Nursing Case Study Question 2022

Running Head: Nursing
Case study
Name of the Student
Name of the University
Authors Note

CASE STUDY1
Response to Question 1
Ted William, an 82-year-old patient, was admitted to the hospital for the colostomy.
His biopsy report showed the presence of a malignant mass in his gastrointestinal system.
The patient had undergone through the surgery four days ago for removal of the malignant
mass.
According to the Roper- Logan-Tierney Model of Nursing, the daily activities of
living will be used for the planning of care for patients’ to assess the biopsychosocial,
spiritual and cultural impact of surgery on them (Holland & Jenkins, 2019). Here the
following analysis is given on Ted William as per RLT model.
Maintaining a safe environment
Sign of disorientation is absent in Ted as he was able to answer the questions. He had a pre-
medical history of cardiac failure. He is diabetic and obese.
Communicating
He has no problem with communication. His family members (his children and their family)
live away from him, and he lives with his partner Gwen in the retirement village.
Breathing
His respiratory rate is higher than normal. Coarse crackle sound is present during
inspiration. He has a moist and productive cough.
Eating and Drinking
Initially, Liquid (or fluid) diet was given to him, and later it was upgraded to a light diet.
Eliminating

CASE STUDY2
He has a bowel problem, and sluggish bowel sound is present in him. He has not passed
flatus. No output has been observed after since. However, after his breakfast, he vomited
twice on 4th operative day.
Personal Cleansing and dressing
The patient is unable to help in wound dressing. Additionally, he has occlusive dressing in
the abdominal wound.
Mobilising
He has a pre-medical history of gout. Moreover, he is an older adult so he might have some
ambulatory issues after the surgery. He has pain in the abdominal wound so that he could
not move quickly without the help of the nurses.
Working and playing
One year ago, he retired from his job. He lived in a retirement village.
Sleeping
The case study has no evidence of a poor sleeping pattern of the patient.
Death and Dying
He had not expressed any fear or the worry about death and dying. He faced the grief of his
wife's death three months ago.
Response to Question 2
The person is having chest congestion, and his respiratory rate is high (respiratory rate
=26 bpm). He is already a survivor of cardiac failure. The accumulation of fluid in the small
airways and alveoli due to heart failure can result in the crackling sound during the
inspiration of air (Assaad et al., 2018). The intermittent and non-muscular sound might

CASE STUDY3
represent pulmonary oedema in the patient. However, the signs are indicating clinical
respiratory distress due to ARDS and pre-medical condition of congestive heart failure. The
patient is suffering from ARDS and hyperventilation. 3L Nasal Pronge was administered to
him, and SPO2 was recorded as 94% which is at the borderline of the normal range.
The release of vasoactive substances (like serotonin, histamine and bradykinin) causes
vascular narrowing and obstruction in the Airways. Release of these substances increases or
decreases the blood pressure in a patient. In acute respiratory distress, disruption of the
alveolar capillary membrane can be observed. Non-cardiogenic pulmonary oedema can be
occurred due to an increase in capillary permeability and pressure gradient in the pulmonary
capillaries (Clark & Soos, 2019). Vasoactive substances can increase alveolar-capillary
membrane permeability (Doursout, Deshpande & Williams, 2016). The increased
permeability will outward the migration of the blood cells and fluid from capillaries. As a
result, pulmonary oedema can be observed, which leads to the impairment of gas exchange
and hypoxia will occur (Bhatnagar et al., 2018). The vascular narrowing is directly related to
the cause of pulmonary hypertension.
In this case study, the patient is a survivor of heart failure. Heart failure is not directly
related to acute respiratory disorder but may increase the risk of development of this disease
(Richards & Ho, 2020). Pre-medical history of cardiac failure and hypertension are the two
most prominent risk factor in this case. According to the pathogenesis of respiratory disorder
syndrome, bilateral infiltrates diffused in the body of alveolar and destroyed epithelial cells.
Destruction of epithelial cells accumulates fibroblast (Aranda-Valderrama, & Kaynar, 2018).
Acute respiratory disorder syndrome leads to ventilation-perfusion mismatch. With the
progression of the disease, lung damage can be caused by fibrosis formation (in the hyaline
membrane) which declines the compliance (of the lung) and leads to impairment of gas