussed amongst staff the large amount of food and water Alex consumes (5 litres plus a day and extra meals), they have put this down to his psychosis.The following day Alex’s behaviour deteriorates and he has become aggressive and unable to walk in a straight line, the staff are confused and wondering if one of his visitors has given him something. The staff take routine bloods and decide to do a drug screen as well. They have also noted the number of times a day he has been going to the toilet (this has been frequent at least hourly if not more regularly).
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