AT3: Case Study ScenarioHuman Computer Interaction
It is 1300 hours, and you are working on a gastrointestinal (GI) ward in a large metropolitan hospital.
You are caring for Andrew Collins, a 43-year-old male, who presented to ED yesterday with a 3-day
history of nausea and vomiting with increasing shortness of breath. The GI team assessed Andrew in
ED and following investigation he is diagnosed with Cirrhosis of liver with gross ascites. Andrew
underwent an abdominal paracentesis, which drained 4 litres of ascitic fluid. He is admitted to your
ward following this procedure and you are the nurse caring for him.
Medical history:
· Andrew drinks more than 10 standard drinks per day for at least the last 10 years
· Tobacco use of >15 per day over last 20 years
· Nil known allergies
· Takes no prescribed medication and denies illicit drug use
Blood work and ultrasound demonstrates:
• Deranged Liver Function tests (LFT) – increased levels of the liver enzymes alanine
transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP)
• Full blood examination (FBE) – Largely normal.
• Hepatitis B & C negative
• Liver ultrasound demonstrated a large and fibrotic liver
· Vital signs in ED showed mild tachypnoea, all other signs within normal range.
Social History:
· Andrew lives alone in a rented flat
· He is currently unemployed
· His older brother Frank is visiting with him.
On examination:
· Andrew was noted to be alert in ED, though his brother now reports that Andrew is not quite
himself, he is trying to get out of bed, plucking at the sheets and drowsy at times.
· Andrew’s abdomen is remains slightly distended with a small tegaderm film dressing over his
paracentesis site. The site is dry and intact
· Andrew has mild yellowing of his sclera and mild bruising to both arms
· Mild bilateral lower leg oedema to ankles only
· He denies itchy skin, but appears to be constantly scratching at his chest
Objective data:
· Temp: 36.7 Celsius, HR (Heart Rate): 92 beats per minute, RR (Respiratory Rate): 16 breaths per
minute, BP: 100/50 mmHg, SaO2: 95% on Room air, BSL: 5.7mmol/l
· Alcohol withdrawal Scale rated at mild, managed with appropriate medication
· Andrew reports dull pain to RUQ 2/10, declined analgesia.
· PIVC L) hand with Normal Saline 1L running via @ 24mls/hr
· Last voided (600mls) in ED yesterday evening.
· Dull bowel sounds, with Bowels not Opened (BNO) for 2 days
· No current nausea or vomiting.
Please work through the Clinical Reasoning Cycle to detail the provision of evidence-based, personcentred care.
https://images.app.goo.gl/ouHCDQTYMmDAwyyK7
Ref: Levett-Jones, T. (2017). Clinical reasoning: Learning to think like a nurse. Pearson