Nursing Studies Case Study 2022

Running head: NURSING
NURSING
Name of the Student
Name of the University
Author Note

NURSING
1
Case study
Case study analysis in nursing studies gives an in depth understanding of a particular
patient and improves the problem solving skills of the nurse. Nursing students needs to be
critical thinkers and a growing body of evidence have suggested that development of critical
thinkers are necessary to solve complex medical problem or to provide prompt care as and
when required (Dutra, 2013). During my clinical placement, I was allotted to care for Mr.
Brown, who was a retired 70 years old man with a 20 years history of type 2 diabetes. As
reported by Mr. Brown, his mother also suffered from type II diabetes. He had reported to
have some past records of nocturia. His current weight is 170 lb. When the first time he was
diagnosed with T2D, he was asked to lose weight, but no action has been taken. Mr. Brown
smokes 1-3 packet of cigarettes a day and consumes the 1-2 cocktails per night. He says it
“settles his nerves”.
Mr. Brown had been presented to the hospital with the recent weight gain, nil diabetic
control and a pain on the chest. Mr Brown described the pain to be chest tightedness. As per
his subjective records- “It is in my breast bone and it is not radiating”. He had also informed
that he often feels burning sensation in his chest. Mr. Brown had been taking glyburide
Diabeta) every morning, but had stopped them recently as he had been feeling dizzy followed
by sweating with a feeling of the agitation, sometimes in the late afternoon. Mr. Brown also
takes Atorvastatin (Lipitor, 10 mg daily) for his hypercholesterolemia (Elevated LDL
cholesterol). For the past 6 months he had also been taking gymnema sylvestre and a
pancreatic elixier for improving his diabetes control. Mr. Brown does not monitor his blood
glucose level regularly and does not know to use the normal glucometers. The diet history of
the Mr. Brown signifies excessive intake of carbohydrates in the form of pasta and breads.
For dinner he takes about two cups of pasta and 3-4 slices of Italian bread.

NURSING
2
Physical examination
 Weight: 170 lb; height: 5′′′; body mass index (BMI): 31.6 kg/m2
 Fasting capillary glucose: 165 mg/dl
 Blood pressure: BP right arm 162/94; left arm 160/92
 Respiratory rate is- 16/minute
 Temperature- 98.4 degree F
 Haemoglobin = 15.2g/dL
 Blood Urea Nitrogen (BUN) 11mg/dL
 Lungs are clear to percussion and auscultation.
 Heart: 86/minute, S1 is heard best at the apex, S4 is also heard at the base of the apex
absence of any peripheral oedema.
Describing about the psychosocial aspect, Mr. Brown had lost his wife there years back and
since them, he cannot manage cooking alone and hence consumes read made pasta which are
easy to make. As he is retired, his movements have also become restricted which is also
increasing his body mass index. Mr. Brown stays in a small household with almost no space
where he can do exercise, which had been worsening his cardiac health.
Care Plan
Care priority/Objective 1
One of most important care priority for Mr. Brown would be to alleviate his chest pain, for
which he had been admitted in to the hospital. Typical chest pain or angina are often
described as “ pressure like” Older patients are more likely to have a clinical presentation of a
chest pain. Half of the patients who had been admitted with a chest pain, was diagnosed with
myocardial infarction. Hence, it can be possible that Mr. Brown might have contracted with

NURSING
3
myocardial infarction. It has already been stated that he often felt nauseated. Treatment delay
might increase the chance of mortality. For adults above the age of 65, ischemic heart attack
accounts for about 81 % of mortality and needs to be diagnosed first when any older person
presents to the care with a chest pain. Some of the complications of heart disease might
include heart failure, which occurs when heart cannot pump enough blood to meet the
requirements of the body. Some of the other complications might involve aneurysm and
peripheral artery diseases. If prompt action is not taken. Then it can lead to cardiac arrest
casing death.
Clinical priority 2
Managing diabetic health
It is evident from the case study that the blood glucose level of the patients is quite
higher than the standard value. The normal blood glucose level of a patient is about 72to
99mg/dL while fasting and about 140mg/dL, after eating. A large number of literary sources
have indicated diabetes to be the major risk factor for coronary heart disease. As per the
studies, it has been found that about 68 % of the people older than 65years with diabetes die
from cardiovascular diseases (Currie & Delles, 2014). Studies have reported a positive
association between the insulin resistance and hypertension (Currie & Delles, 2014). The
likelihood of cardiovascular disease doubles, if an individual has a combination of diabetes
and hypertension. Patients having T2D, often have high LDL cholesterol levels and high
triglycerides that is an important risk factor for the development of cardiovascular diseases.
Diabetes affects the heat muscle and can cause both systolic and the diastolic heart failure
(Currie & Delles, 2014). According to Jia, DeMarco and Sowers, (2016) diabetic
cardiomyopathy occurring in patients increases the chance of heart failure in the patients.
Diabetes has been found to be related to micro vascular diseases, causing endothelial