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Nursing Case Study: Medical Care For Mr. LanDury

Question

Task: Prepare a nursing case study analysis report explaining the nursing care for an adult person experiencing a cardiovascular event by linking it to pathophysiology and pharmacology, explaining the nursing care required, while applying an inter-professional model of care?

Answer

Introduction
The discussion revolves around the nursing case study of a 58 years old man, named as Mr. LanDury, who is a resident of rural South Australia. He was admitted to Sister of Mercy Hospital (SMMH) Adelaide South Australia for the chest pain. After observing the condition, the health professional’s suggested for coronary Angiogram with the iodinated radiocontrast medium. The past medical history of Mr. Dury did not seem to be good at all, as he was facing several chronic diseases. Besides that, his past medical history reflects that he was diagnosed with a long history of ischemic heart disease which is commonly known as coronary heart disease. After the coronary angiogram that has been undertaken, it was seen that the fluid balance chart indicates a drop in the urine output from the 1200ml to 450ml within 24 hours, which lead to an urgent call for blood tests for kidney functions. The blood test showed that the condition of his kidney has worsened. The report below aims at explaining the nursing care required to a 58 years old man, to recover. The discussion below will highlight the nursing problems and how these problems have been managed. Besides that, a detailed Pathophysiology of the disease of Mr. LanDurybased on the nursing case studythat he is suffering from is also being discussed.

Primary Admission diagnosis
When Mr. Dury was admitted to the hospital, he was facing chest pain and due to this, he was primarily diagnosed for the coronary artery disease (Stephens, 2019).Artery helps in the supply of the blood to the heart (called as coronary arteries)(Lor, Crooks and Tluczek, 2016).Building of plaque which is made up of the cholesterol inside the coronary arteries leads to narrow the arteries. As a result, the blood supply through coronary arteries is reduced and it is also kmown as atherosclerosis. This unable the bloods to reach the heart which provoke the heart to increase the pumping rate. Hence, the heart pumps much harder to get the blood from the blood vessel or coronary arteries, this excess pumping of the heart leads the feeling of the chest pain.The complication that has been experienced during the time of the admission was chronic kidney disease (CKD). When a damaged kidney declines the amount filtration of the blood due to the poor glomerular filtration working capacity,lead the fluid to accumulate in the body, and edema occurs especially in thelegs, which is one of the preexisting diseases in Mr. Dury medical condition (Moerman’set al, 2018).

What is the main problem faced by the nursein the given scenario of nursing case study?
As per the readings of the nursing case study, the two-nursing problem that arises as a result of the client's complication developed considering the Pathophysiology and clinical manifestation during the admission was to manage the chest pain and edema problem of patient.Thechest pain that was seen in the time of the admission was relatedto ischemic heart disease, for which he has been diagnosed for prolong time. (Tjiaet al, 2017) The past medical history of the diseases is correlated to each other, the disease directly or indirectly contributing to increase the blockage of the blood vessels and leading to chest pain. The chest pain was one of the nursing problems as there are several chances of getting into severe conditions like stroke or heart attack (Cacchione, 2020). Along with this, he was having edema which is also a symptom of the preexisting diseases chronic kidney disease. The damaged kidney fails to filter the blood and leads to retaining the water inside the body. Excessive accumulation of the water results in edema (van Belle et al, 2019). This is also contributing to the nursing problems, as they need to critically observe the fluid balance of him. Any drastic change in the fluid chart will lead to severe complications of Mr. Dury. Management of the nursing to the problems Chest pain management

Assessment
The assessment tool for chain pain is the PQRST pain assessment tool (Koutoukidis, Stainton and Hughson 2016). The rationale to select this assessment tool was that it would help to evaluate multiple sides for diagnosing Mr. Dury. To conduct the assessment, the registered nurse will take assessment sheet based on the PQRST assessment tool or else will note down in a paper, and check down all the standards of the tool and finally discuss it with health specialist. The P stands for the position/provoking factors that can lead to complicatehis situation as several times repositioning helps to improve the pain. The Q represent quality, the type of pain that occurring is dull, sharp, pressured, burning, or any other type need to assess. This helps to predict the severity of the pain. Radiation stands for R, assessing whether the pain is radiating across the chest and indentifying the areas with the assessment tool will help to reach to the position where the pain is radiating, will help to diagnose him. Severity or symptoms stands for S, letting Mr. Dury rate his pain within 10. T stands for time, assessing for how long the pain has occurred, depending upon the time lap further steps can be taken (Ayerbeet al, 2016).

Intervention
The reason to select these intervention methods for nurses based on the nursing case study is that these interventions will help to reduce the severity of the chest pain and will help to recover early. The nurse remains closer to the patient all the time, providing these interventions to him will be easier for them. Treating chest pain: The nurse should stop Mr. Dury from doing all the activities that lead to an increase in his stress factors which can lead to excessive pumping ofheart. He should be suggested to be seated and take rest to calm down his involuntary activity of the heart (HeczkováandBulava, 2018).

Reducing anxiety: explaining improvements that areoccurringwill make him feels relieved and will help to reduce anxiety (Toney-Butler andUnison-Pace 2019).

Medication Management:
The most important role of the registered nurse is to assist the person to have the medication on time. Along with it, the nurse should prepare the medicine for Mr. Dury, so that he can be easily ingested by the patient. The nursing case study signifies that Mr. Dury is old enough hence; the nurse should crush the tablets like aspirin and measure the amount of the liquid medicine like atenolol to make it easier for him to ingest (Meador 2019).

Edema
Assessment

The nurse is required to press the skin of the legs where the edema is visible, and measuring the depth of the indention, the time that the skin of his leg took to rebound to its original position should be recorded. Based on that, the nurse will grade edema on a scale of 1-4. Other than that, the nurse needs to assess whether the skin around the swelling has changed or not like excessive edema lead to woody appearance around the swollen skin (Freseet al, 2016). The reason to select this technique as a nursing assessment method was that, pressing of the skin is considered as the best way to judge the severity of the edema in the patient. The registered nurse will conduct the scaling and note the time and depth of the indention along with it she will also look at the outer appearance of the skin near the swollen area.

Intervention
The below interventions have been selected as these will help the patient to get relief and would reduce the pain which ultimately lead to sort the nursing problem. Movement: The nurse should help him to move his leg; this will help to pump the excess of the fluid back to the heart and will also reduce the swelling. As he is also having chest pain so, the nurse should assist him to move his leg

Protection: The nurse needs to assist Mr. Dury to clean the area to avoid further infection or injury. As the area around edema become cranky and dry, the nurse should take care of the area of the leg by applying the solutions that will keep it moisturized (Moghadamet al,2018).

Medication Management:
The role of the registered nurse in the medication management related to the ongoing nursing management of the odema problem is to assist the patient to provide a proper way to intake the medication. As Mr. Dury is suffering from edema, to remove the excess water from the body diuretics drugs have been given like Hydrochlorothiazide. It is the responsibility of the nurse to administrate the drug with the food or milk so the gastrointestinal upset does not occur in Mr. Dury. The diuretic drug creates issues to buffer drug effect on the stomach lining and causes changes in fluid and electrolytes balance in the body (Gallagher, Marulanda and Gray 2018).

Planning for the discharge of Mr. Dury
The aim of discharge planning is an interdisciplinary approach that helps to continue the care that involves the assessment, identification, planning, implementation, and evaluation. The process helps to provide care to the patient with the help of the persons who are closer to them. An effective discharge plan will help the patient to avoid the further deterioration of the health. The effective discharge planning will provide sufficient observation of the changes, and environment that will be more supportive for the patient. In the case of Mr. Dury, discharge planning by the multidisciplinary will help to observe the improvement in him by providing the personal care of his family with the help of the intervention plans (Akella and Chendrasekhar 2019). The importance of the team or multidisciplinary approach for the patient will be providing multiple benefits, as several professionals of health care will provide their expert opinions that would help the patient to recover in a much better way. This includes improved health outcome to enhance satisfaction for the patient and also provide effective utility of the able resources that are available. This also helps the nurse to provide proper guidelines to the patients with all the aspects that will benefit the patient in support of the health. Healthcare professionalto provide the multidisciplinary in nursing case studyof Mr. Dury will be doctors, nurse, and physiotherapist, the doctors will provide further precautions that he needs to undertake like the level of water he must undertake, and what are the food activity that he needs to completely avoid (Mondalet al, 2017). The registered nurse responsibility will be to provide the ways that their family need to take care of him like he will be suggesting the position that would make him feel comfortable, the food that needs to be avoided and will also suggest what steps their family should have to undertake to tackle to worsen conditions before reaching the health care center in future. The therapist will provide the plan in which he will suggest the exercise and therapy Mr. Dury has to undertake and need to continue (Debonoet al, 2017). The socio-economic factor that will impact his discharge planning is the environment of the house, as only 18 months ago high wife expired after battling prolong with cervical cancer. Hence, he might not afford caretaker for himself and he needs to take care of him on his own(Hess et al, 2016).

Conclusion
The nursing case study analysis can be concluded by saying that the multidisciplinary approach provides proper care to the patient. Especially when care is needed to be provided to an adult person or older person, it needs to be more critically assessed, observed, planned, and implemented by the nurse. An adult person like Mr. Dury who is 86 years old requireshuge care as he is facing a number of the disease which is quite common with the age hence, more critical, and precise examination by the nurse of the condition of Mr. Dury is required. An adult person needs more careful planning and support to achieve the goals of the treatment. The nurses are the closest person to patients to provide the care by assessing the activity that is going in them. Assisting them to get the treatment on time, is the most important role of the registered nurse along with-it providing intervention plans to help them to reduce the severity of the disease also comes under the role of the registered nurse. Hence, while providing care to the adult individuals the registered nurses as well as other health and social care professional should assess the adults more precisely and also prepare need to prepare a health care plan for them. ?

Reference:
Akella, K., and Chendrasekhar, A., 2019. RISK ASSESSMENT FOR VTE: ALL ARE NOT EQUAL. International Journal of Scientific Research, 8(5).

Ayerbe, L., González, E., Gallo, V., Coleman, C.L., Wragg, A., and Robson, J., 2016. Clinical assessment of patients with chest pain; a systematic review of predictive tools.BMC cardiovascular disorders, 16(1), p.18.

Cacchione, P.Z., 2020. Innovative care models across settings: Providing nursing care to older adults. Geriatric Nursing, 41(1), pp.16-20.

Debono, D., Taylor, N., Lipworth, W., Greenfield, D., Travaglia, J., Black, D., and Braithwaite, J., 2017. Applying the theoretical domains framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals.Implementation Science, 12(1), p.42.

Frese, T., Mahlmeister, J., Heitzer, M., and Sandholzer, H., 2016. Chest pain in general practice: frequency, management, and results of the encounter. Nursing case studyJournal of family medicine and primary care, 5(1), p.61.

Gallagher, K., Marulanda, K., and Gray, S., 2018. Surgical intervention for lymphedema.Surgical Oncology Clinics, 27(1), pp.195-215.

Heczková, J., and Bulava, A., 2018. Nurses' knowledge of medication management at intensive care units.Pielegniarstwo XXI wieku/Nursing in the 21st Century, 17(1), pp.18-23.

Hess, E.P., Hollander, J.E., Schaffer, J.T., Kline, J.A., Torres, C.A., Diercks, D.B., Jones, R., Owen, K.P., Meisel, Z.F., Demers, M. and Leblanc, A., 2016. Shared decision making in patients with low-risk chest pain: prospective randomized pragmatic trial.bmj, 355.

Johansson-Pajala, R.M., JorsäterBlomgren, K., Bastholm-Rahmner, P., Fastbom, J., and Martin, L., 2016. Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management. Scandinavian Journal of Primary Health Care, 34(1), pp.37-45.

Koutoukidis, G., Stainton, K., and Hughson, J., 2016. Tabbner's Nursing Care: theory and practice.Nursing case study Elsevier Health Sciences.

Lor, M., Crooks, N., and Tluczek, A., 2016.A proposed model of the person-, family-, and culture-centered nursing care.Nursing Outlook, 64(4), pp.352-366.

Meador, R.D., 2019. PREHOSPITAL TROPONIN TESTING PROTOCOL FOR ACCELERATED DIAGNOSIS AND EARLY INTERVENTION IN CHEST PAIN PATIENTS.

Moerman's, V.R., Bleijlevens, M.H., Verbeek, H., Tan, F.E., Milisen, K. and Hamers, J.P., 2018. The use of involuntary treatment among older adults with cognitive impairment receiving nursing care at home: A cross-sectional study. International journal of nursing studies, 88, pp.135-142.

Moghadam, M.H., Asadizaker, M.A.R.Z.I.E.H., Jahani, S.I.M.I.N., Maraghi, E.L.H.A.M., Saadatifar, H.A.K.I.M.E.H. and Naanaei, F.A.R.H.A.D., 2018. Investigating the effect of nursing interventions, based on wells score results, on the incidence of deep vein thrombosis in patients admitted to the intensive care unit. Asian Journal of Pharmaceutical and Clinical Research, 11(5), pp.377-381.

Mondal, S., Roy, A., Mukherjee, R., Mondal, M., Karmakar, S., Chatterjee, S., Mukherjee, M., Bhattacharjee, S., and De, S., 2017. A socio-economic study along with impact assessment for laterite based technology demonstration for arsenic mitigation. Science of the Total Environment, 583, pp.142-152.

Stephens, G., 2019. Using a structured clinical assessment to identify the cause of chest pain. Nursing case studyNursing Standard, 34(4).

Tjia, J., DeSanto-Madeya, S., Mazor, K.M., Han, P., Nguyen, B., Curran, T., Gallagher, J., and Clayton, M.F., 2019. Nurses' Perspectives on Family Caregiver Medication Management Support and Deprescribing.Journal of Hospice & Palliative Nursing, 21(4), pp.312-318.

van Belle, E., Giesen, J., Conroy, T., van Mierlo, M., Vermeulen, H., Huisman?de Waal, G., and Heinen, M., 2020. Exploring person-centered fundamental nursing care in hospital wards: A multi?site ethnography. Journal of Clinical Nursing, 29(11-12), pp.1933-1944.

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