Nursing Case Study Analysis

This nursing case study analysis discusses the management of chronic conditions in a patient, including the use of medications such as fentanyl, aspirin, LMW heparin, and morphine. It explores the pharmacokinetics of these drugs and the nursing management strategies employed. The patient is also provided with patient education to improve his condition.

Running head: CASE STUDY ANALYSIS
NURSING CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author note

1CASE STUDY ANALYSIS
Introduction
Nursing management is the process in which critical health condition of patients are
controlled with interventions simultaneously with diagnosis of the primary reason for such
condition (Curtis, Comiskey & Dempsey, 2015). There are several aspects which are observed to
understand the patient’s chronic situation such as the anxiety level, cardiac output, and blood
pressure with proper diagnostic tests so that patient’s unstable health condition could be
controlled and improved (Davies, 2014). This paper discusses about the case of Mr. Ferguson
(76), who was admitted to the healthcare facility after having complaint of chest heaviness. Prior
to admit, the patient self-administered 800 mcg of glyceryl trinitrate which provided him
minimal relief, however on admission to the ward symptoms such as pale appearance, shortness
of breath and sweating was observed. On the other hand, the vital signs of the patient indicated
towards high blood pressure (172/86), irregular heartbeat and elevated respiratory rate. These
signs indicated towards two primary chronic conditions, hypertension and myocardial infarction.
The medication provided to the patient indicated towards the presence of these two conditions as
he was prescribed and administered with morphine sulfate and fentanyl that are opioids ingested
for pain management, glyceryl trinitrate to control the heaviness of heart and low molecular
weight heparin to remove any blood clot present (Egan & Ensom, 2015).
In the following section, thorough analysis of the patient condition with the help of recent
researches and application of pharmacological practices to improve the patient condition will be
included.

2CASE STUDY ANALYSIS
Pathophysiological issues and patient condition
Patient’s chronic condition at the time of admission, his vital signs and his medical
history indicated towards episodes of myocardial infarction or hypertension. The patient suffered
from non-ST elevation myocardial infarction, twice before (in 1998 and 2006) and also suffered
from hypertension. The patient was prescribed with fentanyl 50 mcg twice daily for the pain
management. This drug is an opioid with a half-life of 3 to 7 hours. The interaction of fentanyl
with the central nervous system is complicated as once entered, this drug is not easily removed
from the cells as the fentanyl is a lipophilic medication, which enters and exits the blood brain
barrier rapidly, providing a longer relief from the exceeding pain to the patient. Further through
the research of Barratt et al. (2014), it was observed that the drug binds to the mu receptor of
the central nervous system properly and hence provides a longer action to the patient, hence it
was included in the chronic myocardial infarction associated symptoms of the patient. Besides
this, the patient was administered with Morphine sulfate 2.5 mg so that the increasing heart
heaviness and pain could be released and the anxiety level of the patient could be controlled.
Further, inclusion of Morphine in the medication could help the patient to sleep more and relive
the elevated heart rate. However, researches conducted by Smallwood et al. (2015) indicated
providing minimal dose of morphine to Mr. Ferguson was accurate as providing higher dosage in
the presence of higher respiratory rate, elevated blood pressure and heart rate could increase the
patients’ health complication. The third medication which was infused with low molecular
weight heparin so that chronic condition related to myocardial infarction could be minimized.
However, the LMW heparin is different from the standard heparin as this produces very
predictable anti-coagulant that does not require multiple observation and monitoring as well as

3CASE STUDY ANALYSIS
could be adjusted within the first dose of the medication (Zhang et al., 2015). Further, this
medication binds with its receptor rapidly and does not affect the patient negatively.
Besides myocardial infarction, the patient also showed symptoms of hypertension as he
was sweating heavily, has a pale and tired appearance and was suffering from shortness of
breath. It was also noted that he had prior history of hypertension episodes and hence, several
medications such as morphine and fentanyl indicated towards the requirement of managing his
anxiety and stress level (Smallwood et al., 2015). Fentanyl, when presented with anaesthesia,
could help in relieving elevated nerves and hence, could be provided in the symptoms of
hypertension as mentioned by (Bodnar, 2014). Further, it was also seen from evidences that
hypertension and myocardial infarction could produce the vital signs and symptoms presented by
the patient in this case, and hence, all these medications mentioned earlier could help the patient
to provide primary improvement to his chronic conditions.
Pharmacokinetics of the drugs
Pharmacokinetic studies helps the researchers to understand the drug interaction,
absorption, metabolism and excretion pathways so that while application of these drugs on
patients they can understand the effects it will exert on the living organism. In this case study,
two of the chronic health conditions were identified which could be controlled with drugs such
as fentanyl, morphine (opioids), heparin (anticoagulant) and aspirin (to prevent inflammation).
This section will present the pharmacokinetics of these drugs and their interaction.
Fentanyl is an opioid which is used to control pain in patients and it has been reported
through researches that its activity is 50 to 100 times higher than that of morphine (Davies,
2014). Researches revealed that it has higher lipid solubility which increases its regulation

4CASE STUDY ANALYSIS
through the blood brain barrier within the central nervous system and hence, it requires multiple
doses which could be seen in the case of Mr. Ferguson. Further, the half-life of the patient ranges
from 3 to 7 hours that increases the level of redistribution of the drug and hinder its removal
from the body (Barratt et al., 2014). LMW heparin was also included in the medication as the
patient presented the symptoms of chronic heart failure. However, the LMW heparin is an
effective counterpart of the standard heparin as researches has revealed that the half-life of the
medicine is about 3 to 4 hours which is higher than the standard or unfractionated heparin
(Zhang et al., 2015). Further it was also seen that the action of this medication is faster and
requires less monitoring once injected intravenously or sub-cutaneously (Egan & Ensom, 2015).
Aspirin is the drug which is used by the healthcare professionals for patients who are suffering
from myocardial infarction or has completed the bypass surgery as it works as secondary
prophylaxis for this health condition (Vranckx, Valgimigli & Heidbuchel ,2018). `Therefore,
from these pharmacokinetic evidences it is evident that these drugs were accurate to use in the
chronic conditions of Mr. Ferguson.
Nurisng management for patient
Nursing management for Mr. Ferguson should be inclusive of patient’s chronic condition
management, providing culturally competent and patient centered care, managing the adverse
effects of medication and providing patient education so that maximum involvement of the
patient could be achieved. In this aspect, the primary duty of the nursing professional will be
managing adverse effects of the medication (Abubakari et al., 2016). Adverse effect of fentanyl
is inclusive of impaired memory, increasing dependency, risk of overdose which can lead to
coma or death and increased episodes of depression, stress and anxiety (Wilson, 2014).
Therefore, to manage such condition, the nursing professional should reduce the dosage of the

5CASE STUDY ANALYSIS
medication slowly so that addiction or dependency could be avoided. Further the nurse should
observe conditions such as impaired cognition, confusion, low body temperature or presence of
lower oxygen as it could indicate towards the overdose of the medication (Abubakari et al.,
2016). Further, evidence from researches also indicates that providing details of the medication
could help the patient positively as through this, complete participation of the patient in the care
process would be achieved and a holistic patient centered care could be provided (Wilson, 2014).
Patient education
To involve the patient in the care process and increase his engagement in the
interventions, patient education was included in the care. It was evident from the case study that
patient was aware of his health condition and had preliminary knowledge that helped him to use
glyceryl trinitrate pump so that minimal relief could be achieved (Bravo et al., 2015). Therefore,
as part of patient education, he will be provided with details of the drugs, their mode of action,
their requirement in the care process and the precautions he needs to take to improve his health
condition (Chang et al., 2015). Hence, the educational sessions will revolve around three sections
such as exercise, reducing risk factors and dealing with depression, stress and anxiety (Bravo et
al., 2015). Hence, within this the patient will be provided with the side effects of the drugs and
their adverse effects such as elevated blood pressure, high cholesterol, diabetes, diet,
psychosocial therapies and treatment so that while receiving care in the healthcare facility or
after discharge he can take care of the precautions and risk factors to improve his condition.
Besides these, the patient will be provided with simpler presentations so that the mechanism of
action, the long term effects and the precautions required could be easily delivered to the patient
(Chang et al., 2015).

6CASE STUDY ANALYSIS
Conclusion
In this assignment, case study of Mr. Ferguson who was suffering from myocardial
infarction and hypertension and to control these chronic conditions, he was administered with
medications such as fentanyl, aspirin, LMW heparin and morphine so that pain management,
inflammation, blood clotting and depression or anxiety related conditions could be addressed. To
achieve these, the patient was provided with patient education and medication so that holistic
care could be achieved. Further, the patient was provided with details of pharmacokinetics of the
drug, its mode of action and its long term effects so that patient centered care could be provided.

7CASE STUDY ANALYSIS
References
Abubakari, A. R., Cousins, R., Thomas, C., Sharma, D., & Naderali, E. K. (2016).
Sociodemographic and clinical predictors of self-management among people with poorly
controlled type 1 and type 2 diabetes: the role of illness perceptions and self-
efficacy. Journal of diabetes research, 2016.
Barratt, D. T., Bandak, B., Klepstad, P., Dale, O., Kaasa, S., Christrup, L. L., ... & Somogyi, A.
A. (2014). Genetic, pathological and physiological determinants of transdermal fentanyl
pharmacokinetics in 620 cancer patients of the EPOS study. Pharmacogenetics and
genomics, 24(4), 185-194.
Bodnar, R. J. (2014). Endogenous opiates and behavior: 2013. Peptides, 62, 67-136.
Bravo, P., Edwards, A., Barr, P. J., Scholl, I., Elwyn, G., & McAllister, M. (2015).
Conceptualising patient empowerment: a mixed methods study. BMC health services
research, 15(1), 252.
Chang, C. W., Shih, S. C., Wang, H. Y., Chu, C. H., Wang, T. E., Hung, C. Y., ... & Chen, M. J.
(2015). Meta-analysis: the effect of patient education on bowel preparation for
colonoscopy. Endoscopy international open, 3(6), E646.
Curtis, E., Comiskey, C., & Dempsey, O. (2015). Correlational research: Importance and use in
nursing and health research. Nurse researcher, 6, 20-25.
Davies, A. (2014). A new fast-acting sublingual fentanyl (Recivit®) for treating breakthrough
cancer pain. Eur Oncol Haematol, 10(1), 12.

8CASE STUDY ANALYSIS
Egan, G., & Ensom, M. H. (2015). Measuring anti–factor Xa activity to monitor low-molecular-
weight heparin in obesity: a critical review. The Canadian journal of hospital
pharmacy, 68(1), 33.`
Smallwood, N., Le, B., Currow, D., Irving, L., & Philip, J. (2015). Management of refractory
breathlessness with morphine in patients with chronic obstructive pulmonary
disease. Internal medicine journal, 45(9), 898-904.
Vranckx, P., Valgimigli, M., & Heidbuchel, H. (2018). The Significance of drug—Drug and
drug—Food interactions of oral anticoagulation. Arrhythmia & electrophysiology
review, 7(1), 55.
Wilson, J. F. (2014). Stable Ischemic Heart Disease. Annals of internal medicine, 160(1), ITC1-
1.
Zhang, T., Xiong, H., Dahmani, F. Z., Sun, L., Li, Y., Yao, L., ... & Yao, J. (2015). Combination
chemotherapy of doxorubicin, all-trans retinoic acid and low molecular weight heparin
based on self-assembled multi-functional polymeric
nanoparticles. Nanotechnology, 26(14), 145101.