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Critical Analysis On Nursing Case Study



Case study 1
1. Klara was due to pick up her two-year-old daughter Bonnie from childcare. They live nearby, so they usually they walk home with Klara pushing her daughter in a pram. Today, a storm was expected to pass through their suburb and by the time Klara and Bonnie were out of the childcare centre, heavy rain had already started. Klara started to run up the hill pushing the pram with Bonnie in it, but soon found herself experiencing difficulties breathing. She found it hard to maintain her pace and was breathing faster and deeper. Within minutes she had to stop and bend over to catch her breath, but when she straightened up, she felt dizzy. She walked home the rest of the way. Once there, she climbed two flights of stairs carrying the pram. By the time she entered her apartment, Klara had a strong feeling of nausea and light-headedness. This took about 2 minutes to resolve at rest. The following day Klara visited her local medical clinic where blood tests were done. The following results were obtained:


Klara’s results

Reference Range


3.69 x 1012/L

3.8-5.8 x 1012/L


88 g/L

115-165 g/L



27-32 pg



300-350 g/L






80-100 fL


7.8 x 109/L.

4.0-11.0 x 109/L.


300 x 109/L

150-400 x 109/L

Iron studies:


Klara’s results

Reference Range

Serum iron

8 µmol/L

10.0-30.0 µmol/L


3 g/L

2.10 – 3.80 g/L

% Transferrin saturation

11 %



20 µg/L

30-220 µg/L

a) Explain the significance of red blood cell parameters and iron studies in Klara’s blood.
b) Propose a physiological explanation for the respiratory symptoms experienced by Klara. In your answer explain how cellular respiration is likely to be affected in Klara’s case?


Nursing case study1
Answer A

It is noted in the nursing case study that patientis experiencing dyspnoea and tachypnoea while climbing the hill with the sign of feeling nausea, dizziness and light-headedness. It is known that issue in the exchange of oxygen and carbon dioxide in the lungs could causes difficulty of breathing. Research on nursing case study has shown that haemoglobin is the protein present in RBC that carries oxygen molecule to body tissues and maintain the process of respiration. Therefore, this indicates that low count of RBC and haemoglobin could lead to shortness of breath because oxygen is unable to travel to the body tissue despite the normal functioning of lungs and heart. It is noted that at higher altitude, deficiency of haemoglobin could lead to the low level of oxygen in the blood that in turn increase the carbon dioxide and causes hypoxia or dyspnoea. The test for red blood cell parameter can help in interpreting exact concentration of RBC components which can indicates the rationale behind the manifestation of shortness of breath and related associated health issues. Moreover, Iron is significant for the production of Haemoglobin and deficiency of oxygen due to low level of Haemoglobin leads to fatigue and dizziness. Therefore, in the nursing case study, the iron studies are significant as it would help to deduce amount of related iron protein that can indicate the oxygen delivery capacity into the lungs and other organ. Hence, the rationale behind the manifestation of shortness of breath and related signs could be inferred.

Answer B
The process of respiration is performed by lungs through an exchange of gas with the help of various proteins like haemoglobin. It causes delivery of oxygen to the tissue and the elimination of carbon dioxide from the body. The proper functioning of respiration, both carbon dioxide and oxygen must be transported from the internal and external respiration site. The transportation is facilitated by haemoglobin in RBC that allows binding of oxygen and carbon dioxide. These gases are delivered to the lungs and to whole-body tissue. However, the mechanism of respiration is affected with low blood count and atmosphere. Plethora of studies has indicated that at a higher altitude, the atmospheric pressure is low that causes low partial pressure of oxygen in the lungs and decreases the availability of oxygen in lungs. Thus, this indicates that the process of respiration is not balanced and can show the sign of faster breathing or shortness of breath. The condition is accompanied with low RBC and blood components like haemoglobin, Transferrin and Ferritin that function to carry to oxygen into the lungs and heart. The deficiencies of the aforementioned component cause dysfunction in the exchange of gases and its imbalance leading to tachypnoea and dyspnoea or hypoxemia.

It is evident from the nursing case study that patient experience shortness and faster breathing while climbing the hill which can be explained by physiology change in the transportation of oxygen in body. In the situation of the low number of RBC and haemoglobin, the rate and depth of inhalation of oxygen increase to compensate for the state of the low partial pressure of oxygen in lungs when atmospheric pressure is high. The upsurge in the ventilation is interceded by a carotid artery that is highly sensitive to the amount of dissolved oxygen present in the circulating blood. A low level of oxygen is sensed and the presence of carbon dioxide further displaces the oxygen in the lungs causing its high level in blood. The prevalence of hypercapnia then causes primary stimulus which is mediated by chemoreceptor present in the medulla of the brain. The barrier of blood-brain discrete the chemoreceptors from the artery of blood and make it permeable. It causes diffusion of carbon dioxide and an increase in its arterial pressure and hydrogen ion making the blood acidic. Thus, this indicates that acidemia and alkalemia depress respiration in the people climbing hill with issue of anaemia and lead to the issue of tachypnoea. It also manifests difficulty in breathing and its shortness.

Moreover, due to the low level of RBC and haemoglobin in the blood, the oxygen is not able to travel to the brain cells causing its malfunction and manifest the sign of light-headedness, dizziness and nausea. The cellular respiration and the concern dysfunction in the exchange of gas and partial pressure in the nursing case study is the major reason for her poor health condition.The above-mentioned respiratory symptoms are experienced by the patientthat suggests that abnormal blood count results and low iron component are the rationales for breathing issues in the patient.

Nursing case study2
Answer A

The collection of viral swabs for the suspected infection of influenza is the potential test to confirm the causing organism for the infection that causes better diagnosis and treatment. The information provided in the nursing case studyhas stated that influenza is the viral respiratory infection that leads to illness and mostly resides in the mucosal structure of the body. The viral swab of the above-mentionedrespiratory secretions is done with the purpose of the culture of the influenza virus and confirms its infection in the infected person.The viral swab facilitates the easy and fast collection of samples and it is also helpful in detecting the presence of influenza A virus subtypes and influenza A and B virus responsible for fever, sore throat and another sign. Therefore, it helps in clinical judgment and aid guide treatment decisions.

Answer B
According to the nursing case study, the signs and symptoms demonstrate viral infection that has led to the sore throat and cough. Looking into the rationale for the emergence of the aforementioned signs in in the patient, the immune response has the major part to play. It is reported in the nursing case study about the kidney and heart complication, which suggests low immunity in the person. The nursing case studyhas shown that viral infection progress by infecting the upper respiratory tract that leads to the inflammation of the underlying tissue and trachea. The infection is high when the immune cell is unable to kill the pyrogen and viral component leading to immune reaction and interferon response. The research has shown that the neuraminidase and hemagglutinin are released by the virus and function to neutralise the antibodies generated by the body. The adherence of Hemagglutinin to the epithelial lining of the throat and respiratory tract makes the progression of the infection. The Neuraminidase cleaves the bond holding the virus and causes is spread of virions. The infection of virus transfer to the bronchia and trachea leading to mucosal congestion, oedema and infiltration of the inflammatory cells that cause the emergence of coughHence, it can be said that the patient having a viral infection might get spread to the lungs and causes congestion of alveoli causing a dry cough.

Another research has noted that with the viral infection, there is the large secretion of proinflammatory cytokines and chemokines, for example, the interferon IL-1, IL-6 and tumour necrosis factor. It is known to cause inflammation and damage of tissue leading to the issue of pharyngitis. In the nursing case study, the infection and release of inflammatory cytokines include necrosis and shedding of the bronchial and tracheal epithelial cells along with exudates of alveolar fibrin and oedema of the throat leading to dry cough and sore throat. Due to the old age, health complications of the patient and weak immune system, the inclusion of the viral component into the body does not get attacked by the macrophages and other immune cells that cause the emergence of the sore throat and cough.

Answer C
The viral infection manifests various signs like cough, sore throat and fever in response to the release of pyrogens. After the viral infection, the development of fever is articulated from the fact of stimulation of the immune system of the body. Research has suggested that people develop a fever to halt the replication of the virus and make the body unfavourablefor their growthHypothalamus is the site that causes the rise of body temperature in response to the pyrogens and involves interplay between the innate immune system and neuron system of PNS and CNS. When Viral RNA binds with toll-like receptors expressed by macrophages or Dendritic cells, there is a release of various pyrogens like IL-1. Research notes that effector molecules produced by the brain integrate the signal from the pyrogens with an output signal that travels to the hypothalamus and binds with its respective receptor and cause raise of the body temperature. Therefore, it can be said that due to the viral infection, the patient candevelop a fever.

Answer D
Considering the present situation explained in the nursing case study, the emergence of fever of 38.5 degrees, suspects prevalence of viral infection. Paracetamol is reported to act as an antipyretic and function to restrict the release of prostaglandin that is secreted in response to pyrogen. Thus, it causes to lower the body temperature and treat fever. Another medicine in the cupboard of the presence of ibuprofen which is an NSAID and effective in lowering painHowever, according to the nursing case study, the patient is not reported with any extreme pain therefore, paracetamol will be effective for his present health condition.

Nursing case study3
Answer A

The increase in the intracranial pressure after the brain injury can worsen the outcome. The fracture of the cranium is connected with the importance of the Intracranial Pressure (ICP) homeostasis and integrity of the immune defence mechanism. It is articulated from the fact that neurological issue is concerned with the traumatic brain injury that causes loss of regulator of pathophysiology and deregulation of the ICP. With the cranium fracture and haematoma, there is a decreasein the mean systematic arterial pressure (MAP) associated with systolic blood pressure and diastolic blood pressure. In line with the Monro-Kellie hypothesis, a decrease in Cerebral profusion pressure (CPP) causes an increase in ICP. Therefore, with the decrease of the MAP, there is a reduction of the CPP and maintain the rise of ICP. Moreover, in the event of cranium fracture and haematoma, the blood vessel of the brain will get narrowed causing the lowering of the flow of blood to the cranium and maintaining ICP. On cranium injury, the inflammatory response is cast by the recruitment of immune cells like Mesenchymal progenitor cell to the site of injury and ensures healing and immune defence through angiogenesis of vessels, repair of the injured tissue, and eventually remodelling.

Answer B
According to the nursing case study, the CT scan report has indicated of linear fracture of temporal bone and haematoma. The nursing case studyhas noted that temporal bone is associated with the middle and internal ear and damage to it could lead to injury of the vestibule-cochlear nerve, labyrinth, cochlea, external auditory canal (EAC) and ossicular chain. In the nursing case study, the brain swelling due to brain injury indicates the rupture of blood vessels like facial nerve and auditory nerve due to the broken piece of bones. The temporal bone is the part of the inferior wall of the cranial cavity, any injury causes leakage of cerebrospinal fluid into the ear causing rupture of ear drum and ossicles. With the intactness of the tympanic membrane, the fluid may move into the eustachian tube leading to rhinorrhea. However, with the injury of temporal bone and swelling of brain, the tympanic membrane can also be damaged that causes otorrhea. Additionally, extensive swelling of the brain may cause a restriction in the flow of cerebrospinal fluid and reduction of the flow of oxygen-rich blood. It is noted that the brain gets oxygen-rich blood from the carotid artery and jugular vein that passes the blood to the brain Therefore, damage to the carotid artery and jugular vein due to extensive swelling of the brain is catastrophic and lead to loss of function of sense organs. As the nursing case studyhas stated that cranial nerves and blood vessels connected to ear and other senses pass through the temporal bones, therefore, damages the temporal bone that could lead to loss of function of the ear (hearing loss), Nystagmus, vision difficulties, and paralysis of the facial musclesand vestibular dysfunction.

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