Case Study on Clinical - Assignment PDF

Clinical case study
discussion
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Table of Contents
INTRODUCTION...........................................................................................................................3
Part 1.......................................................................................................................................3
Phase 2....................................................................................................................................4
Phase 3....................................................................................................................................5
Phase 4....................................................................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8
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INTRODUCTION
This report is based on the patient whose name is John Smith who is 81 years old retired
farmer which married to Jean. One day, John Smith is found semi-conscious and his wife Jean
has taken him into the hospital. While having primary observation he has been found that his RR
28, SpO2 90% RA, GCS15, HR94 Sinus rhythm, T36.4 tympanic, and have hypertension of
122/64 and also have discomfort which totally shows in the left buttock. For that he has given an
appropriate treatment for lowering down the drugs in an effective manner (Daver and et. al.,
2015).
Part 1
The brief examination when conducted on John, it has been identified that respiratory
rates was around 28 which is normal considering age of patient. The normal respiratory rate of a
person for 80 year and older ranges between 10-30. the next step is considered to check the
saturation of red blood cells through SpO2 which stood near 90%. which also emerged to normal
taking into account age of an individual. The next step which was taken up by the practitioners is
to identify the level of consciousness which is being possessed by patient. The results which
were identified with the GCS tests is that this patient has been suffering from mild brain injury.
The neurological symptoms which were being portrayed by the patients can results in damages in
the neurological systems which were further established through CT scan and MRI. Upon further
tests and examination, it was identified that the patient has been experiencing severe pain on the
left side of the body. There was abrasion on left side of the chest, his back and going until his left
hip joint. The pain in the left part of the body was being rated 8/10 which means it is severe and
unbearable for the patient. It was discovered that this patient has been taking medication for
hypotension as he was experiencing a lower blood pressure (Buyukasik and et. al., 2013).
The primary treatment which was given to patient is FiO2 6L, the reason being the person
is encountering with difficulty with breathing. This approach attempts to insert two cannulas in
nasal of a person so that flow of oxygen could be enhanced and leading to make an individual
ambulate. There is a use of 20G IVC in R cubital fossa so that central catheter is being placed
between the arteries so that pulse could be controlled. The pain which has been encountered by
an individual is being countered with morphine with nominal dosage. However, it is said that
morphine dosages ideal for person suffering from heart diseases and severe pain. Considering the
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history of the individual, there are strong chances that this individual is being experiencing with
TIA, but considering pain in the thigh it can be said that chances of recurrence of GORD are
strong. The symptoms which are being portrayed by a person are a combination of both the
disease therefore it is essential to make sure that necessary tests are to be conducted in the ideal
manner so that treatment can be initiated.
Phase 2
John is facing severe pain while having breathing and it is observed that Pt states pain in
L hip as 6/10 while having rest and 10/10 on the movement. By assessing it has been found that
the respiratory rate of the tells the number of breaths per minute, or can be seen that the number
of movements indicative of inspiration and expiration per unit time. In practical, respiratory rate
is normally identified by counting various times chest up and down per minute. Aim of
evaluating respiratory rate is to identify whether the respirations are within the range, abnormally
fast and abnormally slow. In this cited case, John is having his respiratory rate 26 which is
beyond the normal thing. As this would lead to have the respiratory problems. His SpO2 reflects
the blood oxygen level in the human body and Mr John is having the lesser blood oxygen
saturation levels which is 90. As he has not been able to have proper breathing in a proper
manner. His blood pressure is found 96/50 which is not appropriate as per the prescribed level.
He is on the Hypo blood pressure mode as this might lead to have the coma of the patient (Kelly,
Green and Hainey, 2015).
Nurses in the organisation are to provide vigilance at the bedside so that safety of a
patient could be considered. It is very crucial to provide them with limited number of patient so
that ideal care could be supplied. It has been identified that there is a strong link between staffing
ratio and patient safety. The training which is provided to nurses assure that they chose what is
best for the patients. The doctors and nurses are recommended to undertaken between the flags
approaches so that health of a patient could be further prevented from being deteriorating. In
context of hospitals there are carried out through routine observation of the patients and to make
sure that doctors and nurses acts as a lifeguard and take responsibility of wellbeing of patients.
The clinical excellence commission is responsible to form this safety net for patients and ensure
their well-being.
Considering the case study, it has been identified that john is facing major difficulty in
speaking and there is a symmetrical rise and fall in the chest. The palpitation on the abdominal
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area makes it clear enough that there is a recurrence of the GERD which is further clarified
through detailed examination of the abdomen for specifically its tenderness. The approach to
palpitation of abdomen is being carried out through providing a steady pressure on the abdomen.
The person is having major difficulty in moving and can be referred to as immobile. The nurses
are in this situation are persuaded only to think welfare of the patient and take necessary
measures so that this situation does not deteriorate. The plan which has been formulated for the
patient is to conduct a CT scan results are to be consulted to a specialist so that situation can be
improved (Persell, 2011).
John is facing severe pain while having breathing and it is observed that Pt states pain in
L hip as 6/10 while having rest and 10/10 on the movement. By assessing it has been found that
the respiratory rate of the tells the number of breaths per minute, or can be seen that the number
of movements indicative of inspiration and expiration per unit time. In practical, respiratory rate
is normally identified by counting various times chest up and down per minute. Aim of
evaluating respiratory rate is to identify whether the respirations are within the range, abnormally
fast and abnormally slow. In this cited case, John is having his respiratory rate 26 which is
beyond the normal thing. As this would lead to have the respiratory problems. His SpO2 reflects
the blood oxygen level in the human body and Mr John is having the lesser blood oxygen
saturation levels which is 90. As he has not been able to have proper breathing in a proper
manner. His blood pressure is found 96/50 which is not appropriate as per the prescribed level.
He is on the Hypo blood pressure mode as this might lead to have the coma of the patient.
Phase 3
Central Venous access insertion is a complicated process which has potential for
immediate and delayed difficulties. CVAD insertion is executed in diverse variety of clinical
settings. For instance, in case of emergency in the departments, ICU, operation theatres, cardiac
and interventional radiology suites and inpatient wards by diverse clinicians covering emergency
division specialists, anaesthetists. Here, Mr. John is getting inserted a catheter via large vein into
the more popular vena cava or right atrium for administration of parenteral fluids, medications or
for calculating of central venous pressure (Harrison and et. al., 2011).
After insertion, a chest x-ray is needed to assure that tip is in correct position. The tip of a
CVAD must lie in the superior vana cava, which is outside the right atrium for preventing
arrhythmias or arterial perforation. Mr. John after having CVAD, an emergency abdominal CT is
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required which are needed to be done for knowing the performance in an effective manner. This
surgical team must need to be notified in these situations:
 If a surgical patient emerging an advanced issue of if there is reduction of pre-
existing issues.
 If there are any crucial changes to the patient’s management. This covers
introducing an advanced medication regularly or varying other orders like diet.
 There is a strong need to Handle systolic blood pressure 100mmhg>. If this would
not be done in an effective manner which would lead to have sustaining in the
blood pressure.
After providence of the left CVAD to Mr. John, condition become worse and faced many
consequences. There are large number of aspects which are required to be in effective limit to
live normal life. Such limits are called standards which required to met to become healthier. But
after CVAD the actual figures which are noticed regarding such different aspects includes:
 Blood pressure of John is reached to the mark of 92/54 which below than the normal and
standard limit. The age of John is around 80 and in such age required to have the BP up
to the limit of 150/100 (Barhoumi and et. al., 2011).
 Another this which is noticed that the heart rate of John after CVAD is 134 which is high.
The normal and standard rate under which requited to having heart rate is 80 to 100. This
shows that issues are arise in normal breathing.
 The respiratory rate of John after CVAD is 30 which high required to be under the limit
of 20. This shows that he is facing the problem in proper respiration. It is observed that
John is not able to breathe properly. To overcome from this situation required to provide
external breathing from oxygen cylinder.
 Also, SpO2 in blood is 88% which is quite low from normal range. The normal and
standard rate of SpO2 which required to have in normal human being is around 94%.
 Also, after insertion of CVAD, Cap refill is attained 4 second which is quire high.
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The overall it is addressed that it has huge negative impact upon the health of John after
CVAD. The proper treatment is required to provide which helps in development of their
respiratory system and breathing procedures (Lynn and Lynn, 2014).
Phase 4
After having CVAD, this can be rightly observed that the BP fall down to the 52/25, HR
144. Patient have the cardiac warning which could lead to demonstrating pt in VT. Henceforth,
this can be rightly said that the CPR process is started as the patient condition is getting worse
henceforth speedy recovery is required to be done in an effective manner. As this can be rightly
said that in the chest compression basically with artificially ventilation in an effort to manually
preserve intact brain tasks intact brain function until additional calculation are calculating to
restore instant blood circulation and breathing (Mayordomo-Colunga and et. al., 2013). At the
first CPR, nothing effect is created. During that time, Adrenaline is injected via IV. While on the
second shock, which successfully delivered and his BP has come to 99/64 and Spo2 88%. Which
ultimately recovered an efficient manner.
CONCLUSION
From the above mentioned report, this can be rightly said that an overview of the report is
made John a farmer who is physically and socially active encounters a major health difficulty.
He was found by his wife after 3 hours as he was not home by that time. She called ambulance as
she was familiar that John is being semi-conscious and not responding to her in an proper
manner. Considering the situation and training, nurses thought of providing John with the
emergency treatment. The approach of triage has been employed so that severity of the condition
of patients is to be identified. A brief examination of the circumstances is being carried out so
that problems could be identified.
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REFERENCES
Daver, N., and et. al., (2015). Final report of a phase II study of imatinib mesylate with hyper-
CVAD for the front-line treatment of adult patients with Philadelphia chromosome-
positive acute lymphoblastic leukemia. Haematologica. 100(5). 653-661.
Buyukasik, Y., and et. al., (2013). Hyper-CVAD regimen in routine management of adult acute
lymphoblastic leukemia: a retrospective multicenter study. Acta haematologica. 130(3).
199-205.
Kelly, L. J., Green, A., & Hainey, K. (2015). Implementing a new teaching and learning strategy
for CVAD care. British Journal of Nursing. 24(Sup8). S4-S12.
Persell, S. D. (2011). Prevalence of resistant hypertension in the United States, 2003–2008.
Hypertension. 57(6). 1076-1080.
Harrison, D. G., and et. al., (2011). Inflammation, immunity, and hypertension. Hypertension.
57(2). 132-140.
Barhoumi, T., and et. al., (2011). T Regulatory lymphocytes prevent angiotensin ii–induced
hypertension and vascular injury. Hypertension. 57(3). 469-476.
Lynn, L. A., & Lynn, E. N. (2014). U.S. Patent No. 8,666,467. Washington, DC: U.S. Patent and
Trademark Office.
Mayordomo-Colunga, J., and et. al., (2013). Predicting non-invasive ventilation failure in
children from the SpO2/FiO2 (SF) ratio. Intensive care medicine. 39(6). 1095-1103.
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