Integrated Nursing Practice: Case Studies and Interventions

This document provides case studies and interventions in integrated nursing practice. It covers various conditions such as Parkinson's disease, osteoporosis, multiple sclerosis, and dysphagia. The document includes assessments, diagnoses, and interventions for each condition.

Running head: INTEGRATED NURSING PRACTICE
INTEGRATED NURSING PRACTICE
Name of the Student
Name of the University
Author note

1INTEGRATED NURSING PRACTICE
Case study 1
Assessment
History –
Parkinson’s disease,
Coronary artery disease
and osteoarthritis
Objective data
 Hearing issues
 Coordination
and movement
problems
 Increased heart
rate
Diagnosis
1. Gait problems
2. Incontinence
3. Fall risks
4. Ventricular
arrhythmias
Intervention Rationale
a.The first nursing intervention of
the Parkinson’s disease is the clear
communication with the patient
about the motor symptoms.
b. The next intervention includes
medicine consideration and
involvement of proper exercises in
the nursing care plan.
c. The next most important
intervention regarding the acute
chest pain is maintaining he medical
records of the patient and
identifying the frequency of the
pain, duration of the pain, intensity
of the pain and the location of the
pain.
d. The important intervention for
the pain for the patients suffering
from coronary artery disease are the
nurse must instruct the patient to
notify immediately at the time when
pain occurs. The rationale behind
this is that because of the
stimulation of the sympathetic
nervous system leads to the release
of increased norepinephrine which
leads to the increase in the
aggregation of platelets and
thromoboxane A2 is released.
Coronary artery spasm may occur
which has the capability to
precipitate , complicate or prolong
the original attack of the angina
(Pang et al., 2015).
a. The motor
assessment includes
asking the patient
about the tremor,
rigidity or the
stiffness. The nurse
needs to educate the
patients and the family
members of the
patients also so that
they become
concerned about the
diseases and the
effects of the diseases.
The nurses should
make the patients and
the family members of
the patients to learn
about the different
medical terms
associated with the
disease (Bhidayasiri et
al., 2016).
b. The important
intervention for the
pain for the patients
suffering from
coronary artery
disease are the nurse
must instruct the
patient to notify
immediately at the
time when pain
occurs. The rationale
behind this is that
because of the
stimulation of the

2INTEGRATED NURSING PRACTICE
sympathetic nervous
system leads to the
release of increased
norepinephrine which
leads to the increase in
the aggregation of
platelets and
thromoboxane A2 is
released. Coronary
artery spasm may
occur which has the
capability to
precipitate ,
complicate or prolong
the original attack of
the angina (Pang et
al., 2015).
c. The rationale
behind this
intervention is that by
keeping the record of
the medications of the
patient, the nurse will
be able to keep a track
on how the disease is
progressing. This
helps in evaluation of
the effectiveness of
the intervention. This
also show that
whether the patient
need to change any
medicines or not. By
properly keeping track
on the regularity of
the chest pain, the
nurse will be able to
monitor and evaluate
how much the disease
has progressed (Barth
et al., 2015).

3INTEGRATED NURSING PRACTICE
d.The rationale behind
this is that because of
the stimulation of the
sympathetic nervous
system leads to the
release of increased
norepinephrine which
leads to the increase in
the aggregation of
platelets and
thromoboxane A2 is
released. Coronary
artery spasm may
occur which has the
capability to
precipitate, complicate
or prolong the original
attack of the angina
(Pang et al., 2015).

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Case study 2:
Assessment Diagnosis Intervention Rationale
History –
 Osteoporosis
 Incontinence
 Kyphosis
1. Cognitive
and sensory
impairment
2. Bowel and
bladder
dysfunction
3. Risk falls
4. Best rest
complication
. Identifying
possible risks
present within the
environment and the
related awareness of
the patient and
caregivers should be
assessed
imperatively and
intervened Sepehry
et al., 2017).
a.Orienting the subjects to an
environment is desirable. Keeping
the pictures, calendar and signs in
front of the student can be a useful
strategy. 2. The nursing care should
focus on reducing frustration and
stress of the patient.
c. Assisting with the ADLs are
needed. Advanced disease stages
would reduce the subject’s ability to
execute easy tasks like bathing,
dressing, feeding and hair combing..
d. Promoting communication and
expression in patients can reduce
emotional problems and the
opportunities to make them interact
with others can be helpful indeed
but again – forcing interactions in
these patients can lead to aggressive
or disruptive behaviours.
e. Monitoring the subject’s
a.This wold promote
the subject’s
orientation and make
him feel safe and
secure within the
surroundings. This
nursing intervention
would also stimulate
environmental
awareness. Helping
the patients with
guided and
structured activities
can improve problem
solving and
judgment in the
patients.
b. . Sustaining a
regular schedule and
promoting
organisational skills

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Helping the
caregivers identify
the hazards and risks
is required. An
impairment in
cognitive and in the
perceptual ability
can be a result of an
emotional trauma -
hence the person’s
thought patterns,
depression and
emotional stability
(as in aggression and
violent drives) needs
to be checked for
safety and avoiding
the injury risks.
Being attentive to
the patient for
exhibition of risk
behaviours is
critical.
wandering habits is vital. Mrs Alice
should be checked for any such
habits as this can increase, hunger
and negative behaviours.
f. Home modification and families
cope with the changes is pertinent.
g. A vertebral care with proper
positioning of Alice so as to reduce
the kyphotic problems like shortness
of breath is important.
h. Osteoporotic management and
fall risk management is very
important while caring for Alice.
in the patients would
help them keep
awareness of day,
time and even of
reality.
c. This can
deteriorate self-
esteem in the
patients and the
nursing intervention
should focus on
caring for esteem
needs.
d. Addressing the
subject’s care and
belonging needs will
reduce the feeling of
social isolation.
Encouraging the
subjects to tell their
stories or speak out
their memories can
foster building and

6INTEGRATED NURSING PRACTICE
maintenance of
social relationships.
e. Assessing the
needs and providing
assistance and
direction in
environment is
important. Educating
the family about the
disease process and
the resources for
behavioural coping
like cognitive
behaviour therapy
and family
counselling can be
an important nursing
strategy.
f. The nurse should
decrease anxiety of
the client.
Administering the
appropriate

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medications as
prescribed like
donepezil,
memantine,
antipsychotics and
Benzodiazepines
should be correctly.
g. Shortness of
breath need to be
reduced.
h. The correct
medications such as
calcium supplements
and proper dietetic
changes needs to be
maintained so as to
promote bone
nutrition.

8INTEGRATED NURSING PRACTICE
Case study 3
Assessment Diagnosis Intervention Rationale
 ADL
dependence
 Multiple
sclerosis
 Incontinenc
e
1.There are so
many diagnoses
of the disease
advanced
multiple
sclerosis but the
most important
among them are
fatigue and
impaired
urinary
elimination.
2. The two most
important risks
associated with
multiple
sclerosis are
a.The important nursing intervention
associated with fatigue are noting and
accepting the conditions of the fatigue and
identifying and reviewing the factors
which affect the ability to be active. The
factors include temperature, inadequate
intake of food and medicines.
b. The next important nursing diagnoses is
the nurse must accept at the time the
patient is unable to do the activities of
their own.
c. The next nursing intervention in relation
to the case study is to determine whether
the patient needs the help of walking aids
like wheel chairs or not.
d.The next important nursing intervention
is that the nurse must not force the patient
a.The rationale behind this is
fatigue is most common
symptom of this disease. It is
proved that patients suffering
from this disease are
associated with the more
expenditure of energy than
normal fatigue. The recovery
time is very slow and there is
no direct relationship in
between the patient status and
the expenditure of energy.
The factors are identified for
the purpose of the solving
problem and improve the
mobility (Ahmadi & Sadeghi,

9INTEGRATED NURSING PRACTICE
genetics and
certain
infections.
to get involved in physical exercises which
their body cannot permit and also in
recommending the patients to participate
in groups which are involved in fitness or
exercises.
2017).
b. The rationale behind this is
that the ability can vary from
one moment to another
moment. It helps in
promoting the independence
of the patients while
supporting fluctuations at the
time of giving care to the
patient (Afrasiabifar et al.,
2015).
c. The rationale behind this is
that the motility aids may
decrease the fatigue that the
patient is suffering from. The
use of the wheelchair
increases the independence of
the patient as the patient a
freely roam around alone
without taking the help of
others. It also increases the
comfort and the safety of the
patient but still the patient

10INTEGRATED NURSING PRACTICE
can display poor judgements
in the ability to engage safely
in the safety activities
(Ahmadi & Sadeghi, 2017).
d. The rationale behind this is
if the patient go beyond the
limit and do the exercises
then chances are there that
thy may get nor fatigue and
this will also lead to the
discouragement of doing
more exercises. By involving
indifferent groups of fitness,
the patient will get the
motivation and also without
getting tired or fatigued soon
(Afrasiabifar et al., 2015).
Case study: 4

11INTEGRATED NURSING PRACTICE
Assessment diagnosis Intervention Rationale
Dysphagia
Hemiparesis
Osteoarthritis
Coronary
artery disease
Stroke
Valsalva
maneuverer
The risk diagnosis
will include
checking for
overdose of
antiplatelet agents
like aspirin,
dipyridamole and
other medications
a. As positioning is important for David, his
Head of bed should be maintained at thirty
degrees.
b. Initiating a deep vein thrombosis
prophylaxis is crucial.
c. Rehabilitation is vital for stroke recovery.
d. Fall preventive measures with the use of
non-skid socks, bed locked position and by
keeping the calling bells in near proximity is
to done.
e. Injury prevention.
f. Prevent contractions -.
g. Prevention of aspiration –
h. David should be cared for impaired
swallowing, if present as it can result in
aspiration infections..
i. Prevention of oedema
j. Patients are in bed and exchange of fluid is a
critical issues that has to be observed
carefully.
k. Promotion of self-care in the patients –
which can be compromised due to sensory or
a. This would increases
the venous return,
reduce intra cranial
pressure.
b. Prolonged bed rest
can lead to deep vein
thrombosis which when
dislodged, can lead to
pulmonary embolism.
Hence, maintain venous
return and circulation in
the lower extremities is
important.
c. Rehabilitation is
important for the
purpose of improving
conditions of heart.
d. The fall preventive
measures should be
undertaken to prevent
the patient from falling

12INTEGRATED NURSING PRACTICE
motor deficits and promoting confidence in
the patient is required.
l. Facilitation of safe swallowing – the
ensuring of bedside safety and providing with
speech assessment before food intake is
necessary
m. Promotion of adequate nutrition .
n. Ambulatory care using the proper walking
aids (in this case – walkers) and then a
mobility training is pertinent to achievement
of functional independence.
o. The patient’s degree of inability to move or
feel his extremities, his incontinence and the
inability to communicate regarding his
problems such as pain and sleep needs to be
assed correctly and the nutritional status has to
be used
p. Pelvic floor muscles needs to be
strengthened in the patient in order to treat
urinary incontinence.
down.
f. the paresis
extremities are mostly
immobile and are at the
chance of developing
contractures. Ensuring
the pillow supports,
rolled towels, adaptive
devices and promoting
mobility is critical
extremities are mostly
immobile and are at the
chance of developing
contractures. Ensuring
the pillow supports,
rolled towels, adaptive
devices and promoting
mobility is critical
g. maintaining the
correct head level, moth
level during food intake
and keeping the patient
upright for a meal,

13INTEGRATED NURSING PRACTICE
making the suction
available and assessing
of breath sounds and
the body temperature is
needed.
h. A cluster care like
promoting rest,
maximizing time for
patient care is an
important protocol.
Monitoring of the vital
signs properly and
knowing the blood
pressure limits of David
is required so that the
intracranial pressure
can be managed
properly.
i. Elevating the limbs
(Ochalek et al., 2017)
utilizing the
compression stockings
to enhance ambulation

14INTEGRATED NURSING PRACTICE
while enhancing
bladder emptying.
J. The cardiac output
can be compromised
due to atrial fibrillation
and special care has to
be taken like rest and
sleep promotion.
k. Promoting the
cerebral tissue
perfusion with proper
medications and head
positioning is
important.
l. . Coughing and
sneezing should be
taken care of as it can
lead to aspiration
problems.
m. encouraging the
correct intake of
nutrition is imperative
n. Walker aid help to

15INTEGRATED NURSING PRACTICE
increase the confidence
of the patient.
o. Social and
behavioural coping has
to be fostered by direct
and indirect means.
p. Urinary incontinence
is an important factor
and it need to removed.

16INTEGRATED NURSING PRACTICE
Reference
Afrasiabifar, A., Mehri, Z., Sadat, S. J., & Shirazi, H. R. G. (2016). The effect of orem’s self-
care model on fatigue in patients with multiple sclerosis: a single blind randomized
clinical trial study. Iranian Red Crescent Medical Journal, 18(8).
Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the
nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal–
Experimental, Translational and Clinical, 3(3), 2055217317726798.
Barth, J., Jacob, T., Daha, I., & Critchley, J. A. (2015). Psychosocial interventions for smoking
cessation in patients with coronary heart disease. Cochrane Database of Systematic
Reviews, (7).
Bhidayasiri, R., Boonpang, K., Jitkritsadakul, O., Calne, S. M., Henriksen, T., Trump, S., ... &
van Laar, T. (2016). Understanding the role of the Parkinson's disease nurse specialist in
the delivery of apomorphine therapy. Parkinsonism & related disorders, 33, S49-S55.
Bloem, B. R., de Vries, N. M., & Ebersbach, G. (2015). Nonpharmacological treatments for
patients with Parkinson's disease. Movement Disorders, 30(11), 1504-1520.
Caon, C., Namey, M., Meyer, C., Mayer, L., Oyuela, P., Margolin, D. H., & Rizzo, M. (2015).
Prevention and management of infusion-associated reactions in the comparison of
alemtuzumab and Rebif® efficacy in multiple sclerosis (CARE-MS)
program. International journal of MS care, 17(4), 191-198.
Clark, R. A., Conway, A., Poulsen, V., Keech, W., Tirimacco, R., & Tideman, P. (2015).
Alternative models of cardiac rehabilitation: a systematic review. European Journal of
Preventive Cardiology, 22(1), 35-74.

17INTEGRATED NURSING PRACTICE
Cogné, M., Auriacombe, S., Vasa, L., Tison, F., Klinger, E., Sauzéon, H., & Joseph, P. A.
(2018). Are visual cues helpful for virtual spatial navigation and spatial memory in
patients with mild cognitive impairment or Alzheimer’s
disease?. Neuropsychology, 32(4), 385.
El Haj, M., Antoine, P., Nandrino, J. L., & Kapogiannis, D. (2015). Autobiographical memory
decline in Alzheimer’s disease, a theoretical and clinical overview. Ageing research
reviews, 23, 183-192.
Ide, M., Harris, M., Stevens, A., Sussams, R., Hopkins, V., Culliford, D., ... & Puenter, U.
(2016). Periodontitis and cognitive decline in Alzheimer’s disease. PLoS One, 11(3),
e0151081.
Kähkönen, O., Kankkunen, P., Saaranen, T., Miettinen, H., Kyngäs, H., & Lamidi, M. L. (2015).
Motivation is a crucial factor for adherence to a healthy lifestyle among people with
coronary heart disease after percutaneous coronary intervention. Journal of advanced
nursing, 71(10), 2364-2373.
Kumar, A., & Tsao, J. W. (2018). Alzheimer Disease. In StatPearls [Internet]. StatPearls
Publishing.
Martínez-González, N. A., Rosemann, T., Tandjung, R., & Djalali, S. (2015). The effect of
physician-nurse substitution in primary care in chronic diseases: a systematic
review. Swiss Medical Weekly, 145(0506).
Newland, P. K., Heitkemper, M., & Zhou, Y. (2016). The emerging role of the gut microbiome
in adult patients with multiple sclerosis. Journal of Neuroscience Nursing, 48(6), 358-
364.

18INTEGRATED NURSING PRACTICE
Ochalek, K., Pacyga, K., Curyło, M., Frydrych–Szymonik, A., & Szygula, Z. (2017). Risk
Factors Related to Lower Limb Edema, Compression, and Physical Activity During
Pregnancy: A Retrospective Study. Lymphatic research and biology, 15(2), 166-171.
Paillard, T., Rolland, Y., & de Souto Barreto, P. (2015). Protective effects of physical exercise in
Alzheimer's disease and Parkinson's disease: a narrative review. Journal of clinical
neurology, 11(3), 212-219.
Pang, J., Poulter, E. B., Bell, D. A., Bates, T. R., Jefferson, V. L., Hillis, G. S., ... & Watts, G. F.
(2015). Frequency of familial hypercholesterolemia in patients with early-onset coronary
artery disease admitted to a coronary care unit. Journal of clinical lipidology, 9(5), 703-
708.
Sepehry, A. A., Lee, P. E., Hsiung, G. Y. R., Beattie, B. L., Feldman, H. H., & Jacova, C.
(2017). The 2002 NIMH Provisional Diagnostic Criteria for depression of Alzheimer’s
Disease (PDC-dAD): Gauging their validity over a decade later. Journal of Alzheimer's
Disease, 58(2), 449-462.
Serra, L., Araya, N., Gonzalez, M., Hermansen, I., Mery, V., Descalzi, F., ... & de Marinis, A.
(2015). Cognitive behavioral therapy for insomnia treatment: good results with trained
nurses and a limited number of sessions. Journal of the Neurological Sciences, 357, e435.
Tuong, N. E., Klausner, A. P., & Hampton, L. J. (2016). A review of post-stroke urinary
incontinence. The Canadian journal of urology, 23(3), 8265-8270.
Watila, M. M., & Balarabe, S. A. (2015). Factors predicting post-stroke aphasia
recovery. Journal of the neurological sciences, 352(1-2), 12-18.

19INTEGRATED NURSING PRACTICE
Whitehead, L. (2016). Constraint-induced movement therapy for hemiparesis following
stroke. AJN The American Journal of Nursing, 116(8), 63.