Case Study: The Patient with Altered Conscious State
John Kelly is 82 years old and was admitted to the ward this morning via A&E having fallen at home. John is a widower and has been living on his own for the last 6 years since his wife died. He has 4 grown up children (3 sons and a daughter), 7 grandchildren and 12 great grandchildren.
John’s eldest son and daughter-in-law live nearest to John, so came to the hospital with him and are now on the ward. Physically John appears to be well and, although bruised, x-rays show that he has no fractures. However, John seems to be confused and when you ask his son about this, he insists that his father is ‘just being awkward as usual’. However, John’s daughter-in-law appears concerned and reports that she thinks John has become increasingly confused over the last 2 weeks.
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Airway: Patent, no issues. Able to talk in full sentences.
Breathing: RR – 16 breaths per minute, SpO2 – 93% on air. No wheezing or added sounds.
Cardiovascular: HR 80 bpm, BP 160/80 mmhg (normal range for him). Has passed small amounts of urine frequently since admission. Peripherally warm.
Disability: AVCPU Confusion – GCS 13/15 [E(4) V(3) M(6)].
John seems very quiet and easily distracted by what is going on around him. He also keeps asking for his wife and trying to leave to find her.
Exposure: Temperature 36.8°C. No rashes or breaks to the skin observed.
Signs and Symptoms
Reports ‘being sore’ but is vague about where he has pain.
Past Medical History
Knee replacement 10 years ago.
Family reports he was depressed for about a year after his wife died.
Mother died of cancer aged 38 when he was 7.
Father died in his sleep aged 78.
John’s younger sister has been recently diagnosed with Alzheimer’s disease.
Goes to the pub on a Friday lunchtime and has 2 pints of beer. Likes a shot of whisky every night before bed.
Doesn’t like cooking so tends to rely on microwave meals but does have a roast dinner at his eldest son’s house every Sunday.
Usually active – still walks to the local shop for his paper every day.
CRITICALLY evaluate the communication skills or strategy the nurse will engage in when caring for this patient.
Provide a CRITICAL EXPLORATION of one psychological response of this sign or symptom including a coping strategy and ONE EVIDENCE-BASED STRATEGY.
CRITICALLY discuss the holistic role of the nurse in this scenario based on one EVIDENCE-BASED INTERVENTION to manage the care.
Section 1: Introduction
Introduce your assignment
Set the scene of the essay
Define any major concepts that will be explored
Reference should be made to the patient in the case study
Detail that this is a fictional case study and therefore will not breach confidentiality of any real patients in line with the NMC (2019) code.
Reflect the wording in the learning outcomes to ensure that you give a clear and full introduction.
Approximate word count (100 words
Section 2: Communication Strategy
Evaluate the range of communication skills, models and strategy the nurse might use to interact with this patient.
This will include verbal and non-verbal communication skills, critical analysis of Motivational Interview (MI) or Teach Back Technique as well as communication models and theories.
Provide a critical discussion of the barriers to communication
Your discussion should include factors such as the environment, patient symptoms, fear, anxiety, attitudes and beliefs of the patient and their relatives
Show extensive reading around these skills and strategies
How does the strategy help to improve communication and patient outcomes?
Is it an appropriate strategy for this patient?
What are the advantages and limitations?
Approximate Word Count (400 Words)
Section 3: Psychological Response
Provide a critical exploration of one psychological response of this sign or symptom including a coping strategy
Consider the patient in the case study living with the sign or symptom you have explored and critically discuss how this will result in stress, anxiety, or depression.
Critically discuss one coping strategy in response to the psychological response. Support with literature to critically analyse the coping strategy and its outcomes.
A definition of a coping strategy is expected
Read extensively around coping strategies that the patient may adopt – are these positive or negative? Active or passive?
Why might these be adopted according to literature? Consider the overall patient here (symptoms and psychosocial, lifestyle, perceptions and beliefs.)
Explore one evidence-based strategy or intervention to manage the psychological response you have identified.
A critical discussion of the psychological intervention or strategy is expected. This will demonstrate a critical discussion of findings of relevant resources.
This will include research papers, policies, NICE Guidance, protocols which highlights the efficacy and limitations of the psychological intervention identified.
Read extensively around the psychological intervention
Approximate Word Count of 3a and 3b (400 words)
Section 4: The Holistic Role of the Nurse
Critically discuss the holistic role of the nurse in this scenario based on one evidenced nursing intervention or strategy to manage the sign or symptom discussed.
It is expected that a brief introduction to holistic care is provided.
Choose one evidence-based strategy to manage the sign or symptom.
This should be critically discussed using contemporary research to explore the effectiveness or limitation of this intervention.
What does the literature say about these interventions?
What is the effectiveness or limitations of these interventions?
Present a critical analysis of the intervention or strategy and relate this specialised knowledge to the care of the patient in the case study
Approximate Word Count (500 words)
Section 5: Conclusion
Draw a conclusion from the key points raised in your case study
This must highlight a brief reflection of the key learning you have gained from writing this case study.
Approximate Word Count (100 words)
Discuss one assessment strategy using ABCDE APPROACH
for this symptom/sign and explain the underlying pathophysiology