CCA206 Critical Appraisal of a Case Study Assessment 3 Answer

Task Summary

In this assessment task, you will be required to

• Select one (1) case study to explore.
• Critically evaluate the information provided in your case study scenario.
• Demonstrate an in depth understanding of common adolescent pathologies, and the role of the nurse in the assessment, planning and delivery of care.
• The word limit for this task is 1500 words (+/- 10%). This is an individual task.
• Please refer to the Task Instructions for more details.

Context

As adolescents mature and develop their independence, they will at times present on their own to seek health care services. Adolescents will also commonly present with their parents(s), requiring the nurse to practice family centred care. When planning, delivering, and evaluating nursing care for adolescents who present without a parent in the emergency department setting, the nurse needs to build and sustain a therapeutic relationship with the adolescent, and advocate for their rights and needs.

In clinical scenarios where adolescents present on their own, and do not wish to include their family in their care, the nurse and medical team can be faced with moral and ethical dilemmas as to whether the family should be involved, despite the patient’s refusal. Adolescents should be viewed as individuals, and a determination should be made as to whether they are Gillick competent, whilst ensuring local legislation and policy is upheld. The determination as to whether an adolescent can be deemed Gillick competent, should also be made when an adolescent presents with parent(s) or a guardian, as it is essential to include the adolescent in decision making practices.

The case scenarios provided below, will test your knowledge of different pathologies and your understanding of the role of the Registered Nurse (RN) when caring for adolescents.

Task Instructions

To complete this assessment task, you must:

1. Visualise yourself in the role of the newly graduated Registered Nurse (RN), working in a busy metropolitan emergency department (ED). Your patient has been seen by a medical officer who has commenced assessment and they have handed the patient over to you for nursing care.
2. Choose one case study from the four presented.
3. Write a 1500-word (+/- 10%) essay using the suggested structure below.
4. Incorporate current evidence-based literature into the critical appraisal.
5. Respond to each of the points listed below pertaining to the selected case study:
   • Outline and describe the pathophysiology of the clinical diagnosis.
   • Identify and briefly describe the signs and symptoms of the clinical presentation and how they relate to and/or support the clinical diagnosis.
   • Consider the growth and development milestones for the age of the case study character and how this will influence nursing assessment and the planning of care.
   • Discuss whether the adolescent in the scenario can provide informed consent, and make independent medical decisions based on your knowledge of Gillick competence, considering the clinical diagnosis.
   • Identify the child protection responsibilities of the case study character whilst in the hospital setting and collaborative processes with a multidisciplinary team.
   • Outline any psychosocial and/or cultural needs which should be factored into nursing care and care planning.
   • Explain how the nurse can create and sustain a safe and emotionally supportive environment for the adolescent in the case study.

• Outline and discuss the Registered Nurses role in the safe administration and management of medications for the adolescent.

Suggested Structure

1. Page numbers should be included in the footer along with student ID number
2. A brief succinct introduction should be written to introduce the case study and intention of the critical appraisal (100-150 words).
3. A conclusion should be written which sums up any significant findings and concludes the critical appraisal in an engaging way. No new information should be introduced in the conclusion (150-200 words).
4. Use Headings and Subheadings where appropriate to indicate which question is being addressed.

Referencing

• A minimum of 15 different resources should be used as references, from a variety of source types.
• References must be from credible sources including peer reviewed and evidence based sources. Poor quality resources for example; Wikipedia, blogs and forums, should not be used.
• References must include a combination of source types for example; websites, academic journals, eBooks, government documents and/or publications.
• It is essential that you use appropriate APA (6^th ed.) style for citing and referencing research.

Please see more information on referencing here

h ttp://library.laureate.net.au/research_skills/referencing

Grading

Marking of this assessment will be conducted using the attached rubric below.

Submission Instructions

Please submit ‘Critical Appraisal of a Case Study via the Assessment 3 link in the main navigation menu in CCA206 Care of Children and Adolescents Blackboard site. The learning facilitator will provide feedback via the Grade Centre in the LMS portal. Feedback can be viewed in My Grades.

Case Scenarios:

Please select one (1) scenario to critically appraise, all case scenarios are balanced with equal complexity.

 Clinical Scenario 1

Name: William (Bill) Giovanni

Age: 16 years and 11 months

NOK: Brother Owen Giovanni (20 years old)

Allergies: lactose, fructose

Medical past History: asthma, lactose intolerance, fructose intolerance, smoker (10-15 a day)

Medications: Salbutamol prn

Reason for presenting to hospital: 1/7 of mild bilateral lower abdominal pain, localised to the R) side in the last 2 hours with associated rebound tenderness, nausea, hot flushes and diaphoresis.

Diagnosis: Acute appendicitis.

Vital Signs: HR: 90, BP: 109/65, RR: 22, Spo02: 99% RA, Temp: 38.5

Glasgow Coma Scale (GCS): 15

Investigations:

• Abdominal U/S: Positive for appendicitis
• Bloods: FBE (WBC = elevated), U&E and Blood cross match.
• Urinalysis: NAD

Treatment Plan:

• Admission: requires surgical removal of appendix
• Diet: Fasting for theatre
• Vital signs: 30/60
• Medications:
  • IV Morphine 2mg PRN
  • IV Maxalon 10mg PRN
  • IV Metronidazole 500mg in 100ml N/Saline stat
  • IV Amoxicillin 500mg IV stat
  • IVT N/saline 0.9% 8/24
• Ani-emboli stockings

Handover:

You have been asked to take over nursing care of Bill in the ED, until a bed is ready in theatre.

Bill requires pharmacological management of his pain, intravenous antibiotics (IV a/bs), to remain fasting and be prepared for theatre.

When approaching the cubicle, you see Bill lying in bed, knees bent, guarding his abdomen, and grimacing in discomfort. His brother is with him who looks stressed and waves you over.

Owen (the patient’s brother and next of kin (NOK)) talks to you outside the cubicle, stating that his brother Bill, has a low pain tolerance, and always gets freaked out in hospitals since their father passed away in a hospital when they were children.

Owen states that both he and Bill are estranged from their mother, who is an IV drug user. Owen also states that Bill is afraid of having IV medications as he is fearful of ending up like his mother. Owen asks if he can stay with his brother until he goes to theatre, as he is the only one looking out for his brother, and thinks he can help keep him calm.

 Clinical Scenario 2

Name: Jess Dutch

Age: 16 years and 7 months

NOK: Sister Kelly Dutch (19 years old)

Allergies: Peanuts (anaphylaxis)

Medical past History: Acne vulgaris, depression, anxiety and self-harm.

Medications: Roaccutane once daily

Reason for presenting to hospital: Self-inflicted laceration 7x2cm (LxW) to L) wrist with tendon visible on view. Sustained 2/24 prior with a knife, patient states feeling depressed and anxious.

Diagnosis: Laceration

Vital Signs: HR: 95, BP: 1015/65, RR: 24, Spo02: 99% RA, Temp: 37.5

Glasgow Coma Scale (GCS): 15

Investigations:

• Bloods: FBE, U&E and Group and Hold.

Treatment Plan:

• Admission: requires surgical washout and repair of laceration
• Diet: light meal for dinner then fasting for theatre in the morning
• Vital signs: Every 30 minutes
• Neurovascular observations every 30 minutes for 4/24 then 1/24.
• Saline soaked gauze dressing with combine to wound.
• Medications:
  • IV Ceftriaxone 1g stat
  • IM ADT Booster 0.5ml stat
  • Oral Panadiene forte x1 PRN