Case study: John Smith

John Smith is a 65-year-old MH patient who is admitted to a medical ward with a chest infection. John has Parkinson’s disease and usually lives at home with his wife; he is usually mobile with the assistance of a frame although this is currently limited due to him feeling so unwell.

On admission the nurse (Sam) greets John and his wife, who accompanies him. Sam talks to John and explains what is going to happen in terms of his admission and assessment process over the next few hours. Sam orders John’s medical notes and then gathers all the equipment she will need to assess him, closes the curtains around John and sits next to him. Sam asks John why he thinks he has been admitted to the ward and asks what has happened today leading up to this. John explains that he has been feeling unwell over the past three days and has today developed a productive cough and has felt hot, they visited his GP who arranged for John’s admission to the ward. John becomes breathless after he has talked so his wife also provides some information, to which John nods to in agreement. A letter from the GP accompanies John, Sam reads this which confirms the events already explained as well as providing additional information on John’s usual drug regime; past and present medical conditions.

Sam explains it would be useful to perform some basic observations on John, which he agrees to and she measures his temperature, pulse, respiration rate, blood pressure. As Sam put the blood pressure cuff on John’s arm she notices he feels warm to touch and has a reddened face, his temperature recording confirms he is pyrexial (an elevated temperature). Following a full assessment of John, Sam identifies he has a pyrexia and is breathless. Sam is able to discuss these needs with John who agrees to feeling hot and short of breath, rather weak, although feels well otherwise. The goals set aim to reduce John’s temperature to below 36.8°C and for him to feel comfortable and for John to have a respiratory rate of between 12–16 breaths per minute; with oxygen saturations >94% and for him to state he does not feel short of breath. Sam prescribes and implements actions which will help achieve these goals, ensuring the actions are realistic and evidence based. After 24 hours of care, John feels much better; his temperature and respiratory rate have reduced to within normal limits although he states he feels more breathless than usual. Sam and John discuss John’s progress and decide to evaluate in another 24 hours.

Activity

Highlight in this case study the aspects which pertain to assessment, planning, implementation and evaluation. Think about how Sam has accomplished APIE, involving John and his wife, and consider how you might have done it differently.