NURBN2026 Person Centered Nursing Sample
Assignment Details
Written analysis of case-based scenario (2,000 words):
Utilise the Clinical Reasoning Cycle (Levett-Jones, 2017), to detail the provision of evidence-based,person-centred care for the case study provided. This should detail the persons situation, collection of cues, processing and identification of issues and the establishment of realistic and relevant goals. In processing and identifying patient information you must clearly identify at least two (2) relevant nursing issues/ problems. You will then detail the care you provide related to those issues as well evaluate anticipated responses and reflect on your learning.
Please use information below to structure your case report:
Introduction (100 words):
• Briefly detail what you are going to write about, briefly introducing the patient and the CRC Patient situation (100 words):
• Briefly identify what you know about the patient
• Consider Brett’s situation describing the person and their context
Collect cues (350 words):
• Review relevant current information
• Document what else you would like to know e.g., history, physical assessment, or other investigations
• Recall what you know about his current health condition (Brief pathophysiology – linking Brett’s health to supporting literature).
Process (350 words):
• Interpret cue to explain abnormal vital signs
• Cluster or group important cues, with patterns of health identified
• Develop inferences/hypotheses of cause of illness/potential problems
• Relate all information to supporting literature.
Identify problems/issues (200 words):
• Based on your ‘processing’ of information identify at least two (2) immediate nursing problems/issues related to your shift of care for Brett.
Establish goals (100 words):
• Identify goals of nursing care related to the nursing problem/issues identified for Brett.
• Remember SMART.
Take action (400 words):
• Detail with supporting literature the nursing care for Brett related to your established goal.
Evaluate (100 words):
• Evaluate your nursing care strategies with what you anticipate Brett’s response will be.
Reflect (200 words):
• Reflect on the process of new learning.
• What did you learn by completing this case report?
• Where do you need to focus your efforts for wider understanding?
Conclusion (100 words):
• Briefly describe what you wrote about, as well as a summarising statement.
References:
• At least 10 contemporary academic sources, using APA 7th ed.
https://images.app.goo.gl/ouHCDQTYMmDAwyyK7
Your analysis should relate to your shift of care for Brett.
Ref:
Levett-Jones, T. (2017). Clinical reasoning: Learning to think like a nurse. Pearson
Solution
Introduction:
The assessment will focus on a 55-year-old man with a history of colorectal adenocarcinoma and conduct a thorough evaluation of sudden health deterioration to identify the problem sustained by the patient as well as provide a well-structured nursing consideration. To identify the challenge as well as the necessary nursing management clinical reasoning cycle will be used as a structural process. The clinical reasoning cycle is known to be a process that is widely used by nursing professionals to collect signs and queues evaluate the obtained data as well and understand the issue or situation to plan for a better intervention and sustain the desired outcome (Tan et al., 2019).
Patient situation:
The case study focuses on Brett Patterson who was admitted to the acute oncology ward due to severe vomiting, nausea, chills as well as mild diarrhoea along with chemotherapy two days prior to admission. Brett has a medical history of stage three colorectal adenocarcinoma which was diagnosed 5 months prior the admission with protein bowl screening follow-up. He has been working as a real estate agent and currently lives with his wife Kim and a daughter. He has also undergone different stages of colonoscopy with biopsy removal of the tumour through bowel resection along with anastomosis.
Collect cues:
Brett has been witnessing discomfort since yesterday which was followed by mild diarrhoea, vomiting, nausea, and chills after undergoing his chemotherapy session. His chemotherapy is carried out using FOLFOX with the help of a Baxter pump for a duration of 48 hours which is conducted every 2 weeks. Stage three colorectal adenocarcinoma is considered to be one of the most common as well as curable types of cancer It develops starting from the large intestine Including the colon and rectum. In this cancer type, more than 50% of the patients are identified with full recovery without any risk of recurrence post-treatment and surgery (Alzahrani et al., 2021).
It will be further necessary to evaluate detailed information regarding the past medical history of the patient along with the family history of diseases. It is necessary to understand the family history as well as the patient’s history of disease and medical conditions to sustain a better understanding of the current health complications and risks. Also, it will be necessary to conduct a detailed physical assessment of the patient to investigate and analyze the underlying causeway of the reported symptoms as well as its relation to the past medical condition. It has often been found that post-chemotherapy, a patient sustains a certain set of side effects such as fatigue, constipation, diarrhea, nausea vomiting severe hair loss low blood cell count as well as soreness or ulcer in the throat and mouth. This is due to the fact that chemotherapy functions by damaging the genes that are present within the nucleus of the cancerous cells That are fast-growing in nature (Han et al., 2020). It has often been found that as the chemotherapy drug troubles through the bloodstream and features every part of the body, it often affects healthy normal cells that have a fast-growing nature thus the damage of the normal cells often leads the patient towards witnessing different series of side effects. The condition was similar in the case of Brett due to which he was administered a series of medications He has been prescribed Metoclopramide 10mg TDS, and Endone 5mg PO 4-6 hourly against gastroesophageal reflux disease and pain.
Process:
On analysis of the case report of the patient, it was found that the patient sustained a certain set of abnormalities in his vital signs Which indicated the progression of some underlying health condition. It was found that the patient had a slight increase in the haemoglobin level though the white blood cell count and the platelet count were within the normal range first up It was also found that the neutrophil level was dropped but was still within the estimated normal range. Neutropenia is also considered to be one of the concerning effects of chemotherapy as it decreases the neutrophil level within the blood with significantly increases the risk of serious infections in the patient (Stryczy?ska-Mirocha et al., 2022). Also, the patient report reflected a low potassium level with no significant abnormalities in the Urea and electrolytes (U&E) examination.
In the case of chemotherapy, the agents that are used to conduct the treatment damage the renal tubules which significantly decreases the potassium level within the body. One of the other necessary aspects of low potassium levels in chemotherapy patients is that the patient sustains cancer bowel obstruction and filtration which develops a major imbalance in renal functioning. It has been found that anticancerous drugs that are used in the process of chemotherapy often change the colour and concentration of the urine (Moschen et al., 2022). The condition was similarly identified in the case of Brett as he found his urine to be more concentrated than earlier. It has often been found that patients undergoing chemotherapy against cancer report change in vitals and health condition for university assignment help.
Several researchers and pieces of evidence also highlight the fact that conditions such as low potassium level, increased haemoglobin, diarrhoea, nausea, vomiting, and concentrated urine along with ulcers and dryness in the mouth indicate the progression of kidney disease. Thus it is necessary to conduct a thorough assessment to identify the progression of kidney disease in the case of Brett as chemotherapy is also accounted for the progression of kidney dysfunction in a suffering individual (Muto et al., 2023). It has been found that certain sets of conventional chemotherapy agents sustain major injury within the different parts of the kidneys such as tubules vasculature, glomerulus as well as interstitium which further increases the risk of acute kidney failure.
Identify problems/issues :
Dehydration: One of the potential immediate nursing problems in the case of Brett identifies the risk of severe dehydration stop due to continuous vomiting and diarrhoea. Diarrhoea as a key symptom of chemotherapy is often referred to as chemotherapy-related diarrhoea or CRD which is known to be a potentially life-threatening health condition that demands the need of appropriate nursing care (Kawasaki et al., 2023). Evidence has also supported the fact that diarrhoea is associated with increased cases of malnutrition and dehydration in patients suffering from cancer and undergoing chemotherapy.
Impaired renal function: One of the significant nursing issues that might develop in the case of Brett post-admission to the Acute oncology ward Is impaired renal function or sudden renal failure. It has been found that postchemotherapy the kidney functions by breaking down as well as removing the chemotherapy drugs out of the body. The product developed during this process tends to possess the potential to damage the cells within the Renault system as well as the bladder (He et al., 2019). The condition is often termed as nephron toxic and thus it requires immediate nursing intervention to minimize the risk of a life-threatening condition.
Establish goals: SMART (Gandhi & Sharma, 2023).
Goal 1: Minimize the risk of dehydration due to diarrhea
S: Lessen the risk of dehydration and maintain an appropriate supply of fluid to the patient
M: Cautious and attentive and ensure stability in health against diarrhea and vomiting,
A: It will require intravenous fluid retention therapy and oral supplements
R: Fluid balance and hydration will help treat diarrhea as well as nausea as a post-chemotherapy side effect.
T: Hydration and fluid retention in the body for a duration of 24 hours
Goal 2: reduced the chances of renal dysfunction and deterioration
S: Reduced risk of renal dysfunction
M: Stable and normal vitals along with balanced input and output by the patient
A: Regularly monitor and record renal function and electrolyte balance
R: Routinely monitor the input and output of the patient as well as diet and fluid intake
T: A duration of 24 hours and more based on recovery
Take action:
Focusing on the condition of Brett, it will be necessary that the following actions are taken into account in order to reach the above-identified two nursing goals.
IV treatment for fluid retention or Rehydration Therapy: The patient will be provided with IV Treatment as a process for fluid retention to overcome dehydration. It will help the patient sustain normal hydration as well as recovery from severe vomiting and diarrhoea which further lead to nausea as IV fluid retention ensures an appropriate supply of fluid within the body. Intravenous rehydration therapy is used in the case of patients who are unconscious, severely dehydrated, or are witnessing uncontrollable vomiting and fatigue (Simpson & Mcintosh, 2021). As Brett has been continuously vomiting and is at risk of severe dehydration, it will be necessary to provide him with intravenous rehydration therapy to assist him with stable fluid retention. The IV fluid retention will be carried out for a duration of 24 hours to ensure total recovery. Also, it has been found that fluid management using intravenous rehydration therapy helps ensure significant delivery of nutrients as well as electrolyte supply that are necessary to assist stable kidney functioning (Stickel et al., 2019). It further serves as a necessary nursing intervention to minimize the risk of renal dysfunction or further kidney damage
Routine monitoring: It will be necessary that the patient is routinely assessed over a period of every 15 to 30 minutes to evaluate the volume intake by the patient as well as assess the rate of fluid retention in the body. It will also help in assessing whether the patient is sustaining immediate recovery or requires further assistance to reduce the risk of other complications (Gray, Birkenfeld & Butterworth, 2023). Also, routine monitoring will serve as a necessary nursing action in case of health deterioration associated with renal dysfunction. It will be necessary to routinely monitor the input and output of the patient as well as diet and fluid intake, change in urine color as well and stable level of potassium in the report. It is considered to be one of the possible nursing strategies to manage real function and assess the risk of deterioration (Fabrellas et al., 2020). Thus, it will be carried out for a duration of 24 hours until further assessment.
Evaluate:
After delivery of rehydration therapy through intravenous procedure the patient will sustain the ability to gain consciousness as well as strength in the body. The patient maintained significant electrolyte and fluid balance within the body which is necessary for normal conduction of body metabolism. To assess and evaluate the successful impact of the nursing actions it will be necessary to conduct blood as well as Urea and electrolytes (U&E) assessment (Smout et al., 2022). It will help in analyzing the state of dehydration as well as renal functioning in the case of Brett.
Reflect:
The assessment helped me understand a wide range of knowledge and information that are necessary in case of case study evaluation and nursing care delivery. It has been identified through a case study that a range of symptoms indicates multiple health conditions, thus proper health assessment must be carried out to identify the appropriate reason behind the progression. It helps me understand that it is necessary to conduct a proper health assessment and further plan for better nursing goals and actions to ensure minimized risk of health deterioration and fast recovery for the patient. In analysis, I have gained knowledge regarding the need for better critical analysis and thinking skills in the case of patient case study evaluation and assessment. It is a significant step for a nurse or health care professional that he or she possesses the potential to critically analyze evaluate and think in order to plan for a better nursery action against different health conditions.
Conclusion:
In order to conclude the assessment, it can further be stated that the patient sustained the risk of health deterioration associated with chemotherapy side effects as well as the risk of progression of kidney disease. The patient indicates the necessary need for proper nursing intervention post-identification of nursing issues in order to minimize the risk of deterioration and provide beneficial health recovery. Thus, it will be necessary that a proper health assessment, as well as delivery of appropriate nursing management strategies, are maintained in case of bread for petted treatment and recovery.
References:
Alzahrani, S. M., Al Doghaither, H. A., & Al Ghafari, A. B. (2021). General insight into cancer: An overview of colorectal cancer. Molecular and Clinical Oncology, 15(6), 1-8. https://doi.org/10.3892/mco.2021.2433
Fabrellas, N., Carol, M., Palacio, E., Aban, M., Lanzillotti, T., Nicolao, G., ... & Ginès, P. (2020). Nursing care of patients with cirrhosis: the LiverHope nursing project. Hepatology, 71(3), 1106-1116. https://doi.org/10.1002/hep.31117
Gandhi, I., & Sharma, R. (2023). Improving Delirium Assessment in Palliative Homecare–A Quality Improvement Project at CanSupport. Indian Journal of Palliative Care, 29(1), 70. https://doi.org/10.25259%2FIJPC_48_2022
Gray, M., Birkenfeld, J. S., & Butterworth, I. (2023). Noninvasive Monitoring to Detect Dehydration: Are We There Yet?. Annual Review of Biomedical Engineering, 25, 23-49. Retrieved from: https://www.annualreviews.org/doi/pdf/10.1146/annurev-bioeng-062117-121028
Han, C. J., Yang, G. S., & Syrjala, K. (2020). Symptom experiences in colorectal cancer survivors after cancer treatments: A systematic review and meta-analysis. Cancer nursing, 43(3), E132. https://doi.org/10.1097%2FNCC.0000000000000785
He, L., Li, J., Zhan, J., Yi, F., Fan, X., Wei, Y., & Zhang, W. (2019). The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: a systematic review and meta-analysis. Cancer chemotherapy and pharmacology, 83, 561-571. https://doi.org/10.1007/s00280-018-3762-x
Kawasaki, Y., Kakimoto, K., Tanaka, Y., Shimizu, H., Nishida, K., Numa, K., ... & Nishikawa, H. (2023). Relationship between Chemotherapy-Induced Diarrhea and Intestinal Microbiome Composition. Digestion, 1-13. https://doi.org/10.1159/000528282
Moschen, A. R., Sammy, Y., Marjenberg, Z., Heptinstall, A. B., Pooley, N., & Marczewska, A. M. (2022). The underestimated and overlooked burden of diarrhea and constipation in cancer patients. Current Oncology Reports, 24(7), 861-874. https://doi.org/10.1007/s11912-022-01267-3
Muto, S., Matsubara, T., Inoue, T., Kitamura, H., Yamamoto, K., Ishii, T., ... & Yanagita, M. (2023). Evaluation of kidney function in patients undergoing anticancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022. International Journal of Clinical Oncology, 1-39. https://doi.org/10.1007/s10147-023-02372-4
Simpson, D., & Mcintosh, R. (2021). Measuring and monitoring fluid balance. British Journal of Nursing, 30(12), 706-710. https://doi.org/10.12968/bjon.2021.30.12.706
Smout, E., Phyu, K., Hughes, G. J., Parker, L., Rezai, R., Evans, A., ... & Page, E. E. (2022). Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK. Scientific Reports, 12(1), 19257. https://doi.org/10.1038/s41598-022-23602-1
Stickel, S., Gin-Sing, W., Wagenaar, M., & Gibbs, J. S. R. (2019). The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension. European Heart Journal Supplements, 21(Supplement_K), K46-K53. https://doi.org/10.1093/eurheartj/suz207
Stryczy?ska-Mirocha, A., ??cki-Zynzeling, S., Borówka, M., Niemir, Z. I., Kozak, S., Owczarek, A. J., & Chudek, J. (2022). A Pilot Study Indicates an Essential Link between a Mild Deterioration in Excretory Kidney Function and the Risk of Neutropenia during Cancer Chemotherapy. https://doi.org/10.20944/preprints202211.0200.v1
Tan, M. H., Iyengar, R., Mizokami-Stout, K., Yentz, S., MacEachern, M. P., Shen, L. Y., ... & Gianchandani, R. (2019). Spectrum of immune checkpoint inhibitors-induced endocrinopathies in cancer patients: a scoping review of case reports. Clinical diabetes and endocrinology, 5, 1-21. https://doi.org/10.1186/s40842-018-0073-4
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