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Case studies:Health care problems

NRSG353: Mrs Sharon McKenzie

Case Study 1

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Mrs. Sharon McKenzie is a 77-year-old female who has presented to the emergency department with increasing shortness of breath, swollen ankles, mild nausea, and dizziness. She has a past history of MI at age 65. During your assessment, Mrs. McKenzie reports the shortness of breath has been ongoing for the last 7 days and worsens when she does her gardening and goes for a walk with her husband. On examination, her blood pressure was 170/110 mmHg, HR 54 bpm, respiratory rate of 30 bpm with inspiratory crackles at both lung bases, and Sp02 at 92% on RA. Her fingers are cool to touch with a capillary refill of 1-2 seconds. Mrs. McKenzie states that this is normal and she always has to wear bed socks as Mr. McKenzie complains about her cold feet. Her current medications include digoxin 250mcg daily, frusemide 40mg BD, enalapril 5mg daily, warfarin 4mg daily but she sometimes forgets to take all of her medications. The following blood tests were ordered: a full blood count (FBC), urea electrolytes and creatinine (UEC), liver function tests (LFT), digoxin test, CK, and Troponin. Her potassiumlevel is 2.5mmol/L.Mrs. McKenzie also has an ECG which showed sinus bradycardia, and a chest x-ray showing cardiac enlargement and lower-lobe infiltrate.

Case Study 2:

Ms. Maureen Smith is a 24-year-old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain, and fatigue which has been worsening and was referred to the local hospital for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant. On assessment, Maureen’s vital signs are PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9oC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders. Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low-density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon and is currently collecting urine for a 24-hour cortisol level measurement.

Case study 3

Mr. Nathan James is a 48-year-old male who was admitted to the high dependency unit for investigation of jaundice and ascites. He is an interstate truck driver and is married with 2 children. Mr. James is a current smoker and known to consume 2 glasses of beer per day. He has a previous (15 years ago) history of recreational drug use and was diagnosed with Hepatitis C 10 years ago. On assessment:Mr. James is lethargic but orientated to time, place and person and slightly irritable. He is slightly tachypnoeic with moderate use of accessory muscles. His wife reported that Mr. James has been spitting blood-stained sputum for the last few weeks with no associated cough or shortness of breath. Mr. James reports that he has lost 9 kilos in weight which he attributed simply to a lack of appetite. No changes were reported with his urine output. Onexamination, his sclera is mildly jaundiced and has some “unexplained” bruises on his arms and legs. His abdomen is tight and distended and pitting edema noted on his ankles. Observations: BP: 115/60mmHg, HR: 110 bpm, RR: 24 bpm, SpO2: 88% on RA, 95% on 6L via Hudson Mask, Temp: 37.8C

Questions:

1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family

2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology

a. This can be done in the form of a table – each point needs to be appropriately referenced

3. Describe two (2) common classes of drugs used for patients with the identified condition including the physiological effect of each class on the body

a. This does not mean specific drugs but rather the class that these drugs belong to.

4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient

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