Diploma of Nursing: Case Studies of COPD and Stroke Patients

Running head: DIPLOMA OF NURSING
Diploma of nursing
Name of the Student
Name of the University
Author note

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DIPLOMA OF NURSING
Part A- Case study of Mr Brown
1.
Mr Brown had past habit of smoking. In lungs oxidative and inflammatory stress
responses occurs with cigarette smoke that in triggers process critical to the development of
COPD. The smoke is viewed as danger by the host and activates the mammalian target of
rapamycin (mTOR). The process of alveolar maintenance is disturbed by oxidative stress,
apoptosis and protease-antiprotease imbalance. A destructive pathway persists even after
smoking cessation and result in structural damage. This initiates emphysema an airflow limited
state (Goldklang & Stockley, 2016).
2.
 Low oxygen saturation- is 90 % difficult breathing and due to COPD, restricting
air flow
 Blood pressure- resembling hypertension in pulmonary arteries that are
constricted due to hypoxia (Goldklang & Stockley, 2016)
3.
The imbalance between the oxygen demand and supply to heart results in Angina,
characterised by severe chest pain. The increased demand for oxygen is not met due to
obstruction or atherosclerotic plaques and is related with myocardial infarction, and hypertension
in Mr Brown (Ford et al., 2018).
4.

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DIPLOMA OF NURSING
Myocardial infarction is caused by the unstable atherosclerotic plaque that disrupts the
vascular endothelium. It is due to formation of intracoronary thrombus which forms the coronary
artery blood flow occlusion. The increase of risk of myocardium necrosis increases with the
coronary occlusion being more proximal. Aldosterone hormone plays a role of damaging the
vascular and myocardial function. As a result it promotes the coronary endothelial dysfunction.
This hormone causes the left ventricular dysfunction and fibrosis followed by progression of
heart failure. Thus, it adversely affects the heart and the blood vessels. It explains the myocardial
infarction and left sided heart failure in Mr Brown. There are five different situations to the
myocardial infarction. In case of Mr. Brown, it is the situation of oxygen supply and demand
imbalance (Kristensen et al., 2015).
5.
One half of the patients with myocardial infarction develop left sided heart failure. Mr
Brown has hypertension. High blood pressure increases the work of left ventricle to pump blood
out of circulatory system. This leads to weakening of heart and heart failure or CCF. With past
myocardial infarction, the process of CCF is enhanced due to coronary artery blood flow
occlusion (Mann & Felker, 2014).
6.
Swollen ankle and legs are related to fluid accumulation in body. It is caused by reduced
blood flow from the heart due to CCF. Since, the fluid does not move back from heart to veins
results in fluid accumulation in lungs, liver, lower limbs and congestion. However, with CCF
the swelling in ankles and legs is obvious (Mann & Felker, 2014).
7.

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DIPLOMA OF NURSING
BPH is associated with the posterior urethral gland and affects most men at the age of or
more. It is the non-cancerous enlargement of the prostate gland that results in hypertrophy of
cells and compression of the urethral canal. It results in obstruction of urine flow (Aaron et al.,
2016).
8.
Pulmonary edema is the condition characterised by the fluid accumulation in air spaces of
lungs leading to impairment in gaseous exchange. CCF is the common cause of the pulmonary
edema in most cases. If Mr Brown started to show the signs of PO the signs and symptoms I
would be considering are- extreme shortness of breath, chest pain, rapid irregular heartbeat,
anxiety, wheezing, and cough with frothy sputum and blood (Mann & Felker, 2014).
9.
Problem of patients Goal Course of action Evaluated
O2 saturation 90/% on
room air
Maintenance of
adequate gaseous
exchange
1. Provide
supplemental
oxygen, via
100%
O2 non-
rebreather
mask
2. Assess
respiratory rate,
breathing effort
and pattern
SaO2 via pulse
oximetry is 90 – 100%
High blood pressure Lower the blood
pressure
1.Monitor response to
medication and
administer beta
antagonists
2.Encourage relaxation
techniques such as
distractions and
comfort measures
The patient may
maintain BP in normal
range