Case Study of Violet Paterson

This case study explores the condition of Violet Paterson, a 77-year-old woman with Acute Myocardial Infarction (AMI) and osteoarthritis. It discusses nursing assessments, care planning, and patient education for managing her conditions. The study emphasizes the importance of diet, lifestyle modifications, physical activities, and teamwork in providing holistic care.

Running head: CASE STUDY OF VIOLET PATERSON
CASE STUDY OF VIOLET PATERSON
Name of the student:
Name of the university:
Author note:

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CASE STUDY OF VIOLET PATERSON
Considering the patient condition:
Clinical reasoning cycle can be explained as the systematic framework that guides nursing
professionals to develop evidence based care plans that meet up of the healthcare needs of the patient
and accordingly help the patient in living better quality lives. This cyclical framework advises nurses to
first identify the cues and symptoms of the patients and the, relate them with their health concerns and
the disorders they have. Following these, the nursing professionals need to set nursing priorities which
mainly help in attending the main health concerns that needs care on an urgent basis. Following this,
nurses need to set nursing goals and develop evidence based care plans that help patients overcome
their suborders and achieve holistic health. In the case study it is seen, that the patient named Violet is a
77 year old woman who has been admitted to the ward with Acute Myocardial Infarction (AMI). With
thorough treatments by the experts of the emergency ward, she is now stable. The patient history
reveals that she is also suffering from hypertension as well as osteoarthritis. Both the disorders are not
been able to be managed by the patient successfully and hence they have impacted her life making it
difficult for her to continue her activities of daily living. She is residing currently in her own apartment on
the third floor that has no lift. This is yet another concern for the patient as her restricted mobility due
to osteoarthritis might make it difficult for her to climb up or down. This would ultimately make her
socially excluded which would in turn affect her mental stability.

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CASE STUDY OF VIOLET PATERSON
Nursing assessments:
One of the most important tests that the nurses need to conduct is an ECG or
electrocardiogram. This test helps nurses to diagnose the current condition of the heart. This is mainly
done by recording the electrical activity of the heart. This system mainly utilizes a system of electrodes
which are attached to the skin and this helps in recording the impulses (Fors et al., 2015). It has been
found that the system of ECG mainly helps in revealing the information about whether the heart is
facing the acute myocardial infarction or whether it is in progress. Injured muscles of the heart cannot
conduct electrical impulses and ECG works through identifying such impulses and helping professionals
to understand the condition of the heart. Another important test that can be also conducted for Violet
to know about her health condition is the blood test. It has been found that there are important
proteins in the heart which gets leaked into the blood when the heart gets damaged (Boyde et al.,
2015). Nurses can also follow the blood test report to find out whether those proteins are found in
abnormal conditions in the blood. This would also help nurses to identify whether the heart conditions
are still at the risk or is out of danger.
Another important assessment is to develop an idea about the present condition of
osteoarthritis in the patient named violet. Nurses would first need to identify the pain level of the
patient so as to relieve her from the pain and also develop proper care interventions to relieve her from
the pain (Finney et al., 2016). For this, the pain assessment tool can be used where patients are asked to
provide score to their pain level from 0 to 10 with zero being complete absence of pain to 10 being high
level of unbearable pain. Another important assessment that also needs to be conducted for Violet is
the fall risk assessment (Fors et al., 2016). She is suffering from excessive pain from osteoarthritis which
had restricted her activities of daily life and mobility. Hence, she might be at increased risk for fall both
in the hospital as well as in her apartment. Hence the FRAT tool or the Fall Risk Assessment Tool can be

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CASE STUDY OF VIOLET PATERSON
used which incorporates assessing three important segments. These are the Part 1 - falls risk status; Part
2 – risk factor checklist; and Part 3 – action plan. With the help of the score, the nurses can accordingly
set up precautionary measures and prevent the patient from any form of additional harm.
Nurses should constantly measure the vital signs from time to time. This assessment would
provide a detailed account of her body temperature, blood pressure, respiratory rate, saturated oxygen
level as well as heart rate. Measuring the blood pressure is extremely important in order to assess the
present blood pressure of the patient (Bray et al., 2016). It has been found that nurses need to consider
an average of three blood pressure readings that would be taken 2 minutes apart with the use of the
mercury manometer. In this way, the current blood pressure of Violet needs to be taken and accordingly
care plans would be to help her bring her blood pressure under control.
Care planning:
Nursing goals Nursing interventions and nursing rationale Evaluation
Violet has suffered from acute
myocardial infarction and
therefore, she might be at an
increased risk for decreased
cardiac output. This can result in
inadequate blood pumped up by
the heart which in turn might
affect the metabolic needs of the
body. Hence, the nurses need to
set goals for the management of
the risks for the decreased
 The nurse would need to monitor both
the heart rhythm as well as the heart rate.
She would also need to document any
dysrhythmias with the help of the
telemetry. The main reason behind this
intervention is that both heart rate as well
as heart rhythm responds to different
types of medication as well as activity and
other developing complications. Studies
have also found that dysrhythmias
compromise cardiac function as well as
The nurses
would need to
evaluate the
results of serial
ECGs as this
would help in
providing
information
regarding
status of
ventricular

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CASE STUDY OF VIOLET PATERSON
cardiac output increase in the cardiac function or
increase in cardiac damage (Falsini et al.,
2018).
 Nurses also would need to administer
supplemental oxygen as indicated. the
main rationale is that it would help in
increasing the amount of oxygen which is
important for that of the myocardial
uptake. This would also help in reduction
of the ischemia and other types of
resultant cellular irritations and
dysrthymias (Hardin et al., 2019).
 The patient should be given small as well
as easily digested meals and all forms of
caffeine containing products should be
limited in the diet of the patient. Studies
have found that large meals have the
capability in increasing the different forms
of myocardial workload and can also
result in bradycardia or ectopic beats
(Harris et al., 2015). It is also found that
caffeine acts as direct cardiac stimulant.
This can thereby increase the heart rate
and affect the health of the patient.
function,
electrolyte
balance,
progression or
resolution of
infarction, and
effects of drug
therapies. The
nurse can also
review chest x-
rays from time
to time to find
out whether
any pulmonary
edema is
present or not
due to
ventricular
dysfunction.

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CASE STUDY OF VIOLET PATERSON
Violet is suffering from pain due
to unmanaged osteoarthritis
which might also increase his
chances of fall because she is
also facing mobility issues.
Hence, the nursing goal would
be to manage osteoarthritis and
fall risks.
 The nurse should first allocate
physiotherapists who would be
undertaking physiotherapy sessions of
exercises as well as hot and cold compress
to relieve the patient from pain (Nunes et
al., 2016). He may also recommend the
patient a functional knee or ankle brace as
this helps in supporting the joints. He
would also help the patient to learn to
walk with crutches, a walker, or cane
when needed
 In order to reduce the chances of falls of
the patient, the nursing professionals
should modify the layout of the rooms.
Rooms should be brightly lit along with
support systems like hand bars,
bathrooms rails, lowered height of the
bed and many others (Briani et al., 2018).
Nurses should also provide non-skid shoes
to reduce the risk of fall. Clutters should
be removed from the floors as well
The pain
assessment
scale would be
used to analyze
the pain level
of the patient.
reduction of
pain and
participation of
activities of
daily lives can
help nurses in
understanding
whether
patient is
overcoming
pain issues.
The patient is suffering from high
pressure and the next nursing
goal would be managing
 The nurse should be providing diuretics or
water pills. The main rationale is that the
medication helps in eliminating unneeded
Blood pressure
should be
measured from

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CASE STUDY OF VIOLET PATERSON
hypertension water as well as salt through that of urine.
Studies opine that getting rid of excess
salt and fluid would help in lowering the
blood pressure thereby making it easier
for the heart in pumping blood (Inamdar
et al., 2016).
 Another set of medication that can be also
provided is the beta-blockers. The main
rationale behind using this drug is that it
helps in blocking the effects of the
sympathetic nervous system on the heart
and thereby lowers the blood pressure
(Porcherett et al., 2018)
 Another set of drugs that can be also
provided is Angiotensin converting
enzyme (ACE) inhibitors. These drugs
mainly work by dilating the blood vessels
and improving the amount of blood that is
pumped by the heart. This helps o
lowering of blood pressure
time to time to
find out
whether blood
pressure is
coming under
control or not.
Patient education:

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CASE STUDY OF VIOLET PATERSON
The patient should be educated about the importance of diet and lifestyle modifications as both
of them are found to be intricately associated with the management of heart disorders as well as
hypertensions. This might include avoiding salty foods for reducing blood pressure, avoiding fatty and
cholesterol containing foods, depending more on fruits and vegetables, staying away from fast foods
and many others. The patient should be also educated about importance of physical activities (Conn et
al., 2015). Physical activities are also found to be intricately associated with lowering of the blood
pressure and reduction in the chances of AMI. Studies are of the opinion that cardiovascular exercises
such as running, biking as well as swimming for at least 30 minutes can help in reduction of the blood
pressure. As the patient is suffering from osteoarthritis, running might not be a good option and so brisk
walking for 30 minutes can be advised to her when her health conditions become stable (Von visger. For
handling osteoarthritis, the patient should be educated about the importance of weight loss and weight
managements. Excessive weights put pressure on joints making them vulnerable to developing
osteoarthritis. Hence, nurses can advise her to lose weight. With the help of the physiotherapists, nurses
can educate physical therapy and exercise sessions that can help in improving and strengthening the
muscles surrounding the joints. Freehand exercises, swimming and cycling can be instructed (Jung et al.,
2017). The patient can be also educated about the use of assistive devices like Canes, walkers, electric-
powered seat lifts, raised toilet seats, and tub and shower bars and should be requested to use them to
reduce fall risks. Besides, importance of taking all medications at the right time, regular participations in
the screening sessions and others should be educated so that she feels empowered and manage herself
properly.
Team work:
Violet is suffering from multiple chronic health conditions and therefore, she would need the
service of different experts from multi-disciplinary healthcare team. Apart from the nursing

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CASE STUDY OF VIOLET PATERSON
professionals, the patient would be attended by cardiologist. The nurses would be reporting about the
heart conditions of the Violet to the cardiologist and would be acting according to the advices of the
cardiologist only. She would be also attended by physiotherapists who would be helping her with the
different exercises that would enable her to regain back her mobility and reduce pain. Hot and cold
compress methods would be also taught to her (Fortuna et al., 2015). Physiotherapists would teach her
the ways to maintain body mechanics and the ways for developing her gait. Occupational therapists
should be also included in the team. Occupational therapists help in the teaching the patient different
ways by which the strain in the joints can be reduced during the daily activities. They also participate in
modifying the home of the patients in ways that can prevent aggravation of her arthritis situations. They
mainly help the patients to come in back in normal lives by helping the patient to participate in activities
of daily lives and helping them in regaining back independence in different actions like bathing, dressing
and maintaining the house (Devenhorn et al., 2015). A dietician should be also involved as patients who
had suffered from Ami. She needs to take light meals and dieticians can help the team to plan her meal.
He would be also helping in developing a food diet chart that would help in reducing blood glucose level.
Social aides can be allocated to take care of her and conduct all household chores on behalf of the
patient as he has no extended families to help her. She would be doing the shopping as Violet would not
be able to climb stairs until her osteoarthritis is under control.

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CASE STUDY OF VIOLET PATERSON
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