Produce a 3000 word essay on managing complex care in a rapidly changing situation based on a SEPTIC patient scenario representing your field of nursing.
The essay should include the following;
• Introduction
• Situation
• Background
• Assessment (including care and treatment that followed)
• Recommendation
• Conclusion
• References
Introduction:The size of an introduction will vary but as a guide, it is usually approximately 10% of the total word count. Content will also vary, but should set the scene for the main body of the assignment. Generally the introduction will contain some background information on the topic, a rationale for the choice of topic/client/service user and an outline of the structure adopted. This should be based on the reading you have undertaken.
Situation:Firstly, detail your specific situation (but do not identify the patient or clinical setting by name). You should prioritise the relevant information regarding changes, vital signs and your concerns. This needs to be supported with references.
Background: Include the patient’s reason for admission/intervention. Explain significant medical history, including diagnosis, prior procedures/treatment, current medications, allergies, pertinent laboratory results and other relevant diagnostic results.
Include other 3 relevant factors that may relate to the patient, or incident that was complex and involved rapidly changing circumstances, including references throughout.
Assessment : In this section you will demonstrate critical thinking and assessment skills.
Not only will you review your findings from your assessment, you have also consolidate these with other objective indicators, such as laboratory results/other factors.
Consider what might be the underlying reason for your patient’s condition. Discuss and critically analyse assessment tools and results. Include references to literature throughout.
Recommendation: You need to discuss the recommendation for care and treatment, based on up to date evidence. This recommendation needs to be specific, and expectations need to be clarified. Again, this needs to be supported with references.
Conclusion. This should provide a summary of the work and draw the main points together, highlighting any issues of importance. You should not be providing any new material at this point.
Reference List
This should be provided in accordance with CHHS guidelines. For work at level 6, a wide range of literature should be used, drawing upon specialist journals and texts as necessary.
It is expected that the literature used will be up to date (less than 5 years old), where possible. The reference list is not included in the word count.
Appendices. Appendices are not included in the word count; as such they do not contribute to the final mark. These should be sparingly used to support evidence that is provided in the main body and should be referred to within the text.
The word count should not exceed 3000 words
Scenario (SEPSIS)
You are working on an acute clinical decisions unit. Stephen is 71 years old (80Kg and
1.83m). He was admitted to your unit via his GP following a diagnosis of a chest infection.
This had been treated by the GP with oral antibiotics for the past 7 days. The GP has
referred to your unit for chest x-ray and possible need for IV antibiotics as Stephens
symptoms have persisted. Stephen has been clerked by the medical team, started on 2L O2 via nasal cannula for low saturations of 91% and commenced on IV antibiotics.
Past Medical History
Type II Diabetes
Ex-smoker, gave up 20 years ago when diagnosed with diabetes
Bilateral cataracts
Social History
Stephen lives with his wife Sylvia in their bungalow and is normally independent. Stephen
likes to garden and Stephen and Sylvia are keen walkers. They have three children who have
all remained local and regularly gather for Sunday lunch with their extended family.
Upon admission to your unit at 13.00 hrs, routine observations were taken:
• Respirations 20 breaths per minute
• Oxygen saturations (SaO2) 97% on 2L O2 via nasal cannula
• He was not using his accessory muscles
• Pulse 89 beats per minute
• BP: 130/85 mmHg
• Blood glucose 6.0 mmol/L
• Temperature 37.0oC
10
At 16:30, Stephens’s wife asks for you to come and see him as she reports he seems more
unwell now and she seems very concerned. On approaching Stephen, he does seem visibly
short of breath. You assess Stephen and find the following:
• Stephen is alert
• He appears short of breath with marked use of his accessory muscles and
expectorating green sputum
• You note that Stephen appears to be taking quite shallow breaths
• SaO2: 89% on 2L O2 via nasal cannula
• Respiratory rate is 30 breaths per minute
• He feels hot to touch with dry skin
• Pulse 115 beats per minute, regular and bounding to palpate
• BP 92/65 mmHg
• Capillary refill time is 3 seconds
• Blood glucose 17.4 mmol/L
• He last passed urine at 13:30 and this was recorded as 70ml of dark urine. Nil
detected on ward analysis of urine.
• When talking to Stephen he now appears confused in comparison to your earlier
discussions when he was alert and orientated
• Stephen is denying any pain
• T: 38.8oC
• Nothing obvious to note upon exposure
You are to report this deterioration in Stephen’s condition to the medical team using the SBAR format
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