UNLV Nursing Fabricate a Patient Paper

Description

Signature Assignment: Choose a disease (any disease) and FABRICATE a patient with all signs/ symptoms and lab results. You are going to FABRICATE a case-study and answer all the questions listed.  My advice is to be descriptive and the more you write, the better your paper will be. Your Signature Assignment should be 4-8 pages NOT including title page and reference page. Please use a MINIMUM of 4 REFERENCES (two of the four should be scholarly journals) to support your paper. I am posting a Sample Signature Assignment below for your reference. Please follow the Structural Format of the sample paper.

You will be graded on how well you complete each of the above sections. You will also be graded on your use of APA Style and on your application of nursing journals into the treatments and interventions. For integrating nursing journals, remember the following: 
Make sure to integrate citations into all of your paper
Support all claims of what the disease is, why it occurs and how to treat it with references to the literature on this disease
Always use citations for information that you learned from a book or article; if you do not cite it, you are telling your reader that YOU discovered that information (how to treat the disease, etc
In order to write a case study paper, you must carefully address a number of sections in a specific order with specific information contained in each. The guideline below outlines each of those sections.
SectionInformation to IncludeIntroduction (patient and problem)
Explain who the patient is (Age, gender, etc.)
Explain what the problem is (What were they diagnosed with, or what happened?)
Introduce your main argument (What should you as a nurse focus on or do?)
Pathophysiology
Explain the disease (What are the symptoms? What causes it?)

History
Explain what health problems the patient has (Have they been diagnosed with other diseases?)
Detail any and all previous treatments (Have they had any prior surgeries or are they on medication?)
Nursing Physical Assessment
List all the patient’s health stats in sentences with specific numbers/levels (Blood pressure, bowel sounds, ambulation, etc.)

Related Treatments
Explain what treatments the patient is receiving because of their disease
Nursing Diagnosis & Patient Goal
Explain what your nursing diagnosis is (What is the main problem for this patient? What need to be addressed?)
Explain what your goal is for helping the patient recover (What do you want to change for the patient?)
Nursing Interventions
Explain how you will accomplish your nursing goals, and support this with citations (Reference the literature)
Evaluation
Explain how effective the nursing intervention was (What happened after your nursing intervention? Did the patient get better?)
Recommendations
Explain what the patient or nurse should do in the future to continue recovery/improvementRunning head: CASE STUDY
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Week 6: Signature Assignment: Topic Name
Student Name
Institution Name
Professor:
26 July 2020
Running head: CASE STUDY
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Introduction
Joanna Keaton is a 59-year-old Asian American woman from California. Joanna was
recently hospitalized after having a Bullectomy. Joanna’s surgery was necessary because she has
a history of smoking that developed into COPD. While recovering from her surgery Joanna had
become lethargic, she began to experience arrhythmias, tachypnea, chills, emesis, and developed
a fever of 103. Based on Joanna’s symptoms she was diagnosed with septic shock. As a nurse,
my main focus is to perform early resuscitation therapy. Patients with sepsis who respond to
early resuscitation therapy in the emergency department (ED) and show no evidence of endorgan hypoperfusion may be admitted to a general hospital unit while patients who do not
respond to initial ED treatment (i.e., who have recurrent hypotension despite adequate fluid
challenges) require admission to an ICU for continuous monitoring and continued goal-directed
therapy (Kalil, 2019). Since Joanna did not respond to the ED treatment, my next focus is to have
her transferred into the ICU and determine which stage of shock she is in.
Determining the stage can be determined through clinical manifestations. Certain stages
of septic shock are more severe than others. Based on Joanna’s symptoms she was experiencing
at home I would suggest and unresponsiveness she was in the Progressive stage. Progressive
stage is the third phase of septic shock is the moment when the infection has become so severe
that the body is compensating by igniting an inflammatory process. This inflammatory process is
the body’s defense mechanism to fight off the infection. However, in septic shock, the
inflammatory process has gone haywire, and it has become widespread and systemic (Linares,
2020). I believe Joanna is in the progressive stage because of her continuous cough, and low
body temperature are symptoms of pneumonia. To confirm this, I will order a chest x-ray to see
Running head: CASE STUDY
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if there is any inflammation in the lungs and a blood test to determine what kind of germ is
causing the infection. Chest X-ray helps your doctor diagnose pneumonia and determine the
extent and location of the infection. However, it can’t tell your doctor what kind of germ is
causing the pneumonia (“Pneumonia- Diagnosis and treatment-Mayo Clinic”, n.d.). Joanna will
also have to take a urine analysis, to check the concentration. This is necessary because cloudy
concentrated urine is an indicator of the infection.
Pathophysiology
Septic shock is a life-threatening complication of sepsis. Infections that cause sepsis is
usually derived from the urinary tract, pneumonia, or abdomen. When the blood pressure drops
due to bacteria present in the bloodstream or when gram-positive organism enters the
bloodstream it ignites septic shock. Gram-positive organisms (Staphylococcus aureus,
Staphylococcus epidermidis, Streptococcus pneumoniae) and fungi (Candida species) are also
important causes of septic shock. A frequent portal of entry is the genitourinary tract. Other entry
sites include the gastrointestinal tract, the respiratory tract, and the skin (Banasik & Copstead,
2017). Septic shock is a possible consequence of bacteremia, or bacteria in the bloodstream.
Bacterial toxins, and the immune system response to them, cause a dramatic drop in blood
pressure, preventing the delivery of blood to the organs. Septic shock can lead to multiple organ
failure including respiratory failure, and may cause rapid death (septic shock, n.d.). There are
four stages to the disease: early sepsis, compensatory stage, progressive phrase, refractory stage.
Early Sepsis is the initial phase, where the patient has a low MAP. A drop-in mean arterial
pressure means that the infection has gone worse than it’s turning off some of the barrel
receptors inside the body. Barrel receptors are the receptors in the blood vessels that help
regulate the constriction of blood vessels (Linares, 2020). Compensatory stage is when the body
Running head: CASE STUDY
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is trying to compensate for any type of shock, not just septic shock, it will increase the heart rate
and respiratory rate to get more oxygen since there is not enough blood perfusion (Linares,
2020). Progressive phrase is the moment when the infection has become so severe that the body
is compensating by igniting an inflammatory process. This inflammatory process is the body’s
defense mechanism to fight off the infection. However, in septic shock, the inflammatory process
has gone haywire, and it has become widespread and systemic (Linares, 2020). The last stage is
refractory has the presence of hypotension, with end-organ dysfunction, requiring high-dose
vasopressor support often greater than 0.5 μg/kg/min norepinephrine or equivalent (Nandhabalan
et al., 2018).
Each stage has its specific symptoms and signs, the overall symptoms and signs include
low blood pressure, arrhythmia, fever, chills, nausea, vomiting, confusion, anxiety, and
tachypnea (Medicine net, n.d.). During the early stage, the clinical manifestation is characterized
by high cardiac output and warm extremities because of a lack of sympathetic tone, and a
widened pulse pressure result. The heart rate and stroke volume increase, and cardiac output is
higher than normal, but the patient remains hypotensive (Banasik & Copstead, 2017). The
clinical manifestations for the progressive stage include hypothermia- temperature less than 97,
pneumonia, decreased urinary output-glomeruli in the kidneys become inflamed. The dilated
vessels cause reduced resistance and perfusion that the body compensates by holding on to
volume, high specific gravity- dark brown, thick odorous, and very concentrated urine output,
bleeding- broken vessels due to the inflammation process (Linares, 2020). The risk factors for
the infection are the elderly, patients with chronic health conditions, patients recently
hospitalized after surgery, and patients with suppressed immune systems.
Running head: CASE STUDY
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History
Joanna has been previously diagnosed with type 2 diabetes and hypertension, she has
been taking metformin and lisinopril for 10+ years to treat them. For years she has been having
difficulties breathing due to her being a chronic smoker and developing COPD. COPD is a
chronic inflammatory lung disease that causes obstructed airflow from the lungs. It’s caused by
long-term exposure to irritating gases or particulate matter, most often from cigarette smoke
(“COPD-Symptoms and causes”, n.d.). Her COPD was so severe that she had to receive surgery
to remove a bullae from the lung. Bullectomy is a procedure where doctors remove one or more
of the very large bullae or blebs from the lungs. Bullae are large air sacs that form from hundreds
of destroyed alveoli. These air spaces can become so large that they crowd out the better
functioning lung and interfere with breathing. For those people, removing the destroyed air sacs
improves breathing.
Joanna’s history with diabetes and her chronic health condition of COPD are risk factors
for this infection. Joanna’s recent hospitalization after the Bullectomy made her more susceptible
to contracting sepsis and septic shock. Sepsis and septic shock are common after surgeries.
Surgery takes a toll on the body and weakens the immune system, even if the procedure is a
minor one, which can make infections more likely (Whitlock, 2019).
Nursing Physical Assessment
After taking Joanna’s vitals, her MAP was 59.7 mmHg, due to her blood pressure
dropping to 83/48 mmHg. Her heart rate was 106 bpm, respiratory rate was 39 bpm, and had a
body temperature of 38.7°C. The patient’s lab results showed her WBC have increased to
15,000/mcL; pH balance was 7.07. Her lactate level increased to 5 mmol/L, which caused her
Running head: CASE STUDY
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HCO3 to be 20 mEq/L and her urine output was 15mL and was cloudy. Joanna’s results were
abnormal because the average normal blood pressure 120/80 mmHg, low BP is 90/60. With that
being said if her BP was normal her MAP should be around 93.3 mmHg, Joanna’s was way
below that. Lactate levels higher than 2.5 mmol/L are associated with an increase in mortality.
The higher the serum lactate, the worse the degree of shock, and the higher the mortality (Kalil,
2019). Joanna also had cloudy urine which is also a symptom for septic shock.
Related Treatments
To stabilize Joanna’s breathing she will be placed on a ventilator and be administered
various medications to stabilize her vitals. Treatment for Joanna’s infection will include many
medications. The beginning of Joanna’s will start with the early administration of intravenous
antibiotics to fight the infection. Appropriate broad-spectrum antibiotic therapy is started as soon
as septic shock is suspected and after quickly obtaining appropriate cultures (Banasik &
Copstead, 2017).
Since the patient’s BP dropped to 83/48 mmHg, vasopressor medication will need to be
administered. Vasopressor medications, which are drugs that constrict blood vessels and help
increase blood pressure (Rogers, 2019). Because Joanna’s case is a severe case of septic shock,
protein C is also recommended. Activated protein C is currently recommended for those with
severe sepsis and a high-risk score for mortality. Protein C has both anti-inflammatory and
antithrombotic actions, which may be helpful in sepsis (Banasik & Copstead, 2017).
Nursing Diagnosis & Patient Goal
The patient is experiencing deficient fluid volume related to constant emesis and a fever
of 103. Ineffective breathing pattern due to the patient’s arrhythmias and tachypnea. Ineffective
tissue perfusion related to the progression of septic shock with decreased cardiac output of
Running head: CASE STUDY
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15mL, vasodilation which decreased Joanna’s BP to 83/48 mmHg. The patient will have a
systolic blood pressure above 100 mmHg by tomorrow. Joanna’s breathing pattern will return to
normal resting rate after the administration of calcium channel and beta-blockers. The patient’s
tissue perfusion will increase, and she will be given medication to get rid of the infection.
Nursing Interventions
According to Rochester.edu, the principle of adult sepsis treatment is to measure lactate
level, administer broad-spectrum antibiotics, administer 30 ml/kg crystalloid intravenous fluids
(IVF) for hypotension, or lactate ≥ 4mmol/L. Timely vasopressor administration to maintain
MAP (Rochester, 2018). To accomplish my nursing goals, I will assess the patient’s vital signs
frequently, administer oxygen, and administer intravenous antibiotics to decrease the
inflammation. Norepinephrine will be given to maintain a MAP of 65mmHg. Lastly, to stabilize
the Joanna’s lactate and hypotension, I will administer crystalloid to increase the lactate to
4mmol/L.
Evaluation
The intervention was unsuccessful, even though I measured the patient’s lactate levels
and administer the antibiotics and crystalloid within the three hours and retook her vitals, they
did not improve. Doing these treatments promptly was supposed to decrease the infections and
stabilized the lactate and serum bicarbonate levels. Administrating the vasopressor did not help
increase Joanna’s blood pressure, and her MAP stated the same. Joanna is still lethargic and is
emesis.
Running head: CASE STUDY
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Recommendations
Because my goal of stabilizing Joanna was unsuccessful, I plan on consulting with my
hospital staff to choose the next best course of action. I will continue to assess and monitor
Joanna’s symptoms and signs and increase her IV fluids.
Running head: CASE STUDY
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References
Banasik J. L. & Copstead, L. C. (2019). Pathophysiology (6th ed.). Elsevier, Inc.
COPD – Symptoms and causes. Mayo Clinic. Retrieved from
https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes
Kalil, A. (2019). Septic Shock Treatment & Management: Approach Considerations, General
Treatment Guidelines in Septic Shock, Goals of Hemodynamic Support.
Emedicine.medscape.com. Retrieved from
https://emedicine.medscape.com/article/168402-treatment.
Linares, M. (2020). Septic Shock: Diagnoses and Nursing and Medical Management – Simple
Nursing. Simple Nursing. Retrieved from https://simplenursing.com/septic-shockdiagnoses-and-nursing-and-medical-management/.
Nandhabalan, P., Ioannou, N., Meadows, C., & Wyncoll, D. (2018). Refractory septic shock: our
pragmatic approach. Critical care (London, England), 22(1), 215.
https://doi.org/10.1186/s13054-018-2144-4
Pneumonia – Diagnosis and treatment – Mayo Clinic. Mayoclinic.org. Retrieved 27 July 2020,
from https://www.mayoclinic.org/diseases-conditions/pneumonia/diagnosistreatment/drc-20354210.
Rogers, G. (2019). Septic Shock: Symptoms, Causes, Diagnosis, Treatment & More. Healthline.
Retrieved from https://www.healthline.com/health/septic-shock#symptoms.
septic shock. (n.d.) Medical Dictionary for the Health Professions and Nursing. (2012).
Retrieved from https://medical-dictionary.thefreedictionary.com/septic+shock
Septic Shock Symptoms, Definition, Treatment, Signs & Causes. MedicineNet. (2020). Retrieved
from https://www.medicinenet.com/septic_shock/article.htm.
Running head: CASE STUDY
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Whitlock, J. (2019). Know the Difference Between a Sepsis Infection and Septic Shock. Verywell
Health. Retrieved from https://www.verywellhealth.com/sepsis-and-septic-shock3156848.

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