Complex Care Presentation

This presentation discusses a case of complex care involving a patient with chest pain, hypertension, and Type II Diabetes. It explores the patient's medical history, psychosocial factors, and the inter-professional team involved in her care. The presentation also includes a reflection on the care process and an action plan for future interventions.

COMPLEX CARE
-SUBMITTED BY:

PRESENTING COMPLAINT:
 Rachel presented to the outpatient department with severe
chest pain and a pounding sensation in the chest, neck and
ears
 She reports feeling fatigued and experiencing burning
sensation in her feet
 Vitals assessment:
Temp: 101̊̊ F, Respiratory Rate: 28 breaths per minute, BP:
140/90, Pulse: 102 beats per minute
Body Weight: 174 pounds

Medical History:
 Rachel has a medical history of Type II Diabetes since the previous 6
years
 Her current medication include:
 Metformin 500 mg PO
 Lisinopril 20 mg orally once a day
 No reported allergies

Psychosocial History:
 Suffered from depression because of bullying at school at the age of 14
years
 Does not stay with parents but shares a good relation
 Has recently gone through a bad breakup
 Reports not indulging in social interaction for the far of being bullied
because of her weight
 Relies heavily upon take away meals
 Worked at a salon but had to quit because of her increased health
complications and at present sustains on her savings

Pathophysiology:

Inter-professional team
members involved:
 Nutritionist
 Counsellor
 Community Nurse

Gibbs Reflection Framework:
Fig: Gibbs Reflection Cycle

Description:
 Upon presentment, the patient experienced increased shortness of
breath and a pounding sensation in her chest, neck and ears. The
patient also complained about experiencing a burning feet sensation.

Feelings:
 The patient seemed to be distressed and in pain. It seemed as though
the patient was experiencing the pounding sensation because of
hypertension. The patient appeared to be obese and found it difficult to
breathe normally. I thought it was appropriate to assess the patient and
conduct a vital assessment.

Evaluation:
 I conducted a vital assessment of the patient
 The vital assessment of the patient revealed high blood pressure,
elevated respiratory rate, pulse rate, temperature and obesity.
 The medical history of the patient suggested that the patient had been
suffering from Type II Diabetes
 The health condition of the patient seemed to be influenced heavily by
the life stressors.

Analysis:
 Life style stressors such as sedentary lifestyle and unhealthy diet
routine has triggered obesity and poor management of the symptoms
of Type II Diabetes.
 Obesity could have triggered hypertension
 Poor management of the symptoms of Type II Diabetes might have led
to hypertension
 Increased social isolation and emotional turmoil on ground of breakup
could have triggered depression.

Conclusion:
 Prior to conducting the patient assessment and proceeding with the
care process, I could have asked the patient about her cultural specific/
spiritual requirements.
 Prior to proceeding with the care intervention, I should have asked her
if she would like to involve one of her family member in the process of
care intervention.

Action Plan:
 I would access resources online to read more about the principles of
cultural safety.
 I would browse through the NSQHS standards to develop a better
understanding about partnering with patients and their family members
to render effective care.

References:
Bassot, B. (2016). The reflective journal. Macmillan International Higher Education.
Carey, M., Small, H., Yoong, S. L., Boyes, A., Bisquera, A., & Sanson-Fisher, R. (2014).
Prevalence of comorbid depression and obesity in general practice: a cross-sectional
survey. Br J Gen Pract, 64(620), e122-e127.
Iglay, K., Hannachi, H., Joseph Howie, P., Xu, J., Li, X., Engel, S. S., ... & Rajpathak, S. (2016).
Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes
mellitus. Current Medical Research and Opinion, 32(7), 1243-1252.
Smith, J., & Roberts, R. (2015). Reflective practice. Vital Signs for Nurses: An Introduction to
Clinical Observations, 222-230.
Landsberg, L., Aronne, L. J., Beilin, L. J., Burke, V., Igel, L. I., Lloyd‐Jones, D., & Sowers, J.
(2013). Obesity‐related hypertension: pathogenesis, cardiovascular risk, and treatment: a
position paper of the Obesity Society and the American Society of Hypertension. The
Journal of Clinical Hypertension, 15(1), 14-33.

Thank You!!