Nursing care for respiratory conditions in COVID-19 recovery ...
NRSG378 Assessment 3 – Case Study
Shaun Morely is a 35-year-old male who was taken by ambulance to the emergency department (ED) this evening due to worsening cough, shortness of breath, fever, and general weakness, and was accompanied by his husband George. Shaun is only able to speak a few words at a time before becoming fatigued. George stated that they both tested positive for SARS-CoV-2 virus (tested on PCR) 4 weeks ago, but Shaun has been struggling to recover from his symptoms since then. George noticed that his symptoms were progressively getting worse over the last two (2) days, but they have not been able to make an appointment with their local GP due to a lack of availability.
Shaun states that he has not had an appetite for weeks now and feels he has lost weight since being unwell (although he hasn’t weighed himself). A CT scan was ordered, which showed bilateral consolidation, most likely due to pneumonia, secondary to his initial SARS-CoV-2 infection.
On assessment:
- Shaun appears pale, cool, and clammy. His lips appear dry, and his tongue is cracked.
- He appears lethargic, and George states he “just wants to sleep all the time.”
- He is lying in a semi-Fowler’s position but keeps pushing himself upright while holding his chest.
- He has a frequent productive cough with purulent green phlegm.
- Bilateral crackles in the lower and middle lobes are audible on auscultation. Occasional expiratory wheeze is noted across all lung fields.
- His last urine output was this morning at 9 am.
Health assessment findings and laboratory results at presentation:
- HR: 124 bpm, regular pulse
- BP: 95/56 mmHg
- RR: 30 bpm, moderate WOB with use of accessory muscles
- Temp: 38.7°C
- SpO2: 91% on RA
- Alert and oriented to time, place, and person
- CRT: 2 seconds
- Weight: 92kg, Height: 1.65m
Result
Haemoglobin (Hb) 143 g/L (Normal: 140-180 g/L males)
WCC 11.8 x 10^9/L (Normal: 4-11 x 10^9/L)
Sodium 132 mmol/L (Normal: 135 to 145 mmol/L)
Potassium 3.5 mmol/L (Normal: 3.5 to 5.2 mmol/L)
Lactate 2.4 mmol/L (Normal: <1.0 mmol/L)
C-reactive protein (CRP) 22 mg/L (Normal: <5 mg/L)
Creatinine 115 umol/L (Normal: 60-110 umol/L)
Sputum culture pending
Blood cultures pending
Patient history: Shaun lives with his husband in an outer suburb in Sydney. He is currently studying civil engineering at university full-time while working at his local café as a barista on the weekends. Shaun does not smoke, only drinks alcohol on special occasions, and uses a vape daily, although he has stopped since becoming unwell with COVID-19.
Family history:
- Parents live overseas and are both well with no medical concerns.
Medical history:
- Asthma, diagnosed as a child, now well controlled.
Medications:
- Salbutamol 4-6 puffs via MDI PRN.
Management:
- Administer IV bolus NaCl 0.9% 500ml over less than 15 minutes.
- Commence IV NaCl 0.9% at 100ml/hr.
- Administer IV ceftriaxone 1g BD.
- 30/60 vital observations and 1/24 respiratory assessment.
- Administer high-flow oxygen.
Task:
You are the registered nurse looking after Shaun, and you are required to plan his care guided by a clinical reasoning framework and the provided case study information.
Solution:
