This nursing case study explores the pathophysiology and rationale behind various health issues. It discusses nursing actions and professional issues related to each case.
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Running head: NURSING CASE STUDY NURSING CASE STUDY Name of the Student Name of the University Author Note
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1 NURSING CASE STUDY Case Study 1 Pathophysiology and Rationale Based on the nursing diagnosis of William, the three issues can be found which are sudden cardiac arrest, pulmonary oedema and myocardial infarction. William is a 64-year-old person and had a medical history of NYHA class IV heart failure or severe heart failure. It has been seen that he has laboured breathing condition. Based on the assessment, it can be said that he has a ventricular tachycardia or ventricular fibrillation. This condition leads to the sudden contraction of the heart chambers, which leads to sudden cardiac arrest (Katritsis, Gersh & Camm, 2016). The ventricular fibrillation or the atrial fibrillation would be the cause of the sudden cardiac arrest. Another reason for these factors would be the chaotic electrical impulse in the heart chambers and valves. Which lead to the imbalanced contraction of muscles and the sudden cardiac arrest can lead to the ischemic stroke as well (Arboix, 2015). William also showed the symptoms of the tachycardic pulse along with laboured breathing, which refers to the pulmonary oedemic condition. Pulmonary oedema can be caused by fluid retention in the lungs, The blockage of the oxygen flow in the blood, thus affects the breathing along with the oxygen content of the blood. Other than these, the congestive heart failure could also be the cause of pulmonary oedema as it leads to improper pumping of blood. Thus the blockage occurs into the pulmonary artery and even blocking the air spaces of the lungs (Coccia, Palkowski,
2 NURSING CASE STUDY Schweitzer, Motsohi & Ntusi, 2016). In pulmonary oedema, the lungs filled up with deoxygenated blood, and the oxygen blood ratio hampered; thus the ischemic stroke would be the resulting consequence for the situation (Amarenco et al., 2016). On the other hand, the myocardial infarction or common heart attack would be caused by the decreased blood flow in the heart chambers and damage to the heart muscles. The imbalanced electrical impulse can be the cause of these factors. Other than the imbalanced or chaotic electric impulse in the heart, the cholesterol blocked veins and arteries also create the situation of the lower rate of blood flow. This factor can be the cause of the cholesterol retention in the blood vessels; thus, the blood flow rate reduces to the heart. Other than these, the coronary artery disease also leads to the myocardial infarction (Heusch & Gersh, 2016). The lower rate of blood flow to the lung causes the laboured breathing and affects heartbeat as well as the severe chest, shoulder, arm, back and jaw pain (Talman & Ruskoaho, 2016). Nursing action and Rationales In case of Williamâs prevention of thesudden cardiac arrest, pulmonary oedema and myocardial infarction the nurse should provide the patient with supplementary oxygen. The nurse should administer the tissue plasminogen activator drug for the prevention of the possibility of ischemic stroke(Komajda et al., 2016). Even the diagnosis of the patient needed to be done with the help of the ultrasound, X-ray and other blood tests as well.The nurse should provide support to the patient by means of administering supplementary oxygen by nasal prongs and also diagnose the condition of the heart beat and the pulse rate along with the blood pressure level detection of Williams.
3 NURSING CASE STUDY Professional issue Here as a new nurse, the nurse should be able to consider the consent of the supervisor or the doctor as the ethical condition of a nurse. However, nurses are needed to be able to recognize the factor of the patient health condition over any other aspect.Based on the NMBA nursing standards the nurse should use patient centred care, the nurse should focus on the situation and the needs of the patient over other factors and show compassion to the patients along with integrity, honesty and respect in order to maintain professional behaviour. Other than person centred care the cultural practice and respectful relationship should also be considered by the nurse for maintenance of NMBA standards (Nursingmidwiferyboard.gov.au, 2019).The professional problem of the nurse here basically is the ethical dilemma based on decision making and providing proper care for the patient(Dehghani, Mosalanejad & Dehghan-Nayeri, 2015).The NSQHS standards also needed to be followed which includes the clinical communication, medication safety, comprehensive care, management of pressure injuries and response to the deterioration of the clinical condition of the patient(Safetyandquality.gov.au, 2019). Case Study 2 Pathophysiology and Rationale In the case of Carol the nursing assessment on her condition can refer to three fundamental issues such ashypovolemic shock, septic shock and respiratory distress. Carol, a 59-year-old lady after knee replacement has shown blood pressure of 90/46 mmHg, 12 breaths per minute and 90bpm pulse rate. Other than this closed suction drain system
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4 NURSING CASE STUDY drained 450 ml blood from her knee. Based on this assessment, it can be said that Carol has hypovolemic shock due to the massive amount of blood loss from the knee (Siddall, Khatri & Radhakrishnan, 2017). Thus this condition would lead to seizing in blood transfer to all the cells or tissues of the body; hence, the patient's multiple organ failure and improper tissue perfusion can be seen. All these conditions will lead to stroke and coma and ultimately, death thus the hypovolemic shock and the low blood pressure of Carol needed to be checked as a primary concern (Gulati, 2016). Carol has a medical history of lower coagulation power to the external cuts. Her knee replacement operation site needs blood suction for drying the site as well. Thus the risk of the microbial attack is very much possible in her case, and the septicemia can be diagnosed. The sepsis leads to septic shock as the whole body can be affected by the microbial infection (McConnell & Coopersmith, 2016). In the case of Carol, the nurse found she was dizzy and weak. Her breathing rate was low as well, which would be leading to low blood pressure. The blood flow of the body would be deficient thus lack of blood perfusion in the tissues would be imbalanced, and this condition could lead to the death of the patient (Hotchkiss, Moldawer, Opal, Reinhart, Turnbull& Vincent, 2016). Carol also showed breathing rate 12 per minute; however, as her blood pressure is low and the oxygen content of the blood needs to be higher in this state. Thus the breathing distress occurs, and the causes of the respiratory distress are her hypovolemic shock and the lower blood pressure as well as the septic shock. The coronary heart disease also could be the cause of the distress in breathing (Blondonnet, Constantin,Sapin&Jabaudon, 2016). This condition could lead to the development of acute heart failure when the blood cannot be able to find adequate oxygen.
5 NURSING CASE STUDY Also, the low level of oxygen can lead to multiple organ failure (Thompson, Chambers&Liu, 2017). Nursing action and Rationales Saline would be applied for the sodium content control in her body. The nurse should also provide the needed blood for the patient to address the hypovolemic shock of the patient. The hypotonic saline solution would help address the hypovolemic shock of the patient. Routine blood pressure test would be needed for the determination of the patient's condition.The nurse should also administer medication of clot preserving drug and also fibrin sealants and other medicines such as Morphine in order to prevent her pain as well (Oldenburg et al., 2017).The nurse should check the vital sign of the patient in a uniform interval and also provide the patient with supplementary oxygen if needed. Professional issue Here the partner of the patient does not want to wake the patient, and she insisted on talking to the nurse instead of the patient. However, the nurse needs to speak to the patient about her physical condition and know if the patient is deteriorating or any positive changes occurs to the patient. Whereas, the needs of the conversation with the patient play a crucial role in the treatment procedure of Caroland it also helps the nurse in the assessment of the patientâs present condition.According to the NMBA standards the nurse should focus on the patient centered care and build a professional relationship with the patient along with the patientâs partner to provide best care to the patient(Nursingmidwiferyboard.gov.au, 2019).Along with this the NSQHS standards needed to be followed which includes the clinical communication, medication safety,
6 NURSING CASE STUDY comprehensive care, management of pressure injuries and response to the deterioration of the clinical condition of the patient(Safetyandquality.gov.au, 2019).Thus the lack of conversation with the patient can be termed as the professional issue here in case of Carol (Dehghani, Mosalanejad&Dehghan-Nayeri, 2015). Case Study 3 Pathophysiology and Rationale In the case of Glenn, the nursing assessment on his condition can refer to three key issues such asSpontaneous pneumothorax, hypoxia and pain. Pathophysiology of spontaneous pneumothorax suggests that Glenn has tissue damage in the right lung through ruptured air blisters or blebs. He also could have ruptured bullae; thus, air is spilling out his lungs and fills the thoracic cavity (Taveira-DaSilva, Julien-Williams,Jones& Moss, 2016). This condition leads to the air retention in the pulmonary thorax; thus, severe pain arises, and blood vessels do not have the proper amount of oxygen. Hence the low blood pressure and the hypoxia occur in the body Glenn. The hypoxic condition raises the problem of improper tissue perfusion; thus, the multiple organ failure can be seen in Glennâs case.The hypoxia of Glenn could be caused by the improper placement of the underwater seal drainage as it affects the oxygen up take procedure and the failed operation would also be the cause of the pain in the chest of the patient. The swelling in the operated portion caused the pain of Glenn, which leads to the severe pain experienced by Glenn (Cattarossi, Copetti,Brusa&Pintaldi, 2016). The blood clot formed in
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7 NURSING CASE STUDY the artery of the lung could bethe primary pathophysiological factor for the acute painand can be leading to a severe heart attack or stroke as a result of a blockage that can prevent blood flow properly and causes the pain as well.The pathophysiology of the pain can be characterized as the pulmonary embolism and rupture in the blood vessel which could lead to internal bleeding as well and the pain occurs as the result of this condition. Nursing action and rationale The nurse should administer medication for Glenn to address the spontaneous pneumothorax and the chest pain such as talc doxycycline and other comforting agents for the chest pain that are the painkillers. Other than this the diuretics, beta blockers, calcium channel blockers can be used for the lower blood pressure control for the patient. Warfarin and heparin would also be administered as the blood thinner in case of the treatment of the pulmonary embolism. These are the medication interventions which can be taken up by the nurse. The nurse should also divert Glenn's attention from his chest pain and make him realize his priority and make him rest in the medical observation and also motivate him in terms of helping him in bearing the condition of chest pain (Frazier et al., 2016).The nurse should also decide if the sedation is needed or not for the patient in order to control his restlessness. Professional issue Glenn wanted to go outside the hospital for fresh air however; his condition was not as good as he can go anywhere. Thus his restless poses a threat for the nurse and the nurse needs to stop him and make him comfortable. The restlessness of the patient could not let the nurse know about his
8 NURSING CASE STUDY condition properly as he told the nurse that he needs to go outside and he is fine however, he was feeling pain in the chest. Thus this condition also puts the nurse in an ethical dilemma as the patient wanted to go outside and his condition is not that well.The nurse should show passionate and affectionate behavior to the patient to comfort his emotional aspect and this way the nurse should be able to maintain the NMBA standard of nursing and the patient centered care is mandatory as well(Nursingmidwiferyboard.gov.au, 2019).Along with this the NSQHS standards needed to be followed which includes the clinical communication, medication safety, comprehensive care, management of pressure injuries and response to the deterioration of the clinical condition of the patient(Safetyandquality.gov.au, 2019).Thus the nurse needs to prevent the patient from going outside along with conversing with him about his condition or rather diverting his thoughts to other things. This is also a professional issue as the patientâs will, cannot be followed against the consent of the doctor. The presence of mind and professional knowledge would be judged in this case as well how the nurse can avoid the deterioration of the patientâs condition along with preventing his restlessness (Dehghani, Mosalanejad&Dehghan- Nayeri, 2015). Case Study 4 Pathophysiology and Rationale In case of Wendy the nursing assessment on her condition can possibly refer to two key issues such asPain and bleeding. Wendy is a child and experiences severe tonsillitis which was operated by the process of the tonsillectomy after which Wendy could not be able to speak and crying spontaneously. On
9 NURSING CASE STUDY the basis of this assessment and observation it can be said that Wendy facing severe pain in the throat as a result of the bacterial infection that is the tonsillitis and the effect of the operation. This condition could lead to severe trauma in the mind of Wendy and also tissue damage in the throat that could be severely hampers the talking ability of the patient. On the other hand the operation of tonsillectomy of Wendy leads to the internal bleeding which puts Wendy in a discomforting position. The pain can be caused by the internal bleeding also. The internal bleeding can be able to lead to the swelling in the throat and that could be the cause of the tissue damage and severe infection in the throat of Wendy thus the proper care needs focus on the condition of patient (Farooqi, Akram&Zaka, 2017). The tonsillitis can be the primary pathophysiology for the pain in this case. However, the aftermath of the tonsillectomy operation would have been considered as the cause of the pain as well. The key factor of the pain would be internal bleeding because of the operation as well. Nursing action and rationale The nurse should administer themedication for Wendy such as painkillers. Other than the antibiotic would also be administered by the nurse for the prevention of the infection and the proper timing and dosage of the medicines needs to be administered by the nurse as the patient is a child and could not be able to properly administer her medicines for the tonsillitis of the patient. The canopy should be removed from the throat of the patient in order to eliminate the pain and also determine the condition of the internal bleeding as well. The nurse should also comfort the patient by talking to her and let her open upby means of the compassion and affection showingabout the discomfort of her (Palm et al., 2017).
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10 NURSING CASE STUDY Professional issue Wendy is a child and in severe pain however, she cannot depict her condition and in this situation her mother was restless about getting the paper works done and take Wendy home as her brothers were about to come from school. This is the professional and ethical dilemma as well as the nurse needs to proper observe the patient and plan her treatment procedure. According to the NMBA standards the nurse should follow the decision making standards and promote the wellbeing in order to control the actions of the patientâs mother and help the patient by showing compassionate nature of conversation. The nurse should also help the patient in accordance with the patient centered care policies(Nursingmidwiferyboard.gov.au, 2019).Thus it can be clearly seen the nurse needs to prioritize the patient centered care over any other aspect and let the doctor inform about the patient's situation in frequent condition (Dehghani, Mosalanejad&Dehghan-Nayeri, 2015).The NSQHS standards also needed to be followed which includes the clinical communication, medication safety, comprehensive care, management of pressure injuries and response to the deterioration of the clinical condition of the patient (Safetyandquality.gov.au, 2019)
12 NURSING CASE STUDY Dehghani, A., Mosalanejad, L., &Dehghan-Nayeri, N. (2015). Factors affecting professional ethics in nursing practice in Iran: a qualitative study.BMC medical ethics,16(1), 61. Retrieved from https://doi.org/10.1186/s12910-015-0048-2 Farooqi, I. A., Akram, T., &Zaka, M. (2017).Incidence and empiric use of antibiotics therapy for tonsillitis in children.IJAR,3(12), 323-327. Retrieved from http://www.allresearchjournal.com/archives/2017/vol3issue12/PartE/3-12-10-802.pdf Frazier, T., Mooney, D., Al-Dahir, D., Richardson, A., Hillburn, T., Williams, A., ... &Aucoin, V. (2016). (439) Pigtail catheters vs traditional chest tubes and the risk of post pull pneumothorax in trauma patients.The Journal of Pain,17(4), S84. Retrieved from https://www.jpain.org/article/S1526-5900(16)00446-6/pdf Gulati, A. (2016). Vascular endothelium and hypovolemic shock.Current vascular pharmacology,14(2), 187-195. Retrieved from https://www.researchgate.net/profile/Anil_Gulati3/publication/286220614_Vascular_End othelium_and_Hypovolemic_Shock/links/59396748a6fdcc58ae80a550/Vascular- Endothelium-and-Hypovolemic-Shock.pdf Heusch, G., &Gersh, B. J. (2016). The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge.European heart journal,38(11), 774-784. Retrieved from https://doi.org/10.1093/eurheartj/ehw224 Hotchkiss, R. S., Moldawer, L. L., Opal, S. M., Reinhart, K., Turnbull, I. R., & Vincent, J. L. (2016). Sepsis and septic shock.Nature reviews Disease primers,2, 16045.doi:10.1038/nrdp.2016.45
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14 NURSING CASE STUDY Safetyandquality.gov.au. (2019).NSQHS Standards (second edition) | Safety and Quality. Retrieved from https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs- standards/nsqhs-standards-second-edition/ Siddall, E., Khatri, M., &Radhakrishnan, J. (2017). Capillary leak syndrome: etiologies, pathophysiology, and management.Kidney international,92(1), 37-46.DOI: https://doi.org/10.1016/j.kint.2016.11.029 Talman, V., &Ruskoaho, H. (2016).Cardiac fibrosis in myocardial infarctionâfrom repair and remodeling to regeneration.Cell and tissue research,365(3), 563-581.DOI 10.1007/s00441- 016-2431-9 Taveira-DaSilva, A. M., Julien-Williams, P., Jones, A. M., & Moss, J. (2016).Incidence of pneumothorax in patients with lymphangioleiomyomatosis undergoing pulmonary function and exercise testing.Chest,150(1), e5- e8.DOI:https://doi.org/10.1016/j.chest.2015.10.071 Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017).Acute respiratory distress syndrome.New England Journal of Medicine,377(6), 562-572.DOI: 10.1056/NEJMra1608077