Analyzing a case study in Nursing as a RN in 8 hours shift

Please also refer to the documents uploaded in word and pdf format.

I also need to make sure writer is familiar with Austrlian Nursing sector to write this essay.


Assessment Item 1 – Case Study

Instructions to students
When addressing the assignment topic you need to ensure that you write in the third person. It is expected that you will read widely around the topic and correctly reference the paper as referencing constitutes 20% of the overall mark. The Course Study Guide and Course Profile SHOULD NOT be used as reference sources.

Please note “ the assessment criteria outlined in the Assessment Criteria table will be used to assess this assignment and as such it is important you refer to this table when preparing this assignment. A copy of the assessment criteria is attached bellow.

The word limit for this assignment is between 3500 and 4000 words including intext references. The assignment abstract, contents page and reference list are not included in the word limit.

Please note “ the assignment will only be marked to 4000 words. Any assignment content outside this word limit will not be marked. Please ensure all assessable items are in the body of the paper, as the appendix will not be marked.

Important: a) use a minimum of 20 references, including 10 peer reviewed journal articles as well as relevant web sites. b) use Harvard referencing style. c) double space with 12 points font. d) use of Australian references. For complete information refer to the assessment criteria attached bellow.

Prescribed Textbooks
Clinical psychomotor skills: assessment tools for nursing students (Australia-New Zealand edition)
Author/s : Tollefson, J Year : 2010
Edition : 4th edn Publisher : Cengage Learning Australia
City : South Melbourne
Country :

Medical-surgical nursing: critical thinking in client care
Author/s : Lemone, P, Burke, K, Dwyer, T et al Year : 2011
Edition : 1st edn AU Publisher : Pearson Australia
City : Frenchs Forest
Country :

Self Reflection
Critical thinking and problem solving skills are key skills required by the registered nurse. To be able to effectively critically think and problem solve the registered nurse must also be able to critically reflect on their own knowledge and skills. To facilitate the development of this skill you are required to undertake a self assessment of your course. To do this you will need to complete the Assessment Criteria table using the text highlight colour tool available in word to indicate your view as to how you have addressed each item outlined in the assessment criteria in your assignment. The completed Self Reflection Assessment Critical document is to be attached as an appendix to the submitted assignment.

Please note “ assignments submitted without the self reflection assessment criteria will not be marked until the self reflection document is submitted.

Assignment Task

You are the Registered Nurse on duty for the morning shift. Your shift commenced in the High Dependency Unit (HDU) at 0700 hours and you are assigned to admit and plan the care for your client, Stacey Friend. You are required to develop an assignment that presents an analysis of the case study below and a detailed plan for your 8 hour shift that concludes at 1530 hours. You need to identify your priorities and nursing decisions. You need to provide a rationale for nursing interventions and collaborative management strategies.

Please note “ this assignment does not require you to develop a nursing care plan but
instead you are to develop a discussion of how you will plan your shift and what you will do for the client during your 8 hours on duty.

Case Study
Handover notes
0430 hours
Stacey Friend is a 23 year old primary school teacher. She was admitted to the Hospital Emergency Department in the early hours of the morning with a burn injury following a house fire. She was home alone as her partner, Tim was away on business.
Stacey was rescued from the house fire by a neighbour who broke the front bedroom window and dragged her out of the burning house. She had not been unconscious and arrived at the Department of Emergency Medicine (DEM) within 1 hour of the burn injury. She has a history of asthma since she was a child and uses a Ventolin puffer and budesonide inhaler on a daily basis. She has no known drug allergies.

Initial assessment
Primary Survey
Airway – patent and negative for burn injury.
Breathing – present, respiration at 16 breaths /min, productive cough with small amount of yellow sputum. Equal air entry into both lungs.
Circulation – pink in colour, warm to touch. Capillary return is less than 2 seconds. Vital signs, T37.6, HR 88, BP 100/70, Resp rate 16 breaths/min, Sp02 96% with Hudson mask in situ delivering 8L oxygen per/min.
Disability – Conscious and orientated to time and place. PEARL.

Triage Score:
Based on the primary assessment, the nurse allocated Stacey a triage score of 2.

Secondary Survey
Exposure and environmental control – Stacey s clothes were removed to allow visualisation of her burn injury. She was dressed in a sterile hospital gown and covered with a sheet. Her burn was calculated to be 27% partial thickness injury covering the anterior surface of both legs (18%) and her abdomen (9%).
Family – were notified of Stacey s admission to hospital and her mother, Sharon, arrived at the hospital at 0600 hours.
Give comfort measures – Stacey was reassured and advised of the need to admit her to hospital for treatment of her burn injury. Pain management commenced as ordered.
Head to toe assessment – revealed no other injuries. Respiratory assessment determined that Stacey s lungs were clear and that air entry to each lung was equal. Stacey is 163 cm tall and weighs 60 kg. The assessment showed Stacey to be a well nourished young woman with no history of illnesses other than asthma.

Collaborative treatment
The Parkland formula for fluid replacement was used to calculate the fluid required by Stacey during the resuscitation period of her burn injury. Based on the extent of the burn and her weight (60 kg), Stacey s fluid resuscitation was calculated to be 6480 mL of Hartmanns solution for the 24 hour period after the burn. 50% of the fluid is required to be infused in the first eight hours and the remaining half over the next 16 hours.

0500hours A large bore IV cannula was inserted in both wrists and blood was drawn for electrolytes, serum chemistry, full blood count, and cross-match. Right arterial stab was used to collect blood for ABG analysis. The IV therapy was commenced.

0515hours Stacey was given IVI Morphine 10mg for pain.


0545hours Stacey was ordered IV infusion of Morphine 30mg in 30ml of normal saline infusion to run at 3 mg per hour for pain relief.

The morphine infusion was commenced.

0600hours Stacey was ordered salbutamol 5mg via the nebuliser q4h and this was given at 0605hours. She was also order Budesonide puffer x 2 puffs daily for 0800hours

0630hours The following blood test results were received by the RN in DEM

Analyte Plasma Reference range
Na+ 132 mmol/L 132-144 mmol/L
K+ 5.6 mmol/L 3.5-5.0 mmol/L
Cl- 105 mmol/L 98-109 mmol/L
HCO3- 24 mmol/L 23-33 mmol/L
Creat 0.1 mmol/L 0.06-0.12 mmol/L
Glu 5.5 mmol/L 3.5-6.0 mmol/L
PO4 1.05 mmol/L 0.65-1.25 mmol/L

Red cells count 2.8×10^12/L 3.6-5.2
Platelet count 140 x10 ^9/L 150-450
White cell count 15.3 x 10^9/L 4.0-11.0

ABG results
PH 7.33 7.35-7.45
Pa02 78 mmHg 80-100 mmHg
PaC02 50 mmHg 35-45mmHg
HCO3 24 mmol/L 22-33 mmol/L

Cross-match results “ A positive blood group

Following receipt of the blood test results at 0630hours the medical officer orders:
an MSU to be collected along with a sputum culture and throat swab.
Blood transfusion of 2 units of packed cells. Each unit of packed cells contains 300 mls and is ordered to run over 3 hours.
IVI Pencillin 600mg q6h. First dose of the IV antibiotic is due to be given at 0800 hours.
Repeat blood tests for 1500 hours.

The RN from DEM checks with the blood bank and is told that the packed cells required for transfusion will be available just before 0800hours.

0645 hours – Stacey is visited by the Surgical Burn Team. She has been scheduled for a light general anaesthetic and explorative surgery to her burn injuries at 1600 hours that day so the burn team can fully assess the extent of her injuries. Stacey s burns are dressed with Bactigras, Melonin and bandages.

0700 hours – The RN from DEM arranges for the transfer of Stacey to the High Dependency Unit (HDU).

0730 hours
Stacey is admitted to the HDU for observation and continuation of her treatment. She is accompanied by her mother. On admission to HDU Stacey is pale in colour. Her Sp02 is 92%, respiratory rate 20 breaths per minute, BP 95/45. She was placed on a cardiorespiratory monitor and the following cardiac rhythm strip obtained.

As she is transferred to the HDU bed Stacey removes her Hudson oxygen mask and vomits a small amount of clear fluid on her bed sheets. Stacey appears short of breath following the vomiting episode and tells you she is dizzy and in a lot of pain. She grabs for your hand and says is a whisper – I think I m going to die, please don t let me die.

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