HSK0114-Integrated Nursing Care of the Adult Patient Essay – Medical science Assignment Help

Assignment Task


Learning Outcomes

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  • Understand the need for evidence based, seamless care through person and relationship centred care and discharge planning at the onset of access to health services.
  • Be able to analyse and discuss the interrelationship between spiritual, sociological, psychological, physical, emotional, and cultural aspects of care.
  • Use enquiry-based methods to identify and evaluate the effectiveness of adult patient coping strategies in relation to their health.   
  • Source and use knowledge of underpinning pathophysiology to interpret common physical symptoms of ill health.
  • Identify and explain the signs and symptoms of acute deterioration.
  • Use an enquiry-based approach to select and utilise appropriate assessment tools to detect the presence of acute deterioration and respond accordingly.

Essay title and case study 
This essay will present an evidence basedcase study focusing on a person with a long term condition or acute illness, who is at risk of acute deterioration. The essay will show how the understanding of psycho-socialas well as physical symptoms contribute to individualised assessment and person-centred care. The case study chosen is as follows:

A 64 year-old woman, 6 days post appendicectomy presented to the emergency department from home accompanied by her son. At presentation the main complaints were fever, oozing from surgical wound site and restlessness. Physical examination showed she was pyrexic, tachypnoeic, tachycardiac and confused mental status with delirium. Her vital signs were: temperature of 39.8 C, pulse 112 beats per minute, blood pressure 75/41 mmHg, respiratory rate 26, oxygen saturation: 78%, and mean arterial pressure of 52mm Hg.  Abdominal examination showed redness, swelling, and pus oozing around the surgical site with generalised pain and tenderness. The staff attendedimmediately,and management was started under theworking diagnosis of sepsis and septic shock secondary to wound site infection. Bloods were drawn and intravenous fluid bolus with normal saline was started. Simultaneously wound swabs were taken for culture and broad-spectrum antibiotic therapy initiated. The laboratory result came back with white blood count of 19,800 with 90% of neutrophils, haematocrit 38%, creatinine 2.4 mg/dL, Lactate 6 mmol/L and blood glucose of 145 mg/dL. The surgical Registrar and ICU Registrar were informed about the patient. 

Medical history:  The son provided history that the patient has type -2 diabetes and hypertension and is on medication. He lives at a close distance from his mother and daily visits her and attends to her since the surgery. Prior to surgery she was living independently. The previous day she was mobile and able to walk to the bathroom and manage to care for herself.

Introduce your assignment. Clearly introduce the acute orlong-term condition for the case study you have chosen. Supply some context of the prevalence of the condition and impact on the individual and their family. Include one or two current statistics. Outline the themes that this essay will be including pathophysiology, psychosocial, coping strategies, potential deterioration, and appropriate nursing assessment. Emphasise that this is based on a fictional case study, not a real person. 
Suggested word count150 words.

Surgical site infection following appendicectomy is common, despite appendicectomy being a relatively safe surgery.  SII is defined as nosocomial infections occurring at the wound site within 30 days post-surgery (Horan et al 1992).  The SII incidence globally is reported 7 per 100 appendicectomies with higher rates in the low-middle and income countries (Dangwang et al 2020).   SSI can lead to sepsis, which is a serious condition, especially with co-morbidities like diabetes and if left untreated can rapidly progress to septic shock (Ninh et al 2019). The epidemiology of sepsis and septic shock varies depending on the type of surgery. One study reported the incidence trend from ICU admissions varying from 23.4% to 6.0?tween Septic-2 and Septic-3 shock (Shankar-Hari et al 2017). Described below is the pathophysiology, pharmacology, acute deterioration and care,  and emotional and psychological experience with reference to the clinical status of a fictitious case ofsepsis.

Explain the primary pathophysiology of the acute or long-term condition. Discuss the physiological changes that occur and how they lead to the common physical signs and symptoms that a person with this condition may experience. 

The patient is a diabetic which is a high-risk category for SSI. At the time of presentation, her clinical signs and symptoms were present within six days of surgery which falls within the characteristic time defined for post-surgical infection. The wound site showed typical features of inflammation due to underlying infection which could trigger a systematic inflammatory response resulting in the clinical features of fever, tachycardia, leukocytosis and nuetrophiliafound at presentation.  The tachycardia indicates the compensatory mechanism of heart. The low oxygen saturation and hypotension indicates poor tissue perfusion and hypoxia leading to tachypnoea. Considering her vital signs, symptoms and laboratory results,it is clear that the patient’s statuscomesunder the diagnosis of sepsis-3. In addition, the low arterial pressure and high lactate levels indicates septic shock and organ dysfunction based on the raised creatinine. The metabolic changes leads to the body becoming acidotic and mental state deteriorates as seen in this patient, by her altered consciousness and delirium. The bacterial organism at the wound site would have released endotoxins which could trigger the onset of the inflammatory pathway leading to the release of cytokines and interleukins such as IL-6 and IL 2 and possibly TNF-alpha. The increased production of cytokines affects vascular permeability and brings about metabolic changes indicated by the lactate levels. It is important to start appropriate treatment promptly, otherwise bacterial toxins together with cytokines can result in intravascular coagulation leading to multiple organ failure. This patient has a post appendicectomy wound infection with comorbidity of diabetes, andit could result in peritonitis, and bowel ischaemia or necrosis.  Prompt diagnosis of sepsis is critical to initiate the “bundle of care” to prevent the septic shock progression which eventually could lead to death secondary to deranged haemostasis and coagulation system.

Acute Deterioration
Explain how and why this patient might deteriorate in their physical and/or mental health and wellbeing. Relate to the signs and/or symptoms in the case study and choose one or two key signs of deterioration to discuss. Integrate theory and research in your explanation. For example, you might explore acute physical deterioration such as breathlessness and acute mental health deterioration such as anxiety. 

Discuss a suitable assessment tool that would be used for one of the signs of deterioration. Explain how this assessment tool is used and the appropriate nursing response when acute deterioration is detected. Integrate theory and evidence in your explanation. You can choose to focus on the assessment of deterioration in physical or mental health in this section. 

Integrated psychosocial care
Choose two individual featuresfrom the case study and discuss how spiritual, sociological, psychological, emotional, and/or cultural aspects impact on the individual and influence nursing care. Integrate theory and evidence in your explanation. You should only choose two aspects from this list. 

Consider the coping strategies shown in the case study. Discuss the individuality of the person in your case study and explain how their fears, concerns and beliefs may influence their capacity to cope with the symptoms associated with the long term condition or acute illness. 

Pull together the key learning from your essay and show how this can be applied to nursing practice. Check the focus in this section is the chosen case study and aims of the essay.


The references should be listed as per the current HSK school guidelines (insert link). Check that the list matches all citations within the essay.

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