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EVIDENCE-BASED CASE STUDY ASSESSMENT 2

Subject: Management

Keywords : EVIDENCE-BASED CASE STUDY ASSESSMENT 2


Question:

EVIDENCE-BASED CASE STUDY

ASSESSMENT 2

In this written assessment, you will formulate a plan of care attributed to a patient scenario using the clinical reasoning cycle as a guide. This will allow you to demonstrate your understanding of associated pathophysiology, pharmacology, development of patient goals, interventions and evaluation of care.

This is an individual assessment task based on a patient clinical scenario where you are expected to apply clinical reasoning and critical thinking to develop a plan of care. You need to draw upon knowledge gained through workshops, clinical labs, simulations and your own self-directed learning through your pre/post learning resources and from Contemporary Nursing A & B, and Contemporary Nursing A & B Mental Health as well as Research and Evidence Based Practice.

ASSESSMENT OVERVIEW


Key Assessment Information

Overview: Case Study

Length or Duration: 1500 (+/-10%) words

Worth: 50%

Due: Week 3, Monday 14th November 23.59hrs

PURPOSE


The purpose of this assessment task is to:

  • Assist you in consolidating knowledge gained on the various focus topics relating to provision of evidence-based care for patients with acute and chronic disorders.
  • Apply knowledge obtained through participation in workshops, clinical labs, simulations and your self-directed learning through your pre & post activities in problem solving and decision making in authentic clinical scenarios.
  • Reinforce theoretical underpinning of caring for patients with acute and chronic conditions prior to your professional experience placement (PEP).

LEARNING OUTCOMES THAT ALIGN TO THIS TASK


  • Learning Outcome 1: Appraise knowledge and further expand clinical decision making through critical thinking and skills in contemporary nursing interventions in current health priorities.
  • Learning Outcome 2: Integrate previous knowledge about pathophysiology and pharmacotherapeutics and quality use of medicines to utilise a systematic problem-solving and evidence-based approach in decision making about patients with acute, chronic and mental health issues across the lifespan and cultural contexts.
  • Learning Outcome 4: Analyse and reflect upon professional nursing practice and the safe delivery of ethical and culturally competent care within their current scope of practice as a student registered nurse.

ASSESSMENT DETAILS


The written assessment task is related to a case scenario below. The context of the scenario will be based on disorders that have been covered in the first week of the block, and from Contemporary Nursing A & B, Contemporary Nursing A & B Mental Health.

The assessment piece should be developed with reference to the clinical reasoning cycle but DO NOT submit a clinical reasoning cycle. Through application of critical thinking and clinical reasoning you are to explore the following points:

  • Patient’s history, presenting problems and the related pathophysiological processes to identify priority problems
  • Comprehensive assessment, i.e., specific observation, assessment tools and or tests
  • Holistic plan of care is developed by setting specific goals
  • Formulate nursing interventions and or treatments, with rationales and consider ways to evaluate the effectiveness of actions
  • Consider relevance of specific nursing standards, code of conduct, code of ethics and legalities and relevant legislation
  • Adherence to cultural awareness and diversity considerations
  • Consider patient-centred care, recovery-oriented and trauma-informed practice, patient/consumer perspectives, and or lived experience research
  • Consider current/future nursing practice and research implications

Scenario:

Jessica Jones is an 18yo female who was previously diagnosed with Bulimia Nervosa. Jessica lives at home with her mother, Marie. Her parents are divorced, and her father lives in Western Australia. She has two older brothers, both of whom live overseas, in the UK and USA respectively. Jessica decided to defer going to university for a year and currently works for a logistics company as a receptionist. Jessica was diagnosed with bulimia when she was 16 years old. She was treated with cognitive behavioural therapy and made a good recovery.

Over the last six months, Marie has noticed that Jessica has lost weight, and there has been a change in Jessica’s behaviour including being secretive around food, becoming more antisocial and withdrawn, eating alone and avoiding other people at mealtimes, and frequent trips to the bathroom after eating.

Jessica was reviewed by the GP who referred her to the local hospital with hypokalaemia, hypernatremia, and cardiac arrhythmias. Vital signs: low blood pressure, irregular pulse, and feeling dizzy at times for unclear reasons. Jessica’s weight and height in ED: 170cm and 40kg. Admitted to the cardiac unit for cardiac monitoring and treatment of hypokalaemia (2.5mmol/L) and hypernatremia (149mmol/L), on background of binge eating, purging, and laxative abuse. Jessica voiced feelings of regret, guilt, low mood, and shame. Jessica was reviewed by the Mental Health Team, and the SCOFF questionnaire was performed. A plan of care was arranged that included potassium supplements and continuous cardiac monitoring, referral to Dietician, fluid balance chart, food chart and supervision at all mealtimes, bed rest with supervised toilet privileges before meals and 1 hour after meals, and 1:1 nursing. Jessica has voiced her anger at these rules and plan of care and does not wish to comply.

Case Study Question:

How would you as the Registered Nurse prioritise and manage this situation?

In your answer, you will need to consider the Registered Nurse Standards for Practice (Nursing and Midwifery Board of Australia [NMBA], 2016), Mental Health Act (2014); Recovery Focused Principles; Trauma Informed Care; Strengths Based Practice; The Mental Health Nursing Standards by the Australian College of Mental Health Nurse (2013); and the Medical Treatment Planning and Decisions Act (2016).

CASE STUDY- ESSAY STRUCTURE


(The clinical reasoning cycle & essay key points will also be interwoven into the below structure. DO NOT submit a clinical reasoning cycle).

Your case-study essay should be structured as follows:

  • Introduction: Start by setting the context and providing relevant background information. Include a statement that is a response to the case-study-essay question, and that summarises the main aim or points of the case-study essay. Outline the main ideas to be discussed in the case-study essay, in the order they appear in the body of the essay.
  • Body: Each paragraph should cover a single idea expressed in a topic sentence, followed by supporting evidence and examples from contemporary academic literature, including peer-reviewed journal articles.
  • Conclusion: A summary of your appraisal. Restate your essay question, and sum up your main points.

This is an academic assignment; therefore, academic standards inclusive of grammar, sentence structure, paraphrasing and APA 7th edition referencing for both in-text citations and referencing apply.

ASSESSMENT CRITERIA


  • Criterion 1: Critical analysis and critical thought (LO 1, 2, 4) - 30%
  • Criterion 2: Identification of theoretical and practical concepts with establishment of relationships (LO2 1, 2, 4) - 35%
  • Criterion 3: Language, expression & writing style (LO 4) - 15%
  • Criterion 4: Use of literature (LO 1, 2, 4) - 10%
  • Criterion 5: Referencing in-text and reference list (LO 4) - 10%

INSTRUCTIONS


  1. Read through the case study, essay instructions and rubric for this assessment task.
  2. Use the above essay structure, clinical reasoning cycle and essay key points to plan your essay: CRC Template opens in new window.
  3. Write your essay using contemporary evidence-based literature and alignment with academic standards.
  4. Check for similarity using Unkind system.
  5. Submit your work before the due date by following the submission instructions below. Please ensure you submit your complete assignment as one document.

ASSESSMENT CRITERIA


  • Criterion 1: Critical analysis and critical thought (LO 1, 2, 4) - 30%
  • Criterion 2: Identification of theoretical and practical concepts with establishment of relationships (LO2 1, 2, 4) - 35%
  • Criterion 3: Language, expression & writing style (LO 4) - 15%
  • Criterion 4: Use of literature (LO 1, 2, 4) - 10%
  • Criterion 5: Referencing in-text and reference list (LO 4) - 10%

Solution:

Clinical Case Study

Table of Contents

Introduction

Jessica Jones, an 18-year-old female, was previously diagnosed with Bulimia Nervosa and has undergone treatment with cognitive behavioral therapy. Over the last week, her mother noticed changes in Jessica’s behavior, physical and mental condition. She has been secretive around food, losing weight, eating alone, and avoiding others. On medical examination, it was found that she is suffering from hypokalemia, hypernatremia, and cardiac arrhythmias. A care plan has been developed by the Mental Health Team, which Jessica is resistant to, and she has expressed anger and non-compliance with the plan. Therefore, this case study aims to understand the patient care plan according to the situation and analyze how a Registered Nurse (RN) would intervene and provide effective care. This study will also explore how developing a clinical reasoning cycle impacts the treatment of mentally ill patients and the positive outcomes that result from it.

Discussion

Identifying the priority problem that leads to Bulimia Nervosa allows healthcare professionals to analyze the issue. Hay et al. (2020) opined that general practice is heavily involved in diagnosing symptoms of binge-eating disorder. Therefore, the patient requires intensive therapy such as cognitive behavioral therapy. This disorder is characterized by self-induced vomiting, weight loss, eating habits, and isolation. In this case, Jessica presents feelings of guilt, lack of control, frequent trips to the washroom, shame, low mood, and regret along with binge eating. These symptoms of anxiety and stress are associated with Bulimia Nervosa (Milano et al., 2018). The pathophysiological process of this disorder includes the rupture of the stomach followed by damage to the esophagus, which can be life-threatening.

Bulimia Nervosa is evident through compensatory behaviors, and cognitive behavioral therapy (CBT) is vital in treating this condition. Studies show that 30% of the population benefits from CBT (Gundogmus et al., 2020). Specific observations required for this disorder include weight loss, eating alone, and becoming increasingly antisocial and withdrawn. A comprehensive care plan is crucial to regulate food intake and nutritional uptake, and the patient’s symptoms indicate a re-emergence of Bulimia Nervosa along with chronic medical complications.

Hypokalemia, characterized by low potassium levels, often causes heart arrhythmias and weakening of the heart, a common complication in Bulimia Nervosa. Gundogmus et al. (2020) suggest that this condition results from purging behaviors such as vomiting and laxative abuse. Diuretic abuse also exacerbates electrolyte imbalance, which highlights the need for a well-structured care plan. As per Treasure et al. (2020), chronic fluid depletion can cause hypovolemic shock, and purging behavior leads to diarrhea and metabolic alkalosis, resulting in significant electrolyte loss. The patient has been admitted to the cardiac unit for monitoring hypokalemia and hypernatremia, indicating the importance of a holistic care plan to address all aspects of Jessica’s condition.

Nursing interventions for Bulimia Nervosa patients include reducing disordered eating behaviors. Gibson et al. (2019) emphasize that negative self-esteem, commonly seen in these patients, contributes to social dysfunction. Electrolyte imbalances, due to excessive sodium release, cause hypovolemia, which further impacts kidney function. It is essential to understand the mental health aspect of the patient when developing a care plan. As seen in the case scenario, Jessica is receiving potassium supplements to maintain electrolyte balance. Additionally, the nursing plan includes a fluid balance chart to monitor intake and output.

Setting goals for weight management and nutritional status is crucial, as Jessica is underweight. Additionally, her potential suicidal tendencies and mental health challenges need to be considered. Monitoring fluid balance and managing electrolyte levels, as mentioned in the care plan, will help prevent further complications. According to Trainor et al. (2022), nursing interventions based on both subjective and objective data can help patients recover from the chronic stage of Bulimia Nervosa. The patient’s meals should be supervised to prevent purging, and an exercise program should be set up to maintain muscle strength and regulate calories.

Establishing a care plan as a Registered Nurse involves following the Registered Nurse Standards for Practice under the Mental Health Act (2014), Recovery-Focused Principles, Trauma-Informed Care, Strengths-Based Practice, and the Medical Treatment Planning and Decisions Act (2016). These standards ensure quality care, maintaining professionalism and ethical practices across healthcare settings. Cultural awareness in Australia plays a crucial role in the delivery of respectful and effective nursing care, considering patients' beliefs and values. Juarascio et al. (2021) explain the importance of cultural awareness in healthcare settings, as it helps develop a safe and supportive environment for the patient. In Jessica's case, her resistance to the care plan might indicate a lack of cultural awareness, which nurses should address to foster a positive relationship.

Patient-Centered Care and Trauma-Informed Practices

Patient-centered care emphasizes considering the patient’s values and beliefs when developing treatment plans. As Wilson & Bannon (2018) suggest, this approach respects the patient’s dignity and ensures they receive proper care. Trauma-informed care is another crucial aspect of nursing practice, especially when treating patients with mental health disorders. According to Lampe et al. (2022), trauma-informed practices allow nurses to prevent triggering the patient’s emotional and psychological distress. Recovery-oriented nursing practice focuses on the patient’s mental health and facilitates recovery by creating an environment that promotes stability and mental wellness. Given the severity of Jessica’s condition, developing an intervention plan that incorporates these principles is essential.

Clinical Reasoning and Critical Thinking

Developing a care plan requires clinical reasoning and critical thinking, particularly for mental health patients. Srivastava et al. (2022) explain that healthcare professionals should apply theoretical perspectives to guide their decision-making. Contemporary nursing practices also integrate these approaches to ensure that the care provided is both evidence-based and effective. Implementing clinical interventions based on research ensures that nursing care is consistent with current healthcare standards, as reported by Roberts & Skipsey (2022). By considering cultural awareness, nurses can establish comfort and trust, enabling better care delivery.

Conclusion

Bulimia Nervosa is a serious condition that not only impacts the patient's mental health but also has severe physical consequences. The patient’s symptoms of weight loss, social withdrawal, and secretive eating habits call for an urgent and structured care plan. The risk of cardiac death necessitates timely intervention. The care plan should focus on preventing purging behaviors, addressing electrolyte imbalances, and managing mental health issues. By adhering to the NMBA standards and integrating cultural awareness, patient-centered care, and trauma-informed practices, nurses can provide effective and holistic care. Overall, the nursing care plan must support Jessica’s recovery and ensure her physical and psychological well-being.

Reference List

References will be listed in APA 7th edition format here.