Cecil Jones Age: 68 Gender: Male Medical History: Hypertension, Type 2 Diabetes, Chronic Kidney Disease (Stage 3), Congestive Heart Failure, Osteoarthritis, Chronic Obstructive Pulmonary Disease (COPD)
Social History: Cecil lives alone in Kippa-Ring, in a single-story house. He does not have any live-in family members, as he is widowed. Cecil is a retired high school teacher and has been living on his pension since then. Cecil has limited social support. His children and close relatives live in Melbourne and Adelaide, and he rarely sees them. Cecil is a current smoker and started smoking at the age of 18, Cecil smokes approximately 15 to 20 cigarettes a day. Cecil takes Aclidinium long-acting muscarinic antagonist (maintenance medication) for COPD, whilst using a short-acting bronchodilator as a reliever, however, Cecil recently has stopped using Aclidinium. Cecil is a moderate drinker, consuming up to two standard drinks per day. He does not engage in regular exercise due to his chronic health conditions but used to be physically active in his younger years. Cecil can mobilise independently at home but does become short of breath on exertion. Presenting Condition Cecil Jones was admitted to Griffith University Hospital on October 10, 2023, with a chief complaint of increased shortness of breath, generalised weakness, peripheral oedema, cough, and loss of appetite. He was not able to recall if he had been experiencing fevers. He has a complex medical history and has been under the care of several specialists for the past few years. Cecil had previously been hospitalised three times in the last six months due to exacerbations of his chronic conditions. Chest X-ray on admission shows consolidation.
ISOBAR Communication Approach In Cecil Jones’s case, the ISOBAR approach was used to facilitate communication between the registered nurse (RN), Emily, and the registered medical officer (RMO) covering the late shift. Emily introduced herself to Cecil at the commencement of the shift, gathered key patient information, and ensured the patient’s identity. She also confirmed Cecil Jones’s current health issues, medications, and relevant history
I – Introduction: RN Emily contacted the RMO at 21:30hrs, introduced herself, and identified the ward calling from and patient of concern.
S – Situation: Cecil was noted to have a QADDS score of 5 at 21:25hrs (Case Study 1 – Adjunct Data QADDS). RN Emily outlined Cecil Jones’s current situation, emphasising the worsening shortness of breath, low oxygen saturation, increased blood pressure, elevated heart rate, and the presence of atrial fibrillation. She also highlighted the patient’s profound lower extremity oedema and difficulty in speaking full sentences due to dyspnoea.
O – Observation: RN Emily provided observations, including, bilateral crackles on lung auscultation, the patient’s fatigue and weakness, and the titration of supplemental oxygen to maintain SpO2 between 88-92%, via nasal prongs at 0.5-2L/min1 . BP – 145/100 mmHg (post daily dose of antihypertensive medication) HR – 118bpm and irregularly irregular Respiratory rate – 21 bpm Temperature – 37.5 Degrees Centigrade SpO2 88% Capillary Refill – Greater than 2 seconds Glasgow Coma Score – 15/15
B – Background: RN Emily shared Cecil Jones’s relevant medical background, including his complex medical history, recent hospitalisations, and the chronic conditions he was managing.
A – Assessment: RN Emily discussed her assessment findings, including the need for diuretic therapy to manage fluid overload and the presence of new-onset atrial fibrillation on the ECG. Chest X-ray (Case Study 1 – Adjunct Data) Full Blood Test Results (Case Study 1 – Adjunct Data) ECG (Case Study 1 – Adjunct Data) Urinalysis (Case Study 1 – Adjunct Data)
R – Recommendation: RN Emily immediately notified the team leader and planned a medical resident review within 30 minutes. Cecil was commenced on hourly observations. RMO reviewed Cecil at 21:45 and ordered a stat IV dose of Frusemide 40mg and to monitor vital signs hourly. Deterioration: Despite RN Emily’s utilisation of the ISOBAR communication approach, Cecil Jones’s condition continued to deteriorate rapidly over the next 2 hours. His oxygen saturation did not improve, and he required increased oxygen support. His heart rate remained elevated, and his blood pressure continued to rise, along with his respiratory rate. He became more dyspneic and fatigued, cooling peripherally with a prolonged capillary refill time and reduction in GCS, arterial blood gas indicates respiratory acidosis.
Vital signs HR 124bpm irregularly irregular BP 158/106 mmHg Respiratory rate 26 bpm Temp 37.3 Degrees Centigrade SpO2 86% on 2L/min Oxygen Capillary refill time > 2 seconds Glasgow Coma Scale 14/15 Arterial Blood Gas pH: 7.32 (7.35 – 7.45) PaO2:58 mmHg (80 – 100 mmHg) PaCO2:52 mmHg (35 – 45 mmHg) HCO3- : 26 mEq/L (22 – 28 mEq/L)
Task Descriptions to do:
scholarly literature:
1. Identify TWO (2) actual or potential priority problems related to failure to rescue described in the selected case study. For each problem, justify your choice as a priority (e.g., by referring to the patient’s assessment data in the selected case study and to appropriate literature)
2. For EACH priority problem, identify ONE (1) SMART goal for care of the selected patient (total 2 goals). Remember a SMART goal is specific, measurable, attainable, realistic, and timely
3. For EACH goal, describe TWO (2) evidence-based nursing interventions you would implement to meet the goal (total 4 interventions). For each nursing intervention, justify your choice by referring to appropriate literature.
4. For EACH goal, identify the expected outcomes and describe your evaluation approach (e.g., how, and when, would you evaluate whether your interventions have been effective or not?)
5. Analyse the impact of failure to rescue on the patient, their family, and the health care system.
Criterion One (12 Marks)
Identify two potential/actual priority problems related to failure to rescue and justify the selection
Criterion Two (12 Marks)
Identify and prioritise two goals (G) for care using SMART structure
Criterion Three (24 Marks)
Describe four relevant nursing interventions and provide an evidence-based rationale for nursing intervention
Criterion Four (12 Marks)
Discuss expected outcomes for interventions and provide description of how this outcome would be evaluated
Criterion Five (12 Marks)
Analyse the impact of failure to rescue on the patient, their family, and the health care system
Criterion Six (16 Marks)
Evidence and referencing