Pseudonym Jane Case Study Assessment

Assignment Overview

Case study: pseudonym Jane

Jane 64 yr old female admitted to the Intensive care unit with severe septic shock secondary to multilobe pneumonia.

Jane had been feeling unwell for 2 weeks with GI symptoms and cough, lethargic and unable to work. Found at home by husband after having fallen out of bed. GCS 7/15 with NSWAS.

Jane was intubated on scene with size 7.5 ETT secured at 24cm at teeth and brought into the emergency and then transferred to ICU. R4 positive for Flu A- Commenced on Oseltamivir and blood culture positive for strep pneumonia.

Illoprost, Augmentin and azithromycin commenced.

On arrival in the ICU Heart Rate 146 AF- Amiodarone infusion 2.1ml/hr commenced, Labile BP 88/56 MAP 65. Noradrenaline commenced at 0.3mcg/kg/min, Dobutamine at 2.5mcg/kg/min, Noradrenaline was then able to wean however blood pressure became unstable post repositioning of the patient systolic dropped to 60s MAP 40s. 250ml bolus of CSL IVF given. Noradrenaline increased to 0.38mcg/kg/min. Pt BP remained hypotensive, Vasopressin (Argipressin) added at 2u/hr and dobutamine increased to 5mcg/kg/min to achieve MAP 65.

Centrally warm, mottled peripherally. Cold lower peripheries with weak pulses and delayed capillary refill 6-8 seconds in lower limbs and 3-5 sec in upper limbs. Temperature 37.9

GCS 3/15. PEARL 2mm brisk, nil movement in limbs. Sedated with Propofol 17ml/hr and Fentanyl 3.5ml/hr. Urine output 20ml/hr.

Ventilation settings: PRVC + PS (SIMV/PRVC + PS) Fio2 80%, PS 10, PEEP 10, RR 20, TV 500

Achieving spo2 95%. Bilateral bronchial sounds with diminished bases on chest AE.  Moderate thick yellow secretions.

Line access: Arterial line L) Radial arm and Central venous catheter (CVC) inserted R) Internal jugular (IJ). R) Lower arm peripheral IVC (PIVC) and L) Lower arm peripheral IVC. OGT 53cm NBM

Other infusions commenced:

Magnesium 20mmol (10ml/hr)  

Potassium 30mmol (10ml/hr)

Hartmann’s IVF 40ml/hr.

Arterial blood gas on arrival:

• pH: 7.24

• pCO₂: 50 mmHg

• pO₂: 98 mmHg

• HCO₃: 19 mmol/L

• K⁺: 3 mmol/L

• Na⁺: 140 mmol/L

• Glucose: 28 mmol/L

• Lactate: 4.4 mmol/L

• Haemoglobin (Hb): 124 g/L

Formal bloods: Urea 6.2 mmol/l, Creatinine 132micromol/l, GFR 37, Troponin 1035nanog/l, Magnesium 0.85mmol/l, WCC 36, Platelets 517, INR 1.7, APTT 32, PT 18.

MRI attended on the same day showed Filling defects in superior sagittal sinus and right transverse sinus consistent with thrombosis. Heparin infusion commenced.

Past medical history:

• Hypertension
• High BMI
• T2DM on OHAs
• Hypothyroidism

Summary of Assessment Requirements

The assessment required students to critically analyze the clinical case of Pseudonym Jane, a 64-year-old female admitted to the Intensive Care Unit (ICU) with severe septic shock secondary to multilobe pneumonia. The key tasks included:

• Clinical data interpretation – Assessing patient presentation, vital signs, and lab results.

• Identification of pathophysiological changes related to sepsis and multi-organ dysfunction.

• Evaluation of current treatments and interventions such as ventilation settings, vasopressor support, and antimicrobial therapy.

• Critical reasoning and prioritization of nursing care based on clinical instability.

• Linking theoretical knowledge to practical ICU management, including pharmacology, fluid balance, and hemodynamic monitoring.

• Understanding complications and comorbidities such as T2DM, obesity, and hypertension impacting recovery.

Step-by-Step Academic Mentoring Approach

The academic mentor guided the student through a systematic, stepwise process to analyze and respond to the case study effectively. The guidance was structured into clear sections to ensure critical thinking, evidence-based reasoning, and academic writing clarity.

Step 1: Understanding the Case Scenario

• The mentor began by helping the student carefully interpret Jane’s clinical data.

• They discussed key findings: low GCS (3/15), septic shock, unstable MAP, high lactate levels, and multiorgan involvement.

• The mentor emphasized the importance of identifying sepsis progression and the associated hemodynamic instability.

Step 2: Organizing the Assessment Framework

• The student was guided to organize the case under headings such as Patient Background, Presenting Condition, Clinical Findings, Investigations, Treatment and Interventions, and Nursing Priorities.

• This structure helped in maintaining logical flow and meeting academic formatting standards.

Step 3: Pathophysiological Analysis

• The mentor guided the student to connect pneumonia-induced sepsis with systemic inflammatory response leading to septic shock.

• Discussion focused on how infection triggered vasodilation, capillary leak, and tissue hypoperfusion, reflected by high lactate and hypotension.

• The mentor also reinforced the importance of understanding metabolic acidosis and renal impairment (elevated creatinine, reduced GFR).

Step 4: Treatment Evaluation

• The student evaluated the use of antibiotics (Augmentin, Azithromycin, Oseltamivir) and vasopressors (Noradrenaline, Vasopressin).

• The mentor explained the rationale behind mechanical ventilation, sedation protocols, and fluid resuscitation strategies.

• The pharmacological mechanisms were discussed, linking each intervention to stabilization goals.

Step 5: Nursing Care Prioritization

• Under mentor supervision, the student developed a prioritized nursing care plan focusing on:

  1. Hemodynamic stability (monitoring MAP, titrating vasopressors).

  2. Respiratory management (monitoring ventilation settings, oxygenation).

  3. Neurological assessment (monitoring GCS, sedation levels).

  4. Renal monitoring (urine output, fluid balance).

  5. Infection control and temperature management.

Step 6: Interpretation of Investigations

• The mentor helped interpret ABG results (pH 7.24, high CO₂, high lactate) indicating respiratory and metabolic acidosis.

• The significance of elevated WCC, Troponin, and INR values was explored to understand systemic response and coagulopathy risks.

Step 7: Critical Reflection and Learning Outcomes

• The student concluded the assessment by reflecting on how clinical data correlates with patient deterioration.

• The mentor guided inclusion of evidence-based literature to support reasoning, ensuring academic integrity and credibility.

Final Outcome and Learning Objectives Achieved

The final assessment submission successfully demonstrated the student’s ability to:

• Interpret complex ICU data and identify priorities in a septic shock case.

• Apply clinical reasoning to connect symptoms, lab findings, and interventions.

• Critically evaluate treatment strategies and justify nursing actions using evidence-based practice.

• Enhance understanding of critical care concepts, including ventilation, pharmacology, and fluid management.

• Develop structured academic writing aligned with professional healthcare standards.

Through this guided mentoring process, the student not only completed the case study effectively but also gained comprehensive insights into critical care nursing, sepsis management, and clinical decision-making in complex ICU settings.

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