{"id":3291,"date":"2018-05-31T20:28:29","date_gmt":"2018-05-31T10:28:29","guid":{"rendered":"https:\/\/casestudyhelp.com\/sample-questions\/?p=3291"},"modified":"2018-05-31T20:31:26","modified_gmt":"2018-05-31T10:31:26","slug":"case-study-assignment-form-jims-immunotherapy-chart","status":"publish","type":"post","link":"https:\/\/casestudyhelp.com\/sample-questions\/case-study-assignment-form-jims-immunotherapy-chart\/","title":{"rendered":"Case Study Assignment Form Jim\u2019s Immunotherapy Chart"},"content":{"rendered":"

Assignment 3 \u2013 Case Study (essay)<\/strong><\/span><\/h2>\n

Word limit: 3000 Grade Worth: 35 %<\/strong><\/p>\n

Due Date: Friday June 8th 5pm <\/span><\/strong>(South Australia Time zone)<\/p>\n

This assignment requires students to critically review a case study and answer the questions<\/a> in the format of an essay as detailed below.<\/p>\n

In reviewing the case study and answering the questions, you should draw on the fundamental concepts related to allergic conditions and allergy nursing best practice that you have learned in the course, including additional evidence-based resources and scholarly literature.<\/p>\n

Your essay should demonstrate critical analysis, evaluation, and synthesis of the findings from your review of the relevant evidence-based resources, course materials, and scholarly literature.<\/p>\n

Ensure that you review the marking criteria, as well as these assignment instructions, when planning and completing the assignment. The assignment will be noticeable according to the assessment criteria set out in the Assignment 3 Marking Criteria and Feedback Form, found in the learn online course site.<\/p>\n

Assignment Structure:<\/span><\/strong><\/h2>\n

The introduction to your essay should provide a succinct overview of the case study, its relevance to allergy nursing, how the essay is organized and the significance of the topic for the reader.<\/p>\n

In the body of the article students should demonstrate their understanding and integration of the following relevant concepts related to allergic conditions and allergy nursing practice:<\/p>\n

    \n
  • path physiology of the conditions<\/li>\n
  • health assessment data<\/li>\n
  • health management<\/li>\n
  • patient education<\/li>\n
  • patient and staff safety<\/li>\n
  • role and professional responsibilities of the allergy nurse<\/li>\n
  • the scope of practice and decision making related to allergy nursing<\/li>\n
  • any other concepts relevant to the case study<\/li>\n<\/ul>\n

    The conclusion should summarise your findings and discussion, drawing on the critical analysis presented in the debate in the body of the essay.<\/p>\n

    Case Study: Jim<\/strong><\/h3>\n

    Jim, a 24-year-old Caucasian male, has been receiving subcutaneous immunotherapy treatment (SCIT) for allergic rhinitis, for one month.<\/p>\n

    Past medical history<\/strong><\/h3>\n

    Jim developed eczema as a baby, which still flares on occasions and he does experience itching most days. He uses a non-soap-based cleanser in the shower. He shampoos his hair twice weekly. He changes brands of shampoo, as some make his head feel itchy. He usually buys the one that is the price reduced. He admits he does not apply moisturizer very regularly. He remembers his mother used to \u2018nag\u2019 him to apply his \u2018creams\u2019 when he lived at home. He now lives alone. He developed mild asthma as a child and this continued through adolescence. During those years, he was prescribed Symbicort as a Turbuhaler, used it when symptomatic, but he has been asymptomatic in adulthood. He plays tennis weekly, goes running 3 times a week and experiences no asthma symptoms when he exercises. At 20 years of age, he developed allergic rhinitis, which has worsened over the past 4 years. He needed to take days off work when the symptoms were severe, usually in Springtime. The prescribed oral and intra-nasal corticosteroid treatments did not provide much symptom relief. Following referral to an allergist at a local, private, allergy clinic, skin testing identified Jim\u2019s allergies to spring pollinating grasses and house dust mite (HDM) in December.<\/p>\n

    Jim\u2019s decision:<\/strong><\/h3>\n

    Subcutaneous immunotherapy treatment (SCIT) was discussed as a treatment option, including the risks and benefits. Jim decided to proceed, starting in March. Written, informed consent was obtained by the allergy specialist, following explanation of the proposed treatments to Jim. The doctor stressed to Jim, that Jim must take one Cetirizine tablet, on the day of his injections and that Jim must wait, in the clinic, for at least 30 minutes after administration of the needles. Jim agreed to these measured when he signed the consent form.<\/span><\/p>\n

    Current Medications<\/strong><\/h3>\n

    Cetirizine 10mg on the day of immunotherapy injection. Aspirin for an occasional headache and Ibuprofen, if any joints hurt after tennis or running.<\/span><\/p>\n

    Current Immunotherapy situation:<\/strong><\/h3>\n

    Jim is attending the clinic for his weekly immunotherapy injections. Emergency resuscitation equipment is available. The nurses (who are not nurse practitioners) in this clinic undertake annual, Cardio-Pulmonary Resuscitation (CPR) and anaphylaxis emergency management training.<\/p>\n

    The nurse undertook base-line observations before Jim commenced the immunotherapy course and documented Jim\u2019s comments on his patient notes and immunotherapy record chart.<\/p>\n

    Baseline spirometry was not undertaken. The doctor\u2019s rationale was that Jim has not had asthma for many years and had no active symptoms.<\/p>\n

    Immunotherapy Treatment:<\/strong><\/h3>\n

    Jim\u2019s weekly subcutaneous immunotherapy treatment (SCIT) consists of one injection, of each extract:<\/p>\n

      \n
    • grass mix (vial A)<\/li>\n
    • House dust mite HDM (vial B).<\/li>\n<\/ul>\n

      Jim has not yet reached the maintenance dose of each extract. He is up to week 4. The SCIT dose of each extract has been gradually increased weekly, according to the manufacturer\u2019s recommended schedule.<\/p>\n

       <\/p>\n

      Jim\u2019s immunotherapy chart<\/strong><\/p>\n

      JIM ZOLLIE DOB 1\/1\/1994<\/strong><\/p>\n

      Baseline observations 10\/3\/2018<\/strong><\/p>\n

      BP 130\/80: PR 72bpm: RR 16 breaths per minute. Height 180cm: Weight 80kg<\/span><\/strong><\/p>\n

       <\/p>\n\n\n\n\n\n\n\n
      extract<\/strong><\/td>\nAnti Histamine<\/strong><\/td>\nBatch number<\/strong><\/td>\nDate given<\/strong><\/td>\nconc<\/strong><\/td>\ndose<\/strong><\/td>\nTime given<\/strong><\/td>\nReaction<\/strong>Measured 30 mins after Inj<\/strong><\/td>\ncomments<\/strong><\/td>\n<\/tr>\n
      HDM<\/td>\nY 0600<\/td>\n123 exp 1\/2\/19<\/td>\n10\/3\/18<\/td>\nBottle 11000TU\/ml<\/td>\n0.1<\/td>\n0900<\/td>\nnil<\/td>\n<\/td>\n<\/tr>\n
      HDM<\/td>\nY 0600<\/td>\n123 exp 1\/2\/19<\/td>\n17\/3\/18<\/td>\nBottle 1 1000TU\/ml<\/td>\n0.3<\/td>\n0910<\/td>\n5mm lump\/10 mm redness<\/td>\nPt report lump grew to golf ball size lump the night of injection. Did not contact dr or clinic<\/em><\/td>\n<\/tr>\n
      HDM<\/td>\nY 0800<\/td>\n123 exp 1\/2\/19<\/td>\n21\/3\/18<\/td>\nBottle 1 1000TU\/ml<\/td>\n0.5<\/td>\n0915<\/td>\n20mm lump\/30mm redness<\/td>\n<\/td>\n<\/tr>\n
      HDM<\/td>\nY 0845<\/td>\n123 exp 1\/2\/19<\/td>\n29\/3\/18<\/td>\nBottle 210,000 TU\/ml<\/td>\n0.1<\/td>\n0900<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n

       <\/p>\n

      JIM ZOLLIE DOB 1\/1\/1994<\/strong><\/p>\n

      Baseline observations 10\/3\/2018<\/strong><\/p>\n

      BP 130\/80: PR 72bpm: RR 16 breaths per minute. Height 180cm: Weight 80kg.<\/span><\/span><\/strong><\/p>\n

       <\/p>\n\n\n\n\n\n\n\n
      extract<\/strong><\/td>\nAnti Histamine<\/strong><\/td>\nBatch number<\/strong><\/td>\nDate given<\/strong><\/td>\nconc<\/strong><\/td>\ndose<\/strong><\/td>\nTime given<\/strong><\/td>\nreaction<\/strong><\/td>\ncomments<\/strong><\/td>\n<\/tr>\n
      Grass Mix<\/td>\nY 0600<\/td>\n789 exp 3\/3\/19<\/td>\n10\/3\/2018<\/td>\nBottle 11000 TU\/ml<\/td>\n0.1ml<\/td>\n0900<\/td>\n2mm lump 2mm redness<\/td>\n<\/td>\n<\/tr>\n
      Grass mix<\/td>\nY 0600<\/td>\n789 exp 3\/3\/19<\/td>\n17\/3\/2018<\/td>\nBottle 11000 TU\/ml<\/td>\n0.2ml<\/td>\n0910<\/td>\n2mm lump 2mm redness<\/td>\nSee HDM chart<\/td>\n<\/tr>\n
      Grass mix<\/td>\nY 0800<\/td>\n789 exp 3\/3\/19<\/td>\n21\/3\/2018<\/td>\nBottle 11000 TU\/ml<\/td>\n0.5<\/td>\n0915<\/td>\n2mm lump 2mm redness<\/td>\n<\/td>\n<\/tr>\n
      Grass mix<\/td>\nY 0845<\/td>\n789 exp 3\/3\/19<\/td>\n29\/3\/2018<\/td>\nBottle10,000 TU\/ml<\/td>\n0.1<\/td>\n0900<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      When Jim returned for his injection in week 3, he reported to the nurse that by the evening on the day of the needles the previous week (in week 2), he noticed a massive, itchy reaction on the \u2018HDM arm,\u2019 the size of a \u2018golf ball.\u2019 The swelling and itchiness lasted for 3 days. He did not contact the allergy clinic or take any medication as he said it was \u2018fine, just itchy\u2019 and it went down in a couple of days. The nurse double checked that Jim had taken his anti-histamine several hours before that injection, as it was recorded. Jim\u2019s responded that he had. The nurse documented Jim\u2019s comments in his patient notes and injection chart and reported this information to the doctor. The doctor, sitting in his office, considered this new information, what had been documented on the day of the week 2 injection, that the \u2018lump went down\u2019 after a couple of days. The doctor then determined that week 3 dose could proceed at the recommended scheduled increase for the schedule, provided Jim had taken his antihistamine. At 30 minutes the reaction was measured (see chart), and Jim left the surgery and went to work.<\/p>\n

      Jim came for his injection in week 4 on a very busy clinic day when a different nurse was working. The nurse checked that Jim had taken his antihistamine and asked if he was making any new medications. Jim said he had taken the anti-histamine, but mentioned only carried it 15 minutes ago, when he set off for this appointment. The nurse drew up the scheduled dose, went and checked the extracts doses with the doctor, at the treatment recommended in the manufacturer\u2019s schedule (see chart).<\/p>\n

      What happened today?<\/strong><\/h3>\n

      Today, week 4, at 0900, Jim received his two injections of immunotherapy, at the increased, scheduled doses. Within 10 minutes of the injections, Jim was agitated, reported he was feeling stomach cramps, like when he had a stomach bug when he went to Bali. His throat was itchy. Inside his ears also felt itchy. Jim was assessed immediately (0915), by the nurse, who noted Jim\u2019s itchy, red conjunctiva, flushed face, neck and hands, persistent cough and diffuse, bilateral expiratory wheezing and scratching of his skin. Jim\u2019s vital signs were BP: 100\/55, HR: 102bpm, RR: 26, at 0915. The nurse summoned the allergist, who came out to see Jim. The allergist and nurse helped Jim walk to a consultation room.<\/p>\n

      Jim\u2019s treatment and management:<\/strong><\/h3>\n

      The nurse drew up 0.3 mg of 1:1000 Epinephrines, from an ampoule, into a syringe, checked it with the doctor and administered the medication, by intramuscular injection, in the anterolateral thigh, at 0920. The nurse administered four puffs of salbutamol, via a metered dose inhaler, at 0930. At 10:00, Jim was given a single dose of 40 mg of oral prednisone, on the doctor\u2019s order. The route, dose, date, time and types of medications were documented in Jim\u2019s notes by the nurse.<\/p>\n

      What happened next?<\/strong><\/h3>\n

      At 10.15 the patient reported that his throat was feeling less itchy, cramps have subsided, and he was \u2018less wheezy.\u2019 Jim\u2019s BP was 120\/65, PR 98, RR 26. The nurse noted and recorded a local reaction of 30mm x 35mm for wheal and 60 x 60mm diameter of erythema on the arm where HDM was administered. There was no local reaction at the site of the grass injection.<\/p>\n

      At 11:15 am, the patient\u2019s vital signs were: BP 130\/75, PR 88 and RR 22. On physical examination, Jim had no more wheezing. Jim said he \u2018felt fine now\u2019 and asked when he could go home.<\/p>\n

      The doctor gave Jim a prescription for prednisone 40 mg orally, asking Jim to take the medication once daily, for three days. When Jim asked why, the doctor explained, that the medication should \u2018prevent any symptoms of a late or delayed reaction to the injections.\u2019 Jim was also asked to take Cetirizine, 10 mg orally, daily, for seven days. Jim was required to attend the clinic the next week for usual, weekly appointment. The allergist advised Jim that he would be assessed by the nurse and the doctor, at subsequent visits. The doctor may adjust his injection dose. The patient was discharged from the clinic at 12:30 pm.<\/p>\n

      Final diagnosis:<\/p>\n

      Anaphylaxis to subcutaneous immunotherapy.<\/p>\n

      Answer the following questions about Case Study B<\/span><\/strong><\/h3>\n
        \n
      1. Using the knowledge, you have gained in this course, additional evidence-based resources and scholarly literature, identify and critically evaluate the aspects of the treatment and management of Jim\u2019s situation that are not consistent with best practice recommendations. Explain how they would have compromised Jim\u2019s safety.<\/li>\n<\/ol>\n
          \n
        1. Critically discuss the role of the nurse, in the health assessment and clinical decision-making process throughout Jim\u2019s scenario, integrating your supporting evidence.<\/li>\n<\/ol>\n

          \"Hire<\/a><\/p>\n