Case Study of Diagnosis of Neutropenia Patient

Case Study of Diagnosis of Neutropenia Patient A 45 year old physically fit patient was admitted to hospital following several visits to his General Practitioner (GP) where is was complaining of decreased appetite, constipation, fever, chills, headaches, cramping, vertigo and respiratory problems after experiencing some hay fever like symptoms one week ago. He was commenced on Roxithromycin 150mg b.d and his GP ordered blood tests that showed his had neutropenia (low white cell count) (Harris et al 2006, p 1185) and thrombocytopenia (low platelet count) (Harris et al 2006, p. 1704). Two days later he was not feeling any better and the GP ordered a chest x-ray (CXR) which the patient to have bilateral pneumonia he was than admitted to the hospital. This essay will identify important events that took place during the patient’s admission to hospital and discuss three of these events in detail with contemporary evidence to support the writer’s discussion. The essay will than look what has been learnt through this case study in relation to future professional practice as a new graduate registered nurse in accordance with the Australian Nursing & Midwifery Council (ANMC) competency standards. Day 2 Why did the patient not received oxygen until his saturation got to 70% there is no mention of the treatment plan to or from nursing staff. Later that day the patient was transferred to main ward, the nursing staff raised the issue that the patient needed to be in the intensive care unit (ICU), the patient was reviewed by Respiratory Physician and was decided to not to transfer patient to ICU. This patient required close monitoring due to saturation decrease and as a newly registered nurse we do not have the experience or the time to monitor this patient in a ward environment (ANMC 2006) competency Professional Practice. Patient safety, patient advocacy. Day 5 The patient was noted to be still febrile and was ordered another CXR as the Computed Tomography Scan (CT scan) was not preformed, why had this pa tient not had the CT scan that was ordered (ANMC 2006) competency Professional Practice. Team communication strategies, chain of command. Later that day it was also noted that the patient had a PR Bleed and a referral was made to the gastroenterologist. No mention of cause or any investigation taken place to assess the PR bleed no blood tests were ordered to determine patient’s status. Patient advocacy, patient safety. Day 6 Respiratory Physician saw the patient and noted he had severe bilateral pneumonia, possible bone marrow suppression and anaemia of an unknown cause, no communication between medical officers as the patient had a PR bleed the day before and is neutropenic and thrombocytopenic. The Respiratory Physician requested an infectious diseases review. Patient advocacy, conflict management, documentation. Day 7 It was documented again that the patient had low saturations and was febrile. He was seen by the Infectious Diseases Specialist and was ordered more tests an d a lung biopsy. The lung biopsy was considered to be of high risk due to the patient’s condition by a Thoracic Surgeon. If this patient was a high risk why was he not in ICU as requested by the nursing staff? Conflict management, chain of command, patient advocacy.