Nursing Case Study Analysis

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