CASE STUDYClinical ScenarioMr Ian Dury is a 58 year old male living in rural South Australia. His wife Elizabeth passedaway 18 months ago from a prolonged battle with cervical cancer.Mr Dury has been transferred to the Sisters of Mercy Memorial Hospital (SMMH) AdelaideSouth Australia for investigation of chest pain and it is planned that he will undergo acoronary angiogram with iodinated radiocontrast medium. Mr Dury has been diagnosed witha long history of Ischemic Heart Disease otherwise known as Coronary Heart Disease (CHD)Past Medical History
●Type 2 diabetes mellitus
●Hypercholesterolaemia
●Chronic Kidney Disease stage 3b
●Hypertension
●Current smoker 25 cigarettes a day
●Obesity●Coronary Artery Bypass 5 years ago
●Anterior myocardial infarction 6 years ago
●EtOH 50grams dailyMedications
●Aspirin (300mg daily)
●Losartan (50mg daily)
● Atenolol (100mg bd)
●Atorvastatin (80mg daily)
●Hydrochlorothiazide (25mg daily)
●GTN spray as neededMr Dury states that he sometimes has difficulty remembering when to take his medication.He commented that he does not like taking his fluid tablets before he goes out because itmakes him go to the toilet too often.
Upon admission Mr Dury is alert and orientated but appears slightly anxious.
During isadmission assessment his vital signs seem unremarkable however, he has noted pittingoedema in both legs with an associated diminished pedal pulse.
He states that he gets breathless on exertion and has used is GTN spray on average about 4 times a day. Hestates that he has not spoken to his son about his admission to hospital. Mr Dury has beenscheduled for a coronary angiogram the following morning.
Nursing notes48 hours following the coronary angiogram that was undertaken to diagnose coronary arterydisease Mr Dury’s fluid balance chart indicates that his previous 24 hour urine output hasdropped from 1200ml to 450ml.
Urgent blood tests for kidney function demonstrate a rise increatinine and a fall in eGFR and Mr Dury is diagnosed with worsening CKD induced by thecontrast used for the coronary angiogram.
Upon commencement of your shift Mr Dury’s vital signs are the following: Pulse 100bpm, BP170/90, RR 18, SaO2 94% on room air and temperature 36.5.His fluid balance chart has had a positive balance of over a litre in the past 24 hours.
It is noted that Mr Dury has a haematoma on his right wrist from the previous angiogram.Task aims:This task is your opportunity to explain the nursing care for an adult person experiencing acardiovascular event by linking it to pathophysiology and pharmacology, explaining thenursing care required, while applying an inter-professional model of care.The course objectives being assessed are;
1.Perform a comprehensive health assessment on adults from a range ofdifferent cultures.
2.Apply an evidence-based framework to develop, implement and criticallyevaluate a plan of care for adults presenting with acute health problems.
3.Explain an inter-professional model of care for the management of adultswith acute health problems.
4.Apply pharmacological knowledge and principles in the management of carefor adults with acute health problems.
5.Analyse the legal and ethical considerations in caring for adults with acutehealth problems.6.Apply the principles of quality, safety and risk management in caring foradults presenting with acute health problems.
Write and present your essay using the following headings:Introduction: (200 Words)Introduce the client and provide a brief overview of their case.
Provide an outline of thepurpose and structure of the report.(You might like to think about the overview of the case study like a verbal clinical handover:what is the key information from the case study that would be relevant for the plan of carefor this client?)Primary
Admission Diagnosis (200 Words)Identify the primary diagnosis for the client (i.e. the reason the client was admitted tohospital). Provide a brief description of the pathophysiology of the disease and demonstratehow the presenting manifestations support the client’s primary diagnosis.Identify thecomplication experienced during admission.
Provide a brief description of thepathophysiology of this complication in relation to the clients pre-existing medicalconditions.Nursing Problems (200 Words)Using your knowledge of pathophysiology and the clinical manifestations of the client;identify two (2) nursing problems that arise as a result of the client’s complicationdeveloped during the admission.
These problems may be actual or potential nursingproblems. Provide a brief description for why these problems arise for this client. Supportthis discussion using current literature.
Nursing Management (800 Words)The nursing management must focus on the inpatient nursing assessment, nursinginterventions and the role of the Registered Nurse (RN) related to medication managementfor this client and will address the two(2) identified nursing problems. Support thisdiscussion using the current literature.
(This section of the report focuses on assessments and interventions that the RegisteredNurse conducts. So avoid reverting to simple referrals to other members of the health team.
What does the nurse physically do to provide optimal person-centred care as part of thenursing management plan? You should also prioritise your care. What is the most pressingconcern for the client at this stage?) Nursing Problem 1: Nursing assessment, nursing intervention, medication management.Discuss one (1) method of nursing assessment that would need to be performed related tothe ongoing nursing management of this nursing problem. Provide a rationale for this typeof assessment and briefly describe how this assessment would be conducted in this case.
Last Completed Projects
| topic title | academic level | Writer | delivered |
|---|
