Case Studies in Nursing: Pathophysiology, Nursing Actions, and Professional Issues

0
Running Head: NSG3TCN
NSG3TCN

1
NSG3TCN
Table of Contents
Case Study One................................................................................................................................2
Case Study Two...............................................................................................................................3
Case study Three..............................................................................................................................5
Case study Four...............................................................................................................................6
References........................................................................................................................................8

2
NSG3TCN
Case Study One
1a) Pathophysiology and rationales
William is a 64-year-old patient with a history of heart failure. He has called for immediate
assistance as he is unable to breathe without discomfort. Upon examination, it was seen that his
heart rate was above the normal while other vitals were well within the normal range. The key
issues that William is suffering from are potential cardiac arrest, pulmonary oedema and
myocardial infarction.
William has not undertaken any exercise and yet his breathing is troubled. It is a common
symptom in level IV heart failure (Coccia et al. 2016). The heart muscles have weakened and is
unable to pump enough oxygenated blood to the body organs. The tachycardia along with
troubled breathing is often a symptom of atrial tachycardia. It may be a response to the electrical
signal generated in the atrial tissues as opposed to the sinoatrial node. It is a common reaction to
drugs or other medication (Arrigo et al. 2016). All the symptoms hint towards a possible cardiac
arrest which is an abrupt loss of the heart’s function and the prevents normal circulation of
blood. The vital organs are deprived of oxygen and if left untreated can cause organ death.
Together with Pulmonary oedema, a condition where the lung is filled with excess fluid, it may
prove to be fatal. Due to pulmonary oedema the air sacs are filled with fluid, which hampers the
exchange of gasses, as a result, the heart cannot receive enough oxygenated blood to the organs
(Walsh et al 2018). As the blood flow to the heart decreases, myocardial infarction or a heart
attack can follow as the heart muscles cannot fuel themselves without oxygen.
The issue that is of top priority is troubled breathing as it prevents the cells to fuel their activity.
In order to compensate for the increased need in the cells and tissues. It is a common
complication arising in level IV heart failure and hints to the weakening of the heart muscles
(Mentz & O'connor, 2016).
1b) Nursing actions and rationales
The issue that needs to be relieved immediately is laboured breathing. After performing a
respiratory test to check for any blockage in the respiratory passage, presence of cough or any
pulmonary infection such as pneumonia (Louge et al. 2016). William’s position can be changed
to improve his breathing. His bed can be inclined less and he may be asked to sit straighter or
even bend a little for clearly any obstruction to breathing. In case of further complications like a

3
NSG3TCN
cardiac arrest, CPR can be provided. Other than that supplemental oxygen can be provided to
make the breathing easier (Harjola et al. 2017). The next issue, tachycardia can be resolved once
the underlying cause is identified. For this purpose, it is safe to call on the doctors as is clearly
mentioned in the instructions.
1c) Professional Issue
A professional issue noticed is that of no unanimous understanding can be attained about
William’s present condition. The buddy nurse that is deployed is unwilling to call the doctors
and considers the issues like laboured breathing and tachycardia as normal symptoms associated
with a terminally unwell patient suffering from level IV heart failure. Moreover, a third-year
student is required to take action beyond his learning and power (Mentz & O'connor, 2016). A
nursing student is unable to administer any medication or treatment approach to the patient
without the supervision and permission of the Residential nurse (Arrigo et al. 2016). However, in
the present case, the nurse deems that no such action is required. However, the vitals chart
indicates that a medical review is necessary in case of an elevated but the RN is unwilling to
call the doctors. The issue can be escalated to the ANUM or the educator. In order to negate any
chances of complication and to safeguard the health of the patient, it is required to call the
doctors to get a better understanding of William’s present condition (Coccia et al. 2016).
Case Study Two
2a) Pathophysiology and rationales
Carol is a 59-year-old woman who has recently undergone total knee replacement surgery. She
has been transferred to the ward and is accompanied by her partner Dianne. Carol has normal
vitals but low blood pressure and her surgical site also appear to be dry and normal. The issues
that Carol may face are Hypovolemia, pain and respiratory distress due to morphine side effect.
Hypovolemia or hypovolemic shock is caused due to a decrease in the quantity of flowing blood
in the body. The drowsy feeling and low blood pressure are some of the symptoms associated
with it. It is a common complication after a major surgery where a high volume of blood has
been lost. Anaemia is another posing threat due to her blood loss (Harjola et al. 2017). Patients
who have undergone recent surgery are often seen to develop respiratory distress which severely
decreases their chances of wellbeing and recovery (Kislitsina et al. 2019). In Carol’s case, a
threat of respiratory distress can be associated with the use of Morphine. Anaesthetics are related