Schaut (English 3306 Unit 1 Final Draft) 1 Peri Schaut English 3306 Tom Akbari Unit 1 Final Draft

22 January 2014 A Case Study for the Continuous Education of Nurses Some of the daily tasks of a pediatric nurse include assessing patients, taking notes on patients, and often referring to the experiences of other patients as reported through case studies. A Case Study of Pediatric Pneumonia With Empyema is an example of a case study written by nurses Vanessa B. Waldrep and Elizabeth Sloan and published in 2013 in the Journal of Pediatric Nursing intended to both educate and serve as a reference for pediatric nurses. This piece represents a case study of a patient diagnosed with and prescribed a care plan for a complicated pneumonia known as pneumonia with empyema. The medical document relays a narrative describing the background information of two-year-old Eddie, along with his symptoms, previous diagnoses, and treatments. Furthermore, the text provides information on complicated pneumonias, care plans, and recommendations for future practice. Through specialized terminology, statistics and facts about complicated pneumonia, and sequential arrangement of knowledge, Waldrep and Sloands case study gives nurses the knowledge they need for encountering a patient with pneumonia with empyema. This text targets an audience of primary care health professionals, specifically nurses, as Waldrep and Sloand1 use specialized terminology not intended for laymen. For example, in the description section of the document, Eddie is examined to have a pulse oximetry reading of 94% and a respiratory rate of 60 breaths per minute with subcostal retractions, shortness of breath, rhonchi and wheezes throughout the lung fields 1(p. 167). The terms pulse oximetry, respiratory rate, subcostal retractions, rhonchi, and wheezes 1(p.167) do not represent

Schaut (English 3306 Unit 1 Final Draft) 2 everyday language, but rather the lexis of the discourse community of pediatric nurses. These terms are not explained because the authors assume previous knowledge of the readers, as the article is targeted to nurses who have learned and use this language daily. Furthermore, these terms refer to the discourse of pneumonia with empyema as they describe the assessments that must be made, such as pulse oximetry, respiratory rate, and auscultation, as well as the observations of symptoms, like shortness of breath, which a patient with pneumonia with empyema may present. The authors must assume that the nurse reading this case study understands, from the terms mentioned, the specific measurements to be taken and observations to be made. This assumption allows the authors to advance into the purpose of the document: educating nurses on the analysis, care plan, and follow up for a patient with pneumonia with empyema. After the description of symptoms, the authors define pneumonia and provide statistics on its prevalence: Pneumonia, an infection in the lower respiratory tract including the lung parenchyma, occurs in 34 to 40 per 1000 children less than 5 years of age in North America and Europe annually 1(p. 168). Here, the authors give a brief definition of pneumonia and alert the reader of the frequency of the infection. They also state that pneumonia [is] the leading cause of mortality among children under 5 years of age in the developing world 1(p. 168). This statistic signals to the reader that this case study is significant as its topic, pneumonia, requires further study and recognition by nurses who are guaranteed to witness a patient with symptoms and possible diagnosis of pneumonia. In addition, the authors mentions a defined age group most effected by pneumonia in order to make nurses more attentive to symptoms of pneumonia when assessing patients under 5 years of age. The writers then address complicated pneumonia: Empyemas, or purulent fluid in the pleural space, occur in 0.6% of all childhood pneumonias.

Schaut (English 3306 Unit 1 Final Draft) 3 Recent studies indicate that the incidence of complicated pneumonias is on the rise 1(p. 168). Although this percentage seems very low, the authors point out that cases of complicated pneumonias are becoming more prevalent. These statistics are used to draw nurses attention to the rising incidence of complicated pneumonias, which nurses study less than common cases, in order to make nurses cognizant of these particular infections, their symptoms, and plans of action as they become more likely to encounter such forms in their patients. Although nurses are taught about rare cases of illnesses in nursing school, it is impossible for textbooks and lectures to cover each rare form of every disease; nurses are unaware of cases like that of Eddie and therefore must read case studies to better understand rare symptoms and diseases that they encounter in their practice. This text provides an informative case study through the order of the knowledge transmitted to its readers. The document begins with a narrative history of a patient, noting symptoms, family concerns, examinations, empirical measurements, prescriptions, and treatments. The sequence of events is in chronological order, which allows the nurse reading the case to incorporate time into the development of the symptoms and infection. The text then defines pneumonia and pneumonia with empyema under the heading Pediatric Empyema 1(p.
168)

to give the reader background information on the infection, as well as the progression of

empyema, the organisms associated with pediatric pneumonia, and the typical signs of pneumonia in children versus adolescents. The document then provides a Diagnostic Plan, Therapeutic Plan, and Follow-up Plan, 1(p. 169) providing nurses with further direction if they encounter pneumonia with empyema or other complicated pneumonias. Within these plans are diagnostic tests, like CT scan and tuberculin tests, as well as treatment methods, such as fibrinolytics and VATS, 1(p. 169) which are not explained but only suggested as methods as the

Schaut (English 3306 Unit 1 Final Draft) 4 authors continue to assume nurses understanding of medical terminology. Finally, the case study concludes with Implications for Practice and Further Research, 1(p. 170) conveying the importance of recognizing complicated pneumonias, taking action to treat and prevent such cases, and studying to determine an optimal treatment. Nurses are not taught in school about all rare forms of diseases, such as complicated pneumonias, and must therefore read case studies to broaden their knowledge so they may identify certain symptoms as characteristic of pneumonia with empyema and know the care plans they must enact to treat the patient. Case studies, such as the one discussed, are documents commonly found throughout the nursing profession. In preparing for this profession, I must be able to both read and write case studies of patients as they are part of the continued education necessary after nursing school. Although textbooks teach nurses about numerous illnesses, including multiple rare cases, they are straightforward and lack the realistic aspect of case studies, which provides details about peculiar cases that nurses may encounter since no patient is the same. Because case studies contain critical information that may not be addressed in school, I will need to write case studies on patients to inform other nurses and allow them to draw similarities and differences between symptoms, diagnoses, and treatments for their patients, for both rare and common infections or diseases. In addition, I will be writing background information, such as the narrative on Eddie, on daily patient assessments. My current writing skills, such as writing in a structured format in lab reports and writing analyses of nutrition and literature, will surely assist in my preparation to write documents such as case studies. However, this document reveals the incorporation of technical terms and statistics, and the sequential organization of knowledge that I must learn to use to convey my thoughts in order to be a successful member in the nursing discourse community.

Schaut (English 3306 Unit 1 Final Draft) 5 Reference 1. Waldrep VB, Sloand E. A case study of pediatric pneumonia with empyema. Pediatric Nursing. 2013;28:167-170.