Case Study: Mr J.
Mr J, a 27 year old man, was admitted to hospital on a Saturday afternoon via the emergency department of a small rural hospital with a diagnosis of acute appendicitis. He underwent an emergency appendectomy. Post-operatively he became unwell with an elevated temperature and heart and respiratory rate. He was complaining of severe abdominal pain. The nurses contacted the medical officer who reviewed Mr J, and ordered an abdominal x-ray, urine for micro and culture, urea and electrolytes, FBE, and C reactive protein. The medical officer also ordered further pain relief for the patient.
The x-ray was normal but the blood results were delayed due to technical issues. The blood results were returned to the ward in the early evening after the medical officer had left the hospital. The results showed a significantly elevated white cell count, and C reactive protein level. The nurse on duty in the evening wasn’t sure about the results so she filed the pathology results in the patient’s
history and did not attempt to contact the medical officer. The results were not reported to any of the other nurses. Brief verbal handovers were given to the other RN’s who came on duty over the weekend, because on the weekends it is normal practice for the nurses like to go home early. None of the RN’s reviewed the patient’s notes or noticed the pathology results. The medical officer did not contact the hospital to ascertain the results until the Monday morning. The patient was given further doses of narcotic analgesia at regular intervals over the next day to control the pain.
On the Monday morning the patient’s condition was assessed and the blood results reviewed. On review of the patient’s notes the nurse’s reports were limited in detail, the trend of the vital signs indicated a gradual reduction in his blood pressure and increase in his heart rate, and his urine output had not been recorded. The patient was immediately commenced on IV antibiotics, and subsequently returned to theatre for an exploratory laparotomy, at which time it was identified a leak of faecal fluid had given rise to peritonitis.
He died a few days later as a result of multiple organ dysfunction and profound septicaemia. How would you have practiced differently if you were looking after Mr J?
Discuss this case with reference to the following:
• Identify any legal implications associated with Mr J’s treatment.
• In this situation was there any negligence, if so by whom and why.
• Are there any ethical issues associated with the care of this patient?
Case Study Assignment guide
Read the following instructions carefully:
? You are required to
[i] Respond to the questions asked in case study.
[ii] Critically discuss the key Legal and Ethical concepts outlined in the box at the bottom.
? In preparing the response consider the following requirements:
a. Clearly identify the core problem(s).
b. What are the main issues?
c. Provide a justification for the choice of core problem(s) – Why are these issues so
d. Analyse the issues underlying the problem in terms of the relevant theory.
– How do these relate to the Law and Ethical theory?
– How do they relate to Nursing and relevant codes and frameworks?
e. You will need to refer to the literature throughout your essay to support your argument.
? Utilise the Marking Guide:
a. Remember that the marking guide attached below is the document that use to mark
the papers, so make sure that you have responded to every requirement on this
b. Consider also the weightings of the grades for the separate sections so that you are
structuring your discussion in a way that will maximise your focus on the core
Referencing & Writing:
• References used must be relevant to the topic, and must be contemporary.
• The types of references used can include textbooks, journal articles, professional
organisations, and government policies.
• You should research the topic through the e-journals.
• You are discouraged from using any internet information that is from an
unauthorised or non-professional organisation or written for the general public
rather than health care professionals (such as personal Web logs, Wikipedia…etc.).
• At least 15 different Nursing, Medical & Allied Health journal articles must be cited
in text and referenced.
• You must reference all information, using appropriate in text referencing
according to the American Psychological Association (APA) style of referencing.
• The use of direct quotes should be kept to a minimum and if used need to
indicate the page number with the citation.
• You must also include a reference list at the end of their assignment,
formatted according to APA referencing style.
• You must use multiple (12+) recent (<5-7 years) sources.