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Original Question

Case Study Mr Tomasz Kowalski, aged 92 has been transported to hospital by ambulance from an aged care facility. He arrived at 10:30 confused, aggressive, yelling in Polish. Ambulance handover states that he has become more confused. The RN at the care facility became concerned and observed he was febrile, tachycardic, hypotensive and confused. Initial observations at the aged care facility by the paramedics: RR 30, Sp02 91%, BP 74/54, HR 145, Temp 38.3. Oxygen was applied via Hudson mask at 5L. Ambulance crew were unable to obtain IV access. He has a history of prostate cancer, regular medication is Apixaban 2.5mg. Mobilises with 4 wheeled walker, self-caring before becoming unwell. His wife died 20 years ago, and his daughter and son live nearby. His daughter has been informed and is on her way to the hospital as she often translates for her dad. On arrival, his observations were RR 28, Sp02 94% 5L Hudson mask, BP 72/48, HR 143, Temp 38.4, confused and agitated. ED staff have inserted an IVC left cubital fossa, bloods and blood cultures were collected, and 2.5mg Droperadol IV was administered with good effect in reducing agitation. On closer inspection, Mr Kowalski has been found to have an abscess in his (R) axillary. The area is swollen, painful and warm to touch. The surrounding tissue is inflamed, and red. Mr Kowalski has been transferred to ICU for urgent treatment of sepsis. He is receiving oxygen at 6L Hudson mask. The team is preparing to insert a PICC line. Criterion 1: Overview of the case Provides an overview of the case including past history, sociocultural information and personal history. Information presented demonstrates depth of understanding and discussion beyond what is provided in the workshop case study. Criterion 2: Health assessment and one (1) acute problem/issue identified Comprehensive health assessment relevant to case study is described with health data integrated into the discussion. One acute health issue is identified through a nursing lens, using a clinical reasoning approach. ie. Patient has __________ related to __________ as evidenced by_______________ (health data/cues) Criterion 3A: Goals of care Applying principles of cultural safety, ethics and situational awareness, describe how the student nurse would partner with this patient/ family to develop person-centred goals of care. Case study specifics are integrated to demonstrate analysis and critical thinking. Criterion 3B: Goals of care Develop one (1) SMART goal to address one of the priority health issues described above. Criterion 4: Evidence based interventions to achieve goal Person-centred evidence-based interventions are described that support achievement of the stated goal. Content is accurate, safe and appropriate for the patient case. Criterion 5: Measuring expected outcomes/evaluation Information presented is accurate and demonstrates specific and appropriate criteria to measure expected outcomes of goal and associated interventions. Criterion 6 Scholarly approach to assessment – APA 7 writing style and referencing. Uses high quality peer reviewed evidence to inform arguments and support definitions. An ethical approach to using the ideas and academic work of others is evident via intext citations and a reference list developed in APA 7th style. Follows conventional academic approach including – academic language, grammar, spelling, punctuation in both the written and narrated components.

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