NURS2005: Pharmacology and Therapeutics
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Relevant Past Medical History (NURS2005)
Added on 2020-04-13
NURS2005: Pharmacology and Therapeutics
Relevant Past Medical History (NURS2005)
Added on 2020-04-13
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Running head: NURSING CASE STUDYNURSING ASSIGNMENT- Case study of Joylene SimsName of the StudentName of the UniversityAuthor Note
1NURSING CASE STUDYINTRODUCTIONThe purpose of this paper is the case study of Ms. X, name not mentioned to protectconfidentiality, to understand her medical history, events leading to her admission, healthrisks, Pathophysiology of the clinical conditions experienced by the patient, pharmacologicalinterventions that might be applicable (including the outcomes, side effects, contradictionsand nursing considerations), assessment of the diagnoses and provide recommendationsbased on the findings. The patient is a 66-year-old lady, residing in SA Housing with her son and primarycare giver, Matthew. She previously was able to live independently with little assistance,needed 4WW for walking, and was able to manage her own medication, finances, toileting,and personal care. She was admitted to Finder’s Medical Centre on 02/05/2017 after her son found hercollapsed on the floor. The patient also had a medical history of Diabetes Mellitus (type 2),Hypertension, Migraine, Fatty Liver, Depression, Right Sub Arachnoid Cyst, Recurrent painof lower back, Left Shoulder Bursitis and Anxiety disorder. A drastic drop in blood sugarlevels caused by Diabetes Mellitus can cause loss of consciousness (Fainting diabetes2017).She was subsequently diagnosed with chest infection and right leg cellulitis withsepticemia. She was administered with intravenous antibiotics immediately. Her condition worsened, and developed rapid Arterial Defibrillation, Acute KidneyInjury, pneumonia and edema in her legs and arms. Her urine tested positive for APMC(multi resistant gram-positive bacterium). She has also admitted to the Intensive Care Unittwice for respiratory failure, which along with her present medical condition causedsignificant deconditioning and a loss of functional abilities.
2NURSING CASE STUDYConsent was obtained as per the healthcare policy guidelines to access herinformation, for ethical concerns (Nursing and Midwifery Board of Australia – Policies,2017).The health risk was aggravated by the history of diabetes, which could have hadstressful effects on the other organs (Matsuda and Shimomura 2013). Hypertension, andarterial fibrillation further complicated the condition, and a damage of the kidneys could beattributed to it, which can also explain the onset of edema (Bonde et al. 2014). Depressionand Anxiety may also be the effect of her clinical condition.She is also suffering fromObesity and Deconditioning.PATHOPHYSIOLOGY/ PHARMACOLOGYDuring the shift the patient experienced a plethora of signs and symptoms thatworsened his condition.The primary concern in the patient was diabetes. Type 2 Diabetesoccurs due to an insufficient production of insulin by the pancreas or an insulin resistance(which causes the failure of cells of muscles, liver and fatty tissues to respond to insulin, evenif they exist in high levels in the blood). This resulted in a rise in blood glucose level, and adepletion of the stored glycogen. Insulin resistance can be caused due to obesity and lack ofphysical activity (Mandal, 2017).Type 2 diabetes represents about 90% of all reported diabetes cases, and can lead toother complications like cardiac arrest, problems with vision and foot ulcer(Diabetesaustralia.com.au, 2017). The risk factors include family history, age more than 45years with obesity or High Blood Pressure, and certain ethnic groups. Typical symptomsinclude: excessive thirst, frequent urination, lethargy, persistent hunger, slow healing ofwounds, skin infection and itching, blurry vision, obesity, mood swings, headache, dizziness,leg cramps (Kirk et al. 2015).
3NURSING CASE STUDYStudy of the patient’s clinical condition shows a clear association with diabetesrelated complications. Her diagnosis of septicemic infection of the leg, Hypertension,Migraine, Fatty Liver, Depression and Anxiety can be attributed to Diabetes.Pharmacological intervention should involve administration of Metformin HCL (1g) daily(Mujeeb and Mutha 2015). This medicine will help in improving her sensitivity to insulin,and will result in a lowered glycogenesis in the liver. However, lifestyle changes like weightreduction and exercise is needed for the medicine to be effective in reducing blood sugarlevels. Side effects include nausea and diarrhea. The patient also reported signs of hypertension, evidenced by blood flow through thevessels with a higher pressure than normal. This requires attention as the condition can createstress on the heart, damage blood vessels, and can also heighten chances of cardiac arrest ormyocardial infarction, cerebrovascular accident, renal dysfunction. It can even lead to death(PubMed Health, 2017).The physiological mechanisms underlying hypertension includes a decrease inperipheral resistance and elevated cardiac output; low levels of rennin and angiotensin II;interaction between the autonomous nervous system and renin-angiotensin system;endothelial dysfunction and genetic factors (ncbi.nlm.nih.gov, 2017). These will lead toheadaches, dizziness and anxiety.The history of migraine headache and anxiety can be attributed to hypertension,which in turn could be related to her obesity (Ahmad et al. 2016).Pharmacological intervention should include administration of Nebivolol (5mg) oncedaily and Frusemide (40mg) thrice daily. Nebivolol is a beta receptor blocker and vasodilator(Perros et al. 2015), and Frusemide helps in the treatment of the buildup of fluid caused bycardiac failure, liver scarring and kidney dysfunctions (Tamargo, Segura and Ruilope. 2014).
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