**NRSG378 Assessment 3 - Case Study**
**Patient Overview:**
Shaun Morely, a 35-year-old male, was admitted to the emergency department with symptoms including worsening cough, shortness of breath, fever, and general weakness. His husband, George, accompanied him and reported that both tested positive for SARS-CoV-2 four weeks ago. Shaun's symptoms have been worsening over the past two days, but they couldn't see their GP due to unavailability. He reports a loss of appetite and weight.
**Medical Assessment Findings:**
- **Physical Appearance:** Pale, cool, clammy skin; dry lips; cracked tongue; lethargic; prefers to sleep
- **Positioning:** Lying in semi-Fowler's position, attempting to sit upright, holding chest
- **Cough:** Frequent, productive with purulent green phlegm
- **Auscultation:** Bilateral crackles in lower and middle lung lobes, occasional expiratory wheeze
- **Urine Output:** Last recorded at 9 am
**Vital Signs:**
- Heart Rate (HR): 124 bpm, regular
- Blood Pressure (BP): 95/56 mmHg
- Respiratory Rate (RR): 30 bpm, moderate work of breathing with accessory muscle use
- Temperature: 38.7°C
- Oxygen Saturation (SpO2): 91% on room air
- Alert and oriented to time, place, and person
- Capillary Refill Time (CRT): 2 seconds
- Weight: 92 kg, Height: 1.65 m
**Laboratory Results:**
- Hemoglobin: 143 g/L (Normal: 140-180 g/L for males)
- White Cell Count (WCC): 11.8 x 10^9/L (Normal: 4-11 x 10^9/L)
- Sodium: 132 mmol/L (Normal: 135-145 mmol/L)
- Potassium: 3.5 mmol/L (Normal: 3.5-5.2 mmol/L)
- Lactate: 2.4 mmol/L (Normal: <1.0 mmol/L)
- C-reactive protein (CRP): 22 mg/L (Normal: <5 mg/L)
- Creatinine: 115 µmol/L (Normal: 60-110 µmol/L)
- Sputum culture: Pending
- Blood cultures: Pending
**Patient History:**
- Shaun lives with his husband in Sydney and is studying civil engineering full-time while working as a barista on weekends.
- He does not smoke, drinks alcohol occasionally, and vapes daily (ceased during illness).
- Family: Parents are well and live overseas.
- Medical: Asthma, well-controlled since childhood.
- Medication: Salbutamol (as needed)
**Management Plan:**
- Administer IV bolus NaCl 0.9% 500 ml over less than 15 minutes.
- Start IV NaCl 0.9% at 100 ml/hr.
- Administer IV ceftriaxone 1 g twice daily.
- Conduct vital observations every 30 minutes and respiratory assessment every hour.
- Provide high-flow oxygen.
**Task:**
As the registered nurse caring for Shaun, use a clinical reasoning framework and the case study information to guide his care plan.
1. **Patient Assessment (250 words):**
- Provide an initial impression of the patient.
- Identify relevant and significant features from the presentation.
- Determine the presenting condition/issue/concern.
- Suggest further elements of a comprehensive nursing assessment, beyond what's already been done.
2. **Disease Pathophysiology and Complications (750 words):**
- Discuss the pathophysiology of the presenting condition and how Shaun's symptoms reflect this.
- Identify risks for complications, and choose two possible complications to explain Shaun's risk based on his history and presentation.
3. **Identify Nursing Issues (400 words):**
- Identify and prioritize three nursing issues to address during Shaun's current admission.
- Justify these priorities with evidence and data from the case study.
- Use the "issue, cause, evidence" format for writing.
4. **Nursing Interventions (600 words):**
- Identify, rationalize, and explain the nursing care strategies to use or plan within the first 24 hours of admission, prioritizing these interventions.
