Health Sciences Research Paper Analysis

This assignment requires you to carefully analyze several research papers in the field of health sciences. The provided list includes studies on topics such as asthma-COPD overlap syndrome, diabetic foot disorders, triple negative breast cancer, and parenting stress in families with children with disabilities. You are expected to examine these papers individually, noting their methodologies, findings, and implications for healthcare practice.

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

Running head: NURSING CASE STUDY
Table of Contents
Assessment 1: Questioning: 3
Assessment 2: 7
Introduction: 7
Past medical history, assessment and diagnosis: 7
Clinical manifestation: 8
Health issues with the patient: 9
Nursing interventions to address the issues: 9
Conclusion: 10
Assessment 3: 11
Scenario 1: 11
Scenario 2: 12
References: 16

Running head: NURSING CASE STUDY
Assessment 1: Questioning:
1. 5 chronic health conditions:
Cancer: It is a chronic health condition characterized by abnormal cell growth and
loss of metastasis.
Congestive heart failure: It is a fatal health condition occurring when the heart is
unable to maintain sufficient blood flowing all throughout the body.
Chronic obstructive pulmonary disorder: It is a chronic obstructive progressive
lung disorder coupled with symptoms like shortness of breath, coughing and sputum
production blocking the airways.
Asthma: it can be defined as a very common long term chronic inflammatory airway
disease characterized by recurring symptoms like blocked airways and bronchospasm.
Diabetes: It is an extremely common albeit chronic metabolic disorder characterized
by insulin deficiency and prolonged periods of elevated blood sugar levels (Miodrag et
al., 2014).
2. a. Acute
b. chronic
c. acute
d. chronic
e. chronic
f. acute
3. Patient education is one of the most important sectors of the health care industry and in
order for the patient to be involved in the entire treatment it is crucial for the patient to be equally

Running head: NURSING CASE STUDY
involved in the process. As an enrolled nurse, the patient should be educated about his or her
medical condition following these steps, assessment of learning needs, development of learning
objective, planning and implementation of patient teaching activities, evaluation of patient
learning and documentation of patient teaching and learning activity (Miodrag et al., 2014).
4. 5 common sites where cancer may develop are breast, lungs, ovaries, blood, brain (Lorig et al.,
2014).
5. Chronic pain can be defined as any kind of substantial pain lasting for more than 12 weeks,
persisting for months and even longer at a stretch indicating severe injury or chronicmedixcal
complications.
Chronic pain is extremely common in Australia and 20% of the Australian adults suffer from
it. The occurrence of chronic pain is more common in women than men in Australia and injury is
the most common contributing factor (Lorig et al., 2014).
6. The components are, vocalisation, facial expression, changes in body language, behavioural
change, physiological changes, and physical changes.
7. The five factors are, age, culture, attention, anxiety and familial support (Patterson,
Moniruzzaman & Somers, 2014).
8. The four non-pharmacological pain management options are message therapy, physiotherapy,
transcutaneous electrical nerve stimulation and spinal cord stimulation.
9. The major clinical manifestation of renal diseases includes azotemia, uremia, acute renal
failure, and chronic renal failure (Miodrag et al., 2014).

Running head: NURSING CASE STUDY
10. Asthma is one of the most common chronic respiratory disorders and clinical signs and
symptoms of it include: severe wheezing, recurrent coughing, shortness of breath, chest pain and
swollen chest and neck muscles or retractions (Patterson, Moniruzzaman & Somers, 2014).
11. Asthma is a respiratory disorder that is triggered very easily, three significant causes of
asthma include: airborne substance allergy for instance with pollens, fungal spores, dust mites,
danders, etc. Another significant cause to asthma can be different respiratory infections, and the
third most common cause to asthma is air pollutants, irritants or extremely cold air
(Moniruzzaman & Somers, 2014).
12. Ventollin is a highly critical drug used for bronchospasm and the oral inhalation of this
medication is carried out by the aid of spacers and inhalers. Although these drugs can be self
administered but the nursing professionals must ensure educating the patient properly about the
usage of spacer and inhalers and the correct dosage. In case of ventollin 180 mcg is needed in
case of adult patients, and the spacers inside the inhaler device stores the medication and ensure
a regulated dosage being administered to the patient easing the procedure of self administration
(Miodrag et al., 2014).
13. Four common symptoms of COPD or chronic obstructive pulmonary disorder include:
shortness of breath during strenuous activities, excessive wheezing, a chronic cough with
excessive sputum production, ad tightness in the chest muscles (Fisher & Dickinson, 2014).
14. COPD is a common respiratory disorder and there are a number of different risk factors that
contribute to it. Six risk factors of common causes to is are excessive smoking, excessive
sensitivity to air pollutants, long term exposure to industrial dust and chemical, genetic
predisposition or inclination, age more than 40 and past medical susceptibility to chronic
respiratory infections (Fisher & Dickinson, 2014).

Running head: NURSING CASE STUDY
15. Cardiac dysfunction is one of the most common age related medical complication which is
seen very frequently in middle aged men and women. The common diagnostic tests that are
performed while assessing a cardiac dysfunction include: physical examination is the first step
where the patient will be checked thoroughly for signs of any physical manifestation of clinical
complications. The second set of tests is blood tests followed by regular chest Xrays. The fourth
test performed on a cardiac patient is electrocardiogram or ECG, which is theb most common
test for cardiac disorders, which shoes the ventricles in detail or any abnormality. The fifth test
preformed are echocardiography which provides more details on the interior of heart ventricles
and muscles, and the sixth is the magnetic resonance imaging or MRI which shows the internal
structures of the heart in acute details (Henry & Schor, 2015).
16. 4 risk factors for stroke are smoking, high blood pressure, diabetes, and aging (Chiauzzi,
Rodarte & DasMahapatra, 2015).
17. Rheumatoid arthritis: It is an autoimmune disease causing chronic inflammation of the joints
and extreme pain and other discomfort.
Ankylosing spondylitis: it is a type of the arthritis of the spine causing extreme pain and
stiffness along the spine.
Gout: Gout is a type of arthritis caused by the accumulation of uric acid crystals in the joints
(Lorig et al., 2014).

Running head: NURSING CASE STUDY
Assessment 2:
Introduction:
Breast cancer is one of the most significant chronic health conditions for women and the
rate of women suffering with this particular chronic health condition has been rising alarming
in the past decade. Although it belongs to the most common occurrence of cancer in the
aging women, according to research studies, 80% of the cases, with early diagnosis and
evidence based treatment plan, it can be easily managed or even cured. However, it
completely depends on the ability of the health care professionals for the early diagnosis and
adequate care planning and evidence based practice is one way of ensuring best practice in
health care (DeSantis et al., 2014). This assignment will attempt to formulate an evidence
based practice for a patient suffering from breast cancer encountered in my professional
practice, although the credentials of the patient will not be disclosed to protect the
confidentiality and privacy (Early Breast Cancer Trialists' Collaborative Group., 2015).
Past medical history, assessment and diagnosis:
The case report presents a scenario where a 38 year old female, divorced with two
children, had been admitted to the facility with a mass in the right breast. The patient
experienced the presence of the 1*1 cm mass over the upper quadrant of her right breast. The
patient assessment data explains that the patient has reported that the mass had been moving
and non- tender to touch. According to the assessment data the mass has gradually enlarged
for a few months and had been nontender to touch all along, however since the past month
the patient has noticed skin dimpling in the right breast coupled with tenderness in her right
breast, which has prompted her to seek medical advice. The past history of the patient

Running head: NURSING CASE STUDY
includes cardiac distress and excessive smoking and anxiety attacks, although she had been
under any heavy medication dosage (Cortazar et al., 2014). The patient is not an alcoholic
and her menstruation cycles had been consistent as well with no major trauma in the past.
The family history indicates mortality in the bloodline of her mother due to right breast
cancer and her signs and symptoms also indicate at breast malignancy. For further
confirmation that patient had been advised to go through a few diagnostic tests like
mammogram and biopsy. Diagnostic mammography will help in discovering subtle
abnormalities in the suspected site before the biopsy is performed. The excision biopsy
revealed a 3*2.5cm mass in the right breast of the patient indicating at the presence of
invasive ductal carcinoma (Wolff et al., 2013).
Clinical manifestation:
Invasive ductal carcinoma is considered to be one of the most common type of braest
cancers frequently seen in women. In this type the abnormal cell growth priginates inthe milk
duct and it gradually breaks through the walls and invade the rest of the breast tissues.
Although, the proliferating cells may stay localized or they may move around in the body
spreading the cancer everywhere, a pursuit usually in the later stages of the carcinoma. The
clinical manifestation of this particular carcinoma includes the formation of a lump or
thickening in the breast tissues which may appear like a hard rounded mass of cells to touch.
The manifestation escalates within a few months by changes in the shape and size of the
breast affected and increasing tenderness to the tissue (Goldhirsch et al., 2013). The clinical
manifestations continue with the secretion of a clear or blood stained exudates from the
nipple and the presence of skin dimpling, presence of scaly tissues or inflammation is also
common occurrence, although it had been absent in case of the patient under consideration in

Running head: NURSING CASE STUDY
the case study. The patient has also had redness on different areas of the breast and the
presence of subtle abnormality in the overall appearance of the affected breast with a marble
like hardened area under the skin or her right breast (Goldhirsch et al., 2013).
Health issues with the patient:
Breast cancer might be one of the most common health concern among middle aged or older
women, the curability depends on early diagnosis and proper and timely treatment. In case of the
patient under consideration for this assignment, there had been a number of health issues that the
patient had been suffering with during her stay in the health care facility. One of the most
important health issues with the patient had been the acute pain and tenderness she had been
suffering with which prompted her to get admitted to the facility. And post diagnosis of her IDC,
another most significant health issue for her had been extreme anxiety and fear (Coates et al.,
2015).
Nursing interventions to address the issues:
Evidence based practice in the health care aims at arriving at best clinical decision regarding
the health issues of the patients and address those issues with individual clinical expertise of the
nursing professional and best external clinical advice or evidence available. In case of the patient
under consideration the first issue that she had been experiencing had been pain for which the
evidence based nursing intervention administered had been to administer non pharmacological
pain management techniques like massage therapy, physical repositioning and relaxation therapy
coupled with mild analgesics. For the extreme anxiety in the patient regarding the breast cancer
and its possible outcome evidence based nursing intervention had been step by step patient
education regarding the curability of IDC and relaxation techniques like meditation and music
along with providing a safe and compassionate experience to the patient (Tutt et al., 2015).

Running head: NURSING CASE STUDY
Conclusion:
On a concluding note it can be stated that any chronic health condition, whether it is breast
cancer or cardiovascular, nervous system or respiratory disorders, the recovery status of the
patient depends completely on the perception of the patient regarding the medical condition and
the proper treatment experience. Hence it is extremely importance for health care professionals
to be compassionate and adhere to evidence based guidelines to ensure best treatment experience
provided to such patients.

Running head: NURSING CASE STUDY
Assessment 3:
Scenario 1:
Actions
1. NURSING CARE PLAN
MINIMIZE SENSORY PERCEPTIONS
Paula may experience a phantom limb pain
in her amputed leg after surgery. She may
experience unusual sensations, numbness,
pain and muscle cramps. When she
describes phantom pain, the nurse should
acknowledge her feelings and help her to
modify the perceptions (American Diabetes
Association, 2016).
PROMOTE WOUND HEALING
The nurse should handle the residual limb
gently. She should use aseptic techniques
while changing the dressing. This will
prevent possible osteomyelitis and wound
infections.
HELP THE PATIENT IN ACHIEVING
MOBILITY
The nurse should prevent development of
knee joint or hip contracture in the patient.
Flexion, abduction and external rotation of
the lower extremities should be avoided.
The residual limb should be placed in an
elevated or extended position for a brief
ENHANCE BODY IMAGE
Amputation alters the body image of the
patient. It is a reconstructive process. The
nurse should establish a good rapport and
trustworthy relationship with her patient.
The patient will be then able to better
communicate her problems. This will
increase acceptance of the nurse for her

Running head: NURSING CASE STUDY
time period following advice from the
surgeon, after amputation. The foot of the
bed should be raised to extend the residual
limb.
patient who has undergone an amputation
surgery. The nurse should encourage the
patient to feel, look at and care for her
residual limb The patient’s resources and
strengths should be identified to facilitate
proper rehabilitation. The nurse should
assist the patient in regaining her previous
confidence and independence. The patient
should be accepted as a complete and
normal person. This will make her readily
resume self-care responsibilities. Her self-
concept will improve and changes in body
image will become accepted (Alavi et al.,
2014)..
2. DISCHARGE PLAN
Continue medication of Panadol and Ibuprofen.
Immediately contact your healthcare provider if
she feels the medicines are not helping.
Seek care from physicians immediately if there
is severe pain in the residual limb or sudden
chest pain occurs.
The skin around stitches can become red or
swollen and may release pus from the wounds.
The area should be cleaned and the doctor
should be consulted.
The stitches can come apart and blood may
soak through the bandage. Care should be
taken to avoid stress on the limbs.

Running head: NURSING CASE STUDY
The foot should be elevated above heart level
as often as the patient can. This will reduce
pain and swelling.
A physiotherapist or occupational therapist
should be contacted. Exercises will improve
strength and movement of the limbs.
Regular monitoring of blood sugar levels
should be done. Insulin doses should not be
skipped. That will aggravate the condition.
A healthy sleeping pattern should be followed
(Wukich et al., 2013)
3. HEALTH TEACHING PLAN
The patient should be encouraged to actively
participate in self-care. Family members should
assist the patient in managing prosthetic
devices if supplied, residual limb care and skin
care.
The nurse should organize practice sessions
that will enable the patient to understand the
instructions needed to be followed after
discharge.
The home environment should be assessed. An
overnight or weekend visit may help in
identifying the problems that will cause distress
in the patient. The patient should be taught to
follow the preventive healthcare measures
written in her discharge plan.
The patient should be given proper information
on the risk factors that can worsen her residual
limb.
She should be taught about the ill effects of
high blood sugar level and the proper
intervention strategies that need to be
maintained for a holistic patient-centered care
(Lowe et al., 2015).
Answer 1.

Running head: NURSING CASE STUDY
Mrs Paula Jones, 68 year old lady was admitted to the hospital ward for a left below knee
amputation. She was diagnosed with Diabetes Type 1 and was dependent on insulin. Along
with that she was suffering with unhealed chronic leg ulcers on the left part of her shin for
eleven months. She was also reported with poor eyesight and peripheral neuropathy in both
the eyes due to glaucoma and cataracts. She did not even adhere to her diabetic diet with
irregular checkups of her blood sugar levels.
Answer 2.
The clinical manifestations of diabetes include polyuria, polyphagia and polydipsia followed
by blurred vision, nausea that results into hyperglycemia (Surya et al., 2014). The feeling of
fatique and weakness is usually caused by wasting of muscles due to insulin deficiency and
weight loss with increased appetite, a catabolic state followed by reduced glycogen. Some of
the long term affects of diabetes are damage in the heart’s large blood vessels followed by
brain and legs. It can also damage the small blood vessels affecting the eyes, nerves, feet and
kidney. The skin, teeth and the immune system are the other body parts that are affected
(Forbes & Cooper, 2013).
Answer 3.
A medical team, ward pharmacist, ward Nurse, Diabetes Inpatient specialist nurse
(DISN) and foot care teams are the list of workers who are involved in the discharge
planning of the diabetic foot amputation patient. The medical team should perform
postoperative monitoring to minimise infection risk after discharge along with special
referral to rehabilitation unit. Ward pharmacist should prescribe proper medicines. The
ward nurse should provide proper guidelines to educate her. A dietician under the DISN

Running head: NURSING CASE STUDY
should provide assessments on nutrition to manage body weight in diabetes. And the foot
care team should provide coordinated care service of glycemic control and proper
management of the amputated foot (Hillson, 2015).
Answer 4.
The strategic goals to manage the diabetic patient with foot amputation are done by
performing the wound closure by removing foreign and infected materials. As diabetes is
believed to be a multi organ disease, all the comorbodities that can influence the healing of
the wound should be managed by the medical team. The primary reason behind the foot
amputation in diabetes is reduced blood sugar control which should be monitored by
measuring HbA1C level test. Offloading technique to modulate the pressures helps in
managing the ulcers. Advanced dressing with proper education on managing the diabetes
should also be implemented in recovery process of Paula (Yazdanpanah, Nasiri & Adarvishi,
2015).
Answer 5.
The physical impact of diabetic foot amputation in Paula’s case is reduced mobility, deficits
in her ADL that will adversely affect her life quality. It will exert negative impact on her
psychosocial and social life with reduced activities with increased tension in the patient and
her family and carers. The psychosocial impacts involves depression, anxiety disorders
followed my adjustment disorders (Crews et al., 2016).
Answer 6.
The available resources and support services that should be made available to Paula upon her
discharge from the rehabilitation centre to home were a proper counselling as she was not

Running head: NURSING CASE STUDY
accepting the pain of being amputed. The social workers of the hospital should assist her for
proper orthotics, assistive devices and physiotherapy at home to recover in an effective way
(Acker et al., 2014).

Running head: NURSING CASE STUDY
Scenario 2:
1. The case study represents a patient named Shane Gillespie, and 80 year old male
suffering with exacerbation of chronic obstructive pulmonary disorders along with
abrasions to his left shin and elbow along with a cut to the forehead due to sustaining a
fall. The chronic health problems associated with the patient include exacerbations of
COPD, risk of fall, living on his own, extreme shortness of breath and anxiety. The
patient has been an smoker for 46 years of his life, and has stopped smoking 20 years ago
all that he had a past medical history of chronic asthma since very childhood and
epilepsy, which indicates significant risk factors for the chronic obstructive pulmonary
disorders he has been suffering with (Ford et al., 2015).
2. The clinical manifestation of chronic obstructive pulmonary disorder includes extreme
shortness of breath with the patient has been experiencing, although the shortness of
breath increases especially during physical activity that may be strenuous for the patient.
Along with that, wheezing and extreme tightness of the chest muscles is also associated
with manifestation of COPD. Chronic recurrent coughing coupled with production and
accumulation of excessive sputum is also considered to be a significant clinical
manifestation of COPD. The long term effects of a severe chronic obstructive pulmonary
disorders on the body system of the patient may include increased susceptibility to
frequent lung infections such as pneumonia and increased risk of osteoporosis in the
patient that are taking oral corticosteroids for COPD (Ford et al., 2015).
3. COPD is considered to be one of the most frequent respiratory disorders, and there are
various contributing risk factors that can cause this particular disease. Among all the risk
factors, smoking is considered to be the most significant one, as the patient has been the

Running head: NURSING CASE STUDY
chain- smoker for 46 years of his life, smoking 25 cigarettes a day, the adverse effects on
his lung passages and respiratory airways due to excessive consumption of nicotine and
smoke fumes, is possibly the most applicable cause for the COPD in the patient under
consideration. Along with that, his previous medical history of chronic asthma since
childhood can be another significant risk factor for this disease (Criner et al., 2015).
4. Multidisciplinary Healthcare is the most vital concept of modern treatment and care
patterns, and COPD being a chronic respiratory disorder, the patient under consideration
will also receive the care of a specialized and specific multidisciplinary healthcare team.
The specialized multidisciplinary team for Shane will include a hospitalist physician who
will be the clinical decision maker for the patient outlining the diagnosis and treatment
pattern, pulmonologist who will take specialized care of the lungs and respiratory system
of the patient, respiratory therapist who will win the patient in Nebulizer treatments and
invasive and noninvasive ventilator support therapies, pharmacist responsible for cash
transactions for the patient including different kinds of therapies, nursing professionals
including registered nurses, enrolled nurses, and physician assistants, responsible for the
entire caring for the patient. And lastly social workers and care manager is responsible
for address in a psycho-social and support issues of the patient (Magnussen et al., 2014).
5. There are different physical and psychosocial aspects associated with the care that the
patients receive in the health care facility. The physical aspects of care will include
ensuring that the patient remains safe and comfortable all throughout his stay in the
facility, as the patient in this case scenario had sustained a few injuries due to falling as
well, the physical aspect of a sound optimal care for him will also include wound and
pain management for his injuries and a complete fall risk assessment for the patient

Running head: NURSING CASE STUDY
(Magnussen et al., 2014). Considering the psychosocial aspects of care, as the patient is
lonely and responsible for his own well being, social support must be provided to him
along with counseling and social inclusion activities like group therapies to help him
overcome his medical complexities with adequate social support (Belchamber et al.,
2015).
6. As the patient is extremely elderly at the age of 80 and is living alone, the support
services and resources that he will be applicable for include respite care, addictive home
care, transport assistance, information services, group and individual counseling
therapies, social inclusion activities, and dementia support programs if applicable
(Postma & Rabe, 2015).
7. As the patient is unconscious, is not breathing and there is no portable Pulse for the
patient it can be considered that the patient is undergoing a heart attack. The emergency
procedures and protocols to be followed in such a situation comprises of immediate
administration of CPR to the patient, followed by administration of oral nitroglycerin
preferably under the tongue of the patient, after breeding of the patient returns moved
immediately to the emergency department and consulting a cardiac specialist as soon as
possible (Callaway et al., 2015).
8. The emergency trolley on crash guard is a set of case laws on self with attached wheels
utilize in the hospital for transportation of emergency medication and equipment for life
support protocols at site at the purpose of potentially saving someone's life. An
emergency trolley generally contains defibrillators, suction devices, BVMs, advanced
cardiac life support drugs such as epinephrine, atropine, amiodarone, sodium bicarbonate,
dopamine, vasopressin, first line drugs for cardiac treatment such as naloxone,

Running head: NURSING CASE STUDY
nitroglycerin, drugs for Rapid sequence intubation, peripheral and Central venous access
drugs, pediatric equipment, etc. Out of these, equipments that could be used in this
situation include advanced cardiac life support drugs, nitroglycerin, suction devices to
clear his airway and defibrillators (Soar et al., 2015).
9. The emergency response team within Hospital scenario includes of members like patient
decontamination expert, who will prevent any contamination happening to the patient,
the emergency department executive, for rapid response, radiation safety officer, who
will review and edit all radiological emergency plans, security officer taking into
consideration complete security of the patient, spill team member, environmental service
officer, what are the responsibility of controlling and management of the entire scenario,
and clinical expert lead the immediate treatment plan for the patient (Soar et al., 2015).
10. The medications used in case of a cardiac arrest are generally, cardiac life support drugs
such as epinephrine, and vasodialators like nitroglycerin.
Epinephrine: use: reversing the effects of cardiac arrest
action: increases arterial blood pressure and causes coronary perfusion
dose: 1mg
side effect: incorrect pulse, headache, nausea, sweating, paleness, vomiting
(Callaway et al., 2015).
Nitroglycerine: use: coronary artery dilator
action: settling coronary vasospasm
dose: 40 U IV/IO
side effects: uneven heart rate, blurred vision, nausea, vomiting, sore
throat (Callaway et al., 2015).

Running head: NURSING CASE STUDY
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R. S. (2014). Diabetic foot ulcers: Part I. Pathophysiology and prevention. Journal of the
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