Introduction

The current assignment is based on developing a case study evaluation related to the symptoms of a 68-year-old patient named Mr. Jheka. The patient has been suffering from pneumonia-induced septic shock which has been clinically presented in this assignment along with the nursing assessments. Moreover, this report also includes the evaluation of two selected interventions for the further management and prevention of the disease condition for this patient.

Finally, this assignment will demonstrate a concise ISBAR status for identifying the patient's condition before handing the patient over to another healthcare professional. Therefore, by summarizing the content of this assignment, it could be stated that this overall report helps in the process of understanding the clinical management approaches associated with a patient suffering from complex co-morbidities like pneumonia and septic shock.

Question-1

After analyzing the overall case details of this patient, two major nursing assessment approaches could be highlighted as a part of the priority nursing approaches which could be taken on an initial basis. These nursing assessment approaches include the primary assessment and the respiratory assessment of the patient which are as follows: 

The primary assessment 

To assess the current presentation of the patient Mr. Jheka, the initial nursing assessment that could be included as the priority approach is known as the primary assessment. The primary nursing assessment is usually completed at the start of every shift, encountering a new patient or during the changes in the condition of a patient. The completed documentation of the primary assessment flow sheet helps in the process of progressing the patient encounter in the future time. 

This assessment includes the overall identification of the patient's condition breathing status, circulation status, observation of the vital signs, pain assessment, hydration assessment, skin assessment, renal output assessment, risk assessment and even the social well-being assessment of the patient (Health Times, 2023). 

Therefore, in the case of starting the nursing management of this patient, the development of this primary assessment is necessary to explore the overall health condition of this patient to compare it with the previously available information. 

The respiratory assessment 

From the observation chart of this patient, it could be highlighted that this patient suffered from an instability in the respiratory rate, where the respiratory rate kept increasing with a final reading of 25 to 29 breaths per minute during 14:00. Moreover, the oxygen saturation level in this patient also demonstrated a decreasing pattern with the last reading of 90-92% oxygen saturation during 14:00.

The previous ISBAR status also highlighted an increasing shortness of breath in the patient prior to the admission along with a consolidation in the right lower lobe and right-sided crackles upon auscultation with increased air entry in both lower lobes.
Therefore, these aspects highlighted the need for respiratory nursing assessment. A respiratory nursing assessment includes the process of airway assessment and breathing assessment. The aim of this airway assessment is to identify the obstruction in the airway anatomy whereas the breathing assessment helps in the process of identifying any respiratory distress signs (The Royal Children’s Hospital Melbourne, 2024). 

In the case of Mr. Jheka, the previous ISBAR report highlighted the presence of nonproductive and moist coughs which created a hindrance during the process of for this patient breathing for this patient. 

Question-2

Part-A: Condition Evaluation and Underlying Pathophysiology

After evaluating the presented patient information in both Case Study Part 1 and Case Study Part 2, it could be highlighted that this patient is estimated to be suffering from septic shock. As an initial symptom of this, the gradual decrease in the blood pressure of this patient could be highlighted which was reported at 90 mmHg/ 50 mmHg during 14:00.

Low blood pressure or hypotension is one of the severe symptoms of septic shock (Healthdirect Australia, 2022). Moreover, the drowsiness in Mr. Jheka along with the dry skin with poor turgor could also be highlighted as the major symptoms of septic shock in this patient. Confusion or disorientation along with discoloured skin is one of the serious symptoms of sepsis in adults which could lead to further issues (Sepsis Australia, 2024). 

As the pathophysiology of this situation, it could be highlighted that the septic shock which is the final stage of sepsis happens due to the development of infections like bacterial infection fungal infection or viral infection inside the body (ACSQHC, 2024). The pneumonia-related infections in the body of Mr Jheka could be highlighted as the contributing factor to the development of this septic shock.

Part-B: Deterioration Pathway and Pathophysiology

As the focused patient, Mr Jheka was assessed with a condition of septic shock, it could be mentioned that the lack of treatment during this situation could lead to the further worsening of his condition. This worsening could even lead to a situation where the patient could develop a multi-organ failure which could further contribute to the death of the patient.

This multi-organ failure includes circulatory failure along with metabolic and cellular abnormalities which causes an increased risk of death. These failures are also characterized by tissue hypoperfusion along with altered mental status and delayed capillary refill (Thompson et al., 2019). These situations Were already becoming prevalent in the focused patient with a delayed capillary return of three to five seconds and increased pain score with deep breathing and coughing. 

Therefore, the lack of treatment in the case of this patient in the hospital could lead to in-hospital mortality condition. In the case of Australian patients suffering from septic shock, the number of in-hospital mortality is 27% higher than in the clinical diagnosis group (Heldens et al., 2018). Thus, these highlighted the challenge for the treatment and management of this total condition for this patient.
Question-3

Part A: Escalation Pathway and ISBAR Handover

Escalation Pathway 

In case of support the process of escalation for this patient regarding the deteriorated conditions like reduction in the oxygen saturation, decrease in the respiratory rate, delay in the capillary refill and enhancing drowsiness; there is a need to incorporate a Medical Emergency Team or MET unit for this patient. These medical emergency team services are part of the emergency medical approaches or the rapid response system within Australian hospitals with the aim of improving patient outcomes specifically for the patients admitted to the ICU (Satyavolu et al., 2023). Therefore, this could be helpful in case of escalating this patient from his continuous deterioration.

ISBAR Handover

• Identification: The patient's name is Mr. Jheka. Was admitted to the ICU with suspected pneumonia-induced septic shock. 

• Situation: Continuously deteriorating with increased drowsiness and delayed capillary refill time. Moreover, there are also bilateral crackles in his lung with dark urine.

• Background: Previously admitted with respiratory issues. On medications like benzylpenicillin and other regular medicines. History included benign prostate hyperplasia and hypertension.

• Assessment: Oxygen saturation was around 90-92%, speaking in short sentences, had weak peripheral pulses and was coughing non-productively without sputum.

• Recommendation: Incorporation of immediate review and management by the Medical Emergency Team to stabilize the cardiovascular and respiratory functions.

Part B: Nursing or Medical Interventions

The initial intervention that could be prioritized for Mr. Jheka, is to provide is oxygen therapy which is a medical intervention. The patient was suffering from declining oxygen saturation (90-92%) which led to an increase in the respiratory rate. This therapy includes the process of using ABG measurement along with the availability of pulse oximetry.

The aim of this oxygen therapy is to improve the oxygen saturation up to 92 to 96%. In acute medical conditions, oxygen is administered with the help of a simple face mask specifically in case of the senior citizens. The standard nasal cannula is used for oxygen delivery (Beasley et al., 2015).

Another major therapy that could be utilized in case of treating the conditions of this patient to prevent further deterioration is the use of antibiotics. The use of antibiotics in patients with sepsis symptoms helps in the process of reducing the progression of the symptoms specifically in the case of the rural areas in Australia (Heffernan et al., 2024). Therefore, the effective administration of broad-spectrum antibiotics could help in the process of treating the overall health issues of the focused patient as a significant medical intervention.

Conclusion

On a concluding note, it could be mentioned that this assessment helped in the process of effectively evaluating the health conditions of the focused patient Mr. Jheka. The evaluation highlighted that the patient was suffering from pneumonia-induced septic shock that caused respiratory challenges and other issues for this patient.

Therefore, this report helped in identifying the appropriate medical interventions that could be helpful for this patient including the use of oxygen therapy and broad-spectrum antibiotics. Moreover, this report also helped in the process of exploring the importance of the Medical Emergency Team in escalating health challenges while developing a new concise ISBAR report. This overall health is the process of developing a critical understanding related to the clinical management of a patient to ensure positive health outcomes.

 

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References

ACSQHC. (2024). National Sepsis Program. Retrieved October 8, 2024, from https://www.safetyandquality.gov.au/our-work/national-sepsis-program#:~:text=Sepsis%20can%20occur%20in%20response,in%20community%20or%20healthcare%20settings.&text=A%20wide%20range%20of%20signs,various%20stages%20of%20sepsis%20development 
Beasley, R., Chien, J., Douglas, J., Eastlake, L., Farah, C., King, G., ... & Walters, H. (2015). Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: ‘Swimming between the flags. Respirology, 20(8), 1182-1191. https://doi.org/10.1111%2Fresp.12620 
Health Times. (2023). Respiratory assessment for nurses. Retrieved October 8, 2024, from https://healthtimes.com.au/hub/respiratory/53/practice/nc1/respiratory-assessment-for-nurses/1539/ 
Healthdirect Australia. (2022, December 19). Sepsis. What It Is and Triggers Like Septicaemia and Blood Poisoning | Healthdirect. Retrieved October 8, 2024, from https://www.healthdirect.gov.au/sepsis-septicaemia 
Heffernan, A. J., Smedley, A., Stickley, T., Oomen, S., Carrigan, B., Heffernan, R., ... & Brumpton, K. (2024). Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments. Australian Journal of Rural Health, 32(1), 179-187. https://doi.org/10.1111/ajr.13079 
Heldens, M., Schout, M., Hammond, N. E., Bass, F., Delaney, A., & Finfer, S. R. (2018). Sepsis incidence and mortality are underestimated in Australian intensive care unit administrative data. Medical Journal of Australia, 209(6), 255-260. doi: 10.5694/mja18.00168 
Satyavolu, R., Ruknuddeen, M. I., Soar, N., & Edwards, S. M. (2023). Dosage and clinical outcomes of the medical emergency team and conventional referral mediated unplanned intensive care admissions. Journal of the Intensive Care Society, 24(2), 178-185. https://doi.org/10.1177%2F17511437211060157 
Sepsis Australia. (2024, May 22). What is Sepsis? | Sepsis Australia. Retrieved October 8, 2024, from https://www.australiansepsisnetwork.net.au/what-is-sepsis/#:~:text=Common%20symptoms%20of%20sepsis%20are,other%20conditions%2C%20like%20the%20flu 
The Royal Children’s Hospital Melbourne. (2024). Nursing guidelines: Nursing assessment. Retrieved October 8, 2024, from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/nursing_assessment/#Primary 
Thompson, K., Venkatesh, B., & Finfer, S. (2019). Sepsis and septic shock: current approaches to management. Internal Medicine Journal, 49(2), 160-170. https://doi.org/10.1111/imj.14199