Diploma of Nursing: Clinical Scenarios and Nursing Care Plan

This article discusses clinical scenarios related to emphysema, myocardial infarction, stroke, and asthma, along with a nursing care plan for patients. It also includes information on allied health care workers and staff required for rehabilitation.

0Running head: DIPLOMA OF NURSING
Diploma of nursing
Name of the student:
Name of the University:
Author’s note

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Clinical Scenario 1
Answer 1:
Emphsyema, a progressive disease of lung is caused by the innate respiratory dense
mechanism of the lung’s epithelial cell and mucociliary transport system after the foreign
antigens infiltrate the lungs cells. The inflammatory immune cells transfer them to lymphatic
tissue layer and the release of proteolytic enzymes leads to the destruction of the lung’s epithelial
barrier and the condition of emphysema (Goldklang & Stockley, 2016).
Answer 2
Heart rate and blood pressure are two vital signs that are affected by
Mr. Brown’s emphysema. This occurs because the condition of emphysema results in inefficient
oxygen diffusion and low oxygen content in blood. Hence, heart also suffers from lack of oxygen
and compensates it by beating faster. Exacerbation of COPD results in hypertension because of
airflow limitation in COPD patients (Imaizumi, Eguchi & Kario, 2014).
Answer 3:
Angina pectoris, a clinical manifestation of myocardial infarction is caused by chemical
and mechanical stimulation of sensory nerve endings in the myocardium. During ischemia, the
degradation of ATP to adenosine leads to the stimulation of receptors in cardiac afferent nerve
ending and induces angina (Ford, Corcoran & Berry, 2018).

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Answer 4:
Myocardial infarction (MI) is the sudden death of myocardial tissue. The
pathophysiology of the condition is linked to the thrombotic occlusion of coronary vessel caused
due to rupture of plaque. It caused rapid depression of systolic function (Frangogiannis, 2015).
Non-ST segment elevation myocardial infarction is one type of MI and it affects the arteries of
the heart.
Answer 5
Mr. Brown’s past AMI (Acute myocardial infarction) might have caused his CCF
(congestive cardiac failure). This is said because heart failure complications increase in patients
having AMI. It leads to acute structural complications of the heart muscle and diagnosis of CCF
signifies acute alterations in left ventricular function of patient (Dharmarajan et al., 2015).
Answer 6:
Swelling of leg is a condition of accumulation of fluids in the tissue also called as edema.
Mr. Brown’s swollen ankles and legs are related to CCF because CCF limits the ability of heart
to pump blood efficiently. Hence, heart failure affect blood pumping ability of the heart and
causes fluids to accumulate in different parts of the body.
Answer 7:
Benign Prostrate Hypermegaly (BPH) is a condition of enlarged prostrate in males. The
prostate grows two times and the BPH results in the second growth phase. It weakens the bladder
and its ability to completely empty the urinary bladder (Hashemzadeh et al., 2017).

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Answer 8:
Pulmonary oedema (PO) is a clinical condition associated with accumulation of fluids in
the lungs. As the condition affects a person’s ability to gain oxygen, they start to struggle for
breath. Hence, symptoms of running out of breath show signs of PO in patient.
Answer 9:
Nursing care plan for Mr. Brown:
Care plan Patient problem One goal Course of action
1. To balance
fluid intake of
patient
Shortness of breath,
edema or swollen legs
To maintain fluid
balance in patient and
decrease symptoms of
edema
 Balance fluid
intake in
patient by
means of diet
changes and
fluid
restriction
 Evaluate and
monitor urine
output in
patient
2. To manage
ineffective
breathing
pattern in
Shortness of breath To improve breathing
rate and tissue
oxygenation in patient
 Conduction
work of
breathing
assessment in

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patient patient to
identify
severity of the
issue
 Provide
optimal body
alignment to
patient by
placing him in
semi-fowler’s
position
3. To help patient
manage his
self-care needs
Activity intolerance and
limited capacity for self-
care in patient
To help patients
achieved desired
activities to manage his
self-care needs
 Provide
assistance to
patient in self-
care activities
 Provide
adequate
exercise to
patient to
strengthen
muscles and
increase
capacity for

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activity
Answer 10:
Allied health care workers include therapist, administrators and those staffs who supports
the health care professionals in providing optimum care to patient. They provide direct care to
patient and enhance the quality of life of patients (Demo et al., 2015).
Answer 11:
The person who can assist Mr. Brown after discharge includes:
Nurses: The nurse can play a role is vital sign assessment of patient and providing medications
on time. As Mr. Brown has symptoms of edema, she will play a role in monitoring urine output
fluid intake schedule. She can also educate patients regarding the knowledge of the disease
process and taking precautions in daily life.
Physiotherapist: The physiotherapist can play a role in providing aerobic and resistance training
to Mr. Brown. This will increase his mobility and endurance capacity (Knocke, 2012).
Clinical scenario 2:
Answer 1:
The difference between TIA and stroke is that stroke is a permanent injury to the brain
and TIA is a temporary blockage where blood flow interruption is for short time. The

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pathophysiology of stroke is linked to heart or blood vessel problem caused by inflammation,
oxidative damage and ionic imbalances (Deb, Sharma & Hassan, 2010).
Answer 2:
Fast is an acronym that helps to identify patients having strokes. The full form of FAST
is:
F- Facial drooping
A- Arm weakness
S- Speech problem
T- Time to call emergency services
Answer 3:
By looking at vital observation of John, it can be said that his BP of 160/95 is a concern
because this means that he is hypertensive and the condition of hypertension may further
increase the chances of stroke in patients. High blood pressure is likely to damage the arteries
and increase chances of stroke. Appropriate pharmacological intervention related to hypertension
will be necessary then to prevent complications in patient (Appiah, Minhas & Robinson, 2018).
Answer 4:
Anxiety, irregular heartbeat, rapid breathing and chest pain might be the few signs and
symptoms that John might have experiences when he was diagnosed with pulmonary embolism.

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Answer 5:
Dyspnea- Dyspnea is a condition of difficult breath or shortness of breath caused due to several
health issues as well as due to intense exercise.
Tachycardia- It is a condition of abnormally high heart rate caused due to heart related
conditions like hypertension and coronary heart diseases.
Haemoptysis- It is a condition leading to coughing up blood from the lungs because of bleeding
within the lungs.
Diaphoresis- It is a clinical condition associated with excessive sweating in a person caused due
to presence of several medical conditions.
Answer 6:
Asthma is caused by the pathophysiological mechanism of airway inflammation,
intermittent airflow obstruction and bronchial hyper-responsiveness. Airway inflammation is
seen because of stimulation of airway smooth muscle in response to exogenous and endogenous
stimuli (Sullivan et al., 2016).
Answer 7:
If John had an asthma attack, I would place him in supine position to prevent asthma
symptoms as it relieves difficulty in breathing and shortness of breath (Kalolella, 2016). (Refer
to the discussion section of this reference which shows that supine sleep position relieves
breathing and shortness of breath in patients with asthma symptoms )

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Answer 8:
The heart rate and respiratory of John would have increased if he had an asthma attack.
This is because it is caused by chronic inflammation of respiratory tubes and intermittent airflow
obstruction. Such conditions increase airflow limitations thus leading to symptoms of high heart
and respiratory rate.
Answer 9:
John would require the following staffs for rehabilitation following stroke:
Nurse: The nurse can play a role in supporting John in activities of daily living and maintaining
the continuum of care.
Therapist: Therapist can help John to perform daily and demanding task like bathing, toileting
and dressing. They can also provide specific training to improve the function of staffs (Hsieh et
al., 2010).
Answer 10:
1-c
2-d
3-e
4-a
5-b

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Reference:
Imaizumi, Y., Eguchi, K., & Kario, K. (2014). Lung Disease and Hypertension. Pulse, 2(1-4),
103–112. http://doi.org/10.1159/000381684
Appiah, K. O., Minhas, J. S., & Robinson, T. G. (2018). Managing high blood pressure during
acute ischemic stroke and intracerebral hemorrhage. Current opinion in neurology, 31(1),
8-13.
Deb, P., Sharma, S., & Hassan, K. M. (2010). Pathophysiologic mechanisms of acute ischemic
stroke: An overview with emphasis on therapeutic significance beyond
thrombolysis. Pathophysiology, 17(3), 197-218.
Demo, D. H., Fry, D., Devine, N., & Butler, A. (2015). A call for action: advocating for
increased funding for the allied health professions ASAHP Leadership Development
Program. Journal of allied health, 44(1), 57-62.
Dharmarajan, K., Hsieh, A. F., Kulkarni, V. T., Lin, Z., Ross, J. S., Horwitz, L. I., ... &
Krumholz, H. M. (2015). Trajectories of risk after hospitalization for heart failure, acute
myocardial infarction, or pneumonia: retrospective cohort study. bmj, 350, h411.

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Ford, T. J., Corcoran, D., & Berry, C. (2018). Stable coronary syndromes: pathophysiology,
diagnostic advances and therapeutic need. Heart, 104(4), 284-292.
Frangogiannis, N. G. (2015). Pathophysiology of myocardial infarction. Comprehensive
Physiology.
Goldklang, M., & Stockley, R. (2016). Pathophysiology of Emphysema and
Implications. Chronic Obstructive Pulmonary Diseases, 3(1), 454.
Hashemzadeh, S., Farrokhi, F., Hozhabrossadaty, A., Ghafarzadegan, K., & Ashraf, H. (2017). A
case of recurrent hematuria in primary prostatic low grade mucosa associated lymphoid
tissue. Journal of nephropathology, 6(2), 49.
Hsieh, C. H., Putman, K., Nichols, D., McGinty, M. E., DeJong, G., Smout, R. J., & Horn, S.
(2010). Physical and occupational therapy in inpatient stroke rehabilitation: The
contribution of therapy extenders. American journal of physical medicine &
rehabilitation, 89(11), 887-898.
Kalolella, A. B. (2016). Sleeping position and reported night-time asthma symptoms and
medication. The Pan African medical journal, 24.
Knocke, A. (2012). Program description: physical therapy in a heart failure
clinic. Cardiopulmonary physical therapy journal, 23(3), 46.
Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the
pathophysiology of asthma. Respiratory research, 17(1), 163.

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