Implement and monitor care for person with chronic disease

This nursing case study discusses the implementation and monitoring of care for a person with chronic kidney disease and heart disease. It also covers the treatment of type 2 diabetes and COPD. Learn more about the nursing diagnosis, medication, and management of daily activities for patients with chronic diseases.

Running head: NURSING
Implement and monitor care for person with chronic disease
Name
Institution

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Case study 1
Question 1 answer
From Beverly’s past health history based on the symptoms presented, the actual health
problem she might be undergoing is identified as the chronic kidney disease which has posed the
above symptoms.
The potential health problem Beverly might be experiencing can be linked to the heart disease
following its effects on the cardiovascular mortality in patients which causes cardiomyopathy.
Question 2 answer
The shortness of breath experienced by Beverly can be linked to the impacts caused by the
chronic kidney disease which has affected proper function of the heart since most of the veins
responsible for the circulation of oxygenated blood in the body is tampered with.
Question 3 answer
Coughing of pink, frothy sputum by Beverly indicates the signs of pulmonary edema. Other
signs of pulmonary edema experienced by Beverly are anxiety and excessive sweating which is
caused by the failure of left ventricular. The pathophysiology of the pulmonary edema is a
condition where fluid leaks into the alveolar spaces which is due to the hemodynamic caused by
pulmonary venous obstruction or micro vascular injury.

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Question 4 answer
The medication for chronic kidney disease has not been established since the condition cannot
be completely treated but medication can be given in order to control the symptoms from getting
worse. Dialysis treatment can be done in order to replicate some of the kidney functions which is
necessary for stage five of the chronic kidney disease. Kidney transplant is also necessary for
controlling the disease as it controls some of the symptoms during stage five of the chronic
kidney disease.
Question 5 answers
Cardiomyopathy can be treated through medications provided by the qualified medical
practitioners through the following process.
Diuretic: This involves increasing the production of urine by the body in order to get rid of the
excess saltwater in the body.
Statin: This involves decreasing the production of harmful cholesterol by the liver.
Blood thinners: This medication will help to prevent the blood clot from forming in the veins.
Question 6 answer
The condition that is chronic kidney disease will negatively impact the daily activities of
Beverly following the medication process she is undergoing. Personal hygiene of Beverly will be
altered with following the symptoms of her conditions which is considered unhygienic therefore
she is expected to improve her hygienic condition than before. Daily activities like doing heavy
work on her farm will be hindered since the condition does not require more energetic activities.

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Question 7 answers
The 1.5 litres fluid intake restriction for Beverly is necessary based on her health condition.
Restriction is necessary in order to reduce the ultrafiltration function of the kidney so as to
reduce the fatigue.
Question 8 answer
Beverly may have a renal dysfunction complication due to the excess consumption of sugar
due to her love for wine. Excessive consumption of sugar into the body will increase the
ultrafiltration work of the kidney leading to kidney fatigue which may result in renal dysfunction
due to overworking.
Question 9 answer
The permanent pacemaker will be essential in implantation on the hemodynamic profile so as
to relieve symptoms on patients with sick sinus syndrome since it will control the pace at which
the ventricular pumps the blood to the whole body.
Question 10 answer
Nursing diagnosis for the chronic kidney disease for Beverly thus according to her health
condition is dialysis process. Kidney dialysis will be necessary in the case of Beverly since it
involves artificial removal of excess body fluids and waste products from the body. The process
of hemodialysis involves filtering waste products and extra fluid from the blood using a thin tube
which is inserted into the abdomen filling abdominal cavity with a dialysis solution that absorbs
wastes and extra fluids from the blood.

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Question 11 answer
The doctor’s recommendation for the daily weigh before six o’clock in the morning is
essential for Beverly who has a chronic kidney disease since at this time, there will be no excess
fluid buildup in the body, therefore, Beverly will be able to know her exact weight. At this time,
the body weight obtained will be similar to the weight which a person with normal kidney
function weighs.
Question 12 answer
The symptoms associated with the hypothyroidism include:
• Whole-body fatigue, lethargy or feeling cold even on a hot day
• There will be a slow growth rate and delayed puberty development
• There will hair loss and dryness of the hair
• Slow heart rate
• Sexual dysfunction
• Irregular uterine bleeding
Question 13 answer
Pantoprazole helps in reducing the amount of the acids in the stomach, heartburn thus also
help treat stomach ulcers. GORD is a condition where one keeps on getting acid reflux.

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Question 14 answer
In managing Beverly’s daily activities following her tired nature due to her health condition,
finding a house help will be appropriate for her to help her to manage some of the household
chores which might need more energy to complete. Hiring people to help her with the farm's
work will be a good idea for managing her daily activities as she will not be involved in most of
the activities due to her medical condition which makes her feel tired and unable to complete her
daily activities.
Question 15 answer
The information and findings based on Beverly’s condition of shortness in the breath before
reporting the condition to the doctor involves gathering information on her daily activities which
might make her feel short in breathing. Her past medical history would be appropriate
information for her condition in order to identify some of the possible cause for the condition.
Question 16 answer
Salbutamol is used to relieve symptoms on asthma by relaxing the muscles of airways into the
lungs which make it easier to breathe therefore it aid to relieve shortness in breathing.
Question 17 answer
Baseline assessment of Beverly’s condition is important so as to get a medical history. The
medical history will provide information on her health status so as to help the doctor to perfectly
analyze her health condition for better medication.

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Baseline assessment will also be essential to her caretaker in attending to her medical needs in
case of an emergency. This quill ensures proper medication for Beverly.
Question 18 answer
Metoprolol is considered as the treatment for cardiomyopathy since it is well-tolerated,
improved symptoms and cardiac function and prevented clinical deterioration in patients with
symptomatic idiopathic dilated cardiomyopathy.
Question 19 answer
Cardiomyopathy is a state where the heart stretch and becomes weak hence cannot pump
blood effectively while heart failure is a condition where the pumped blood does meet the needs
of the body because the heart is week. Therefore the two terms are not similar.
Question 20 answer
In Beverly’s case, the doctor can either use the blood test to be able to check for the glomerular
filtration rate or the urine test for the albumen. Measuring the level of protein content in
Beverly’s urine will also be an option for the doctor in testing chronic kidney disease.

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Case study 2
Question 1 answer
Metformin medication has been administered to Mr. Manuel as a treatment of type 2 diabetes.
Furosemide medication is prescribed to Mr. Manuel since it cures fluid build-up in the body due
to heart failure.
Gliclazide was prescribed for Mr. Manuel since it’s a cure for diabetes mellitus type 2.
Gabapentin is an anticonvulsant medication used to treat restless leg syndrome according Mr.
Cortes case.
Salbutamol was administered to Mr. Cortes in order to cure shortness in breathing.
Panadol osteon was prescribed for Mr. Manuel since it will help to manage osteoarthritis
symptoms.
Irbesartan was prescribe in order to treat high blood pressure experienced by Mr. Manuel health
condition.
Question 2 answer
According to Mr. Manuel health history, he might have suffered a stroke because he had been
previously diagnosed with high blood pressure which might have triggered the stroke. Mr.
Manuel smoking habit might have been a chance for stroke since smoking causes stroke more so
in older age just as Mr. Manuel’s case.

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Question 3 answer
1. Visual impairment. Mr Manuel will not be able to do his daily activities which requires
good eyesight like operation of machines or cooking.
2. Body paralysis. Due to the stroke, some parts of his body will be paralyzed hence he will
not be able to walk normally or do other activities like farming.
3. Body fatigue. Due to his health condition, he will not be able to do some of the heavy jobs
which requires energy due to his tired nature.
Question 4 answer
Mr. Manuel had experienced the following mentioned symptoms of diabetes mellitus
• He experienced increased thirst
• He experienced increased hunger especially after eating
• He had a dry mouth
• He experienced frequent urination
• His Weight reduced
• He was very weak and tired

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Question 5 answer
According to Mr. Cortes case, type 1 diabetes mellitus is due to the pancreatic islet B cell
destruction predominantly by an autoimmune process and there he is prone to the ketoacidosis
while types 2 diabetes is more prevalent form and result from insulin resistance with a defect in
compensatory insulin secretion.
Question 6 answer
Foot care is very important to Mr. Manuel thus following amputation of one foot so as to
prevent any infection which might affect the remaining foot since he is vulnerable to such
infections.
The educational priorities on foot care for mr Manuel includes
1. He must attend regular medical check-up so as fight some foot related infections
2. Mr. Cortes must eat a well-balanced food in order to boost his immune system
3. He should priorities his hygienic status in order to facilitate healing of the imputed leg
and prevents infections.
Question 7 answer
I should contact diabetic educator to meet Mr. Manuel so as to advise him on the diets he
should take that is his eating habit which is very essential since Mr. Manuel is diabetic hence

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there is some particular food he should exclude from his diet like sugary food so as to control
some of the diabetic symptoms.
Question 8 answer
Mr. Cortes’ daughter should also meet with the educator for the guidance on the diet selection
for her diabetic father and mode of preparation which should be less sugar content and little
spices. She will be guided on the best diet for her father according to her father’s diabetic
condition.
Question 9 answer
Mr. Cortes does not need to be treated with insulin in control of his diabetic condition since
insulin can be directly consumed in the diet through food with natural insulin content. Mr. Cortes
can safely consume insulin through his daily diet by eating some of the insulin-containing food.
Question 10 answer
Peritoneal dialysis will involve circulating of cleansing fluid in Mr. Cortes’ body through
catheter in the abdominal cavity or peritoneal cavity. The dialysate absorbs waste products from
blood vessels in the abdominal linings and then discarded out of his body.
Question 11 answer
According to Mr. Cortes dialysis program, peritonitis is caused by the following:
• When he had abdominal wound or injury
• When he had been suffering from stomach ulcer
• If he had perforated colon

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• If in any case he had been diagnose with inflammation of pancreas
• If his gallbladder, intestines or bloodstream are infected
Question 12 answer
Mr. Cortes might experience the following signs and symptoms due to Peritonitis infection:
• Abdominal pain
• Bloating or feeling of fullness
• Fever
• Loss of appetite
• Nausea and vomiting
• Low urine output
• Thirst
Question 13 answer
Peritonitis can be medically treated through the administration of antibiotic drugs which stops
the growth of the bacteria by killing the specific bacteria responsible for the cause of the
infection.
The condition can also be treated through surgical removal of the appendix.
Question 14 answer
According to Mr. Cortes health condition, hemodialysis process qill be used to clean the blood
since it has a special filter called artificial kidney or dialyzer which is divided into two parts, thus

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one of the parts is for blood and the other one is for washing fluid. The artificial kidney comprise
of a thin membrane separating Blood cells and proteins in the blood hence only smaller waste
products pass through the membrane and washed away.
Question 15 answer
The goal of renal diet is to maintain a good nutritional status, slow progression and treat
complications.
Question 16 answer
The best treatment for Mr. Manuel diabetic foot ulcers can be done through the following
procedures:
• Mr. Manuel can keep the ulcer dry and covered with appropriate dressings.
• He can maintain proper blood glucose levels in order to facilitate healing.
• Cleaning the ulcer each day with appropriate topical ointments is also a recommended
treatment.
Question 17 answer
The following signs can be noticed by Mr. Manuel’s daughter concerning the development of
Parkinson disease.
• He might suffer from Tremor. Can occur at rest, hands, limbs or postural
• Mr. Cortes having stiff muscles
• Fatigue, dizziness and poor body balance can be a sign of Parkinson disease.

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• If he is always confused in the evening hours
Question 18 answer
Parkinson disease can be treated medically by use of Levodopa since it is a natural chemical. In
treating Parkinson disease, it is passed into the brain and converted into dopamine, thereafter, it
is combined with the carbidopa which prevents it from being converted into dopamine at early
stage hence prevents nausea.
Question 19 answer
Mr. Manuel is suffering from COPD due to his smoking habit which is a predisposing factor
for COPD.
The pathophysiology of COPD is that it starts with the damage to the airways and tiny air sacs
in the lungs, symptoms progress to coughing with mucus to difficulty in breathing.
Question 20 answer
Mr. Cortes may have experience the following symptoms
• He might be coughing
• He might be tired
• He might suffer from respiratory infections
The condition can be treated through medication like bronchodilator which helps to open the
airways of the lungs.

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Question 21 answer
One of the side effects of corticosteroids is that it can raise the sugar level in the body and
increase insulin resistance which can lead to type 2 diabetes hence cannot be applied in Mr.
Cortes’ case.
Case study 3
Question 1 answer
Voltaren is prescribed for Mr. Raphael due its topical gel content which is used to treat the
pain of osteoarthritis of joints that are amenable to topical treatment.
Mr. Raphael is prescribed a methotrexate treatment since the treatment is a chemotherapy agent
and immune system suppressant used to treat cancer.
Question 2 answer
Mr. Rafael may be facing pain due to injury he sustained at his back.
Question 3 answer
According to Mr. Raphael health history, the term cancer can be described as a disease that
may lead to unlimited growth and cell division. It is a disease with abdominal cell division and
destroys body tissues.
The uncontrolled growth allows the cancer cells to invade adjacent structures and then
destroys surrounding tissues and organs. The malignant cell may also metastasize to other areas
of the body through the cardiovascular or lymphatic system.

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Question 4 answer
Most common cancer in Australia for men includes
• Prostate cancer
• Colorectal cancer
• Lung cancer
Most common cancer for women
• Breast cancer
Question 5 answer
According to Mr. Raphael’s case, causes of cancer can be:
• He might be having poor diet and physical activity
• he might be exposed to sun and other types of radiation
Question 6 answer
Mr. Raphael can experience the following side effects of undergoing chemotherapy
• He might loss of appetite
• He might be tired
• He might have bowel complications like constipation

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Question 7 answer
Internal radiation is a type of cancer treatment which delivers a high dose of radiation directly
to the tumor and helps to spare the nearby tissues since it inserts radioactive materials into the
site of cancer cells.
Question 8 answer
Signs and symptoms of rheumatoid arthritis that Raphael may experience are:
• He might experience pain in the joints
• He might have swelling of the joints
• He might have sensation of pins and needles in the body
Question 9 answer
The treatment of rheumatoid can be done medically by use of the following drugs:
 Nonsteroidal anti-inflammatory drug- pain killer which reduces inflammation and fever.
 Immunosuppressive drug- help to decrease the immune response of the body.
 Anti-inflammatory- aid in control of swelling in the joints.
Question 10 answer
The daily activities affected by rheumatoid arthritis include
 Physical exercise like jogging. This will be affected due to swelling in the joints.
 Bathing. This will be hindered due to general body fatigue.

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Question 11 answer
The back pain suffered by Mr. Raphael cannot be exacerbated during his treatment of testicular
cancer because during chemotherapy process of cancer treatment, the side effect of the process is
back pain hence the pain cannot be exacerbated during the treatment.
Question 12 answer
Mr. Raphael may have the following Signs and symptoms in explaining his back pain:
• He might be experiencing body fatigue
• He might have headache
Question 13 answer
Raphael friend might have described the following Symptoms:
• having Muscle pain
• His Mouth is dry or mouth ulcer
• experiencing a sharp pain in the chest
Question 14 answer
The general treatment for autoimmune disease is by treating one’s personal gut which might
have led to the autoimmune disease.
Question 15 answer
Osteoporosis is a condition in which bones become week.

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The condition can be managed through nutrition and physical exercise. Raphael is therefore
expected to take a well-balanced diet and do some physical exercise daily in order to manage the
condition.
Question 16 answer
Palliative care can be defined as the care for the terminally ill and their families especially that
provided by organized health care.
Raphael will be not needing the care since he is not terminally ill and therefore can do other
activities by himself thus no need for the palliative care.
Case study 4
Question 1 answer
Mrs. Romano is prescribed a tamoxifen medication in order to treat breast cancer.
Furosemide medication is prescribed to Mrs. Romano since it cures fluid build-up in the body
due to heart failure.
Metoprolol is prescribed to Mrs. Romano in order to treat high blood pressure.
Ramipril used to cure high blood pressure, heart failure and diabetic kidney disease hence the
prescription is necessary to Mrs. Romano following her health condition.
Prednisolone used to cure autoimmune disease and certain types of allergy which Mrs. Romano
has been suffering from.

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Mrs. Romano is prescribed a rocaltcitrol medication in order to cure kidney disease with low
blood calcium.
Question 2 answer
Hemorrhagic is when the bleeding occurs directly to the brain parenchyma due to damage of
intracerebral arteries by chronic hypertension and Ischemic stroke results from vascular
occlusion secondary to thromboembolic disease.
Raised intracranial pressure: It is due to the rise in pressure in the brain caused by mass
bleeding into the brain or fluid around the brain or swelling within the brain itself.
Left-sided heart failure: It is a condition where the left ventricle does not pump the blood
normally hence limit the body from obtaining enough oxygenated blood thus causes shortness in
berthing.
Right-sided heart failure: When the left ventricle fails, increased fluid pressure is in effect,
transferred back through the lung, ultimately damaging the heart’s right side.
Asthma: it involves airway inflammation, intermittent airflow obstruction.
Emphysema/Chronic bronchitis: It includes inflammation of mononuclear cell infiltrate in the
airway wall and neutrophil influx into the airway lumen.
In Peritoneal dialysis, the dialysate flows into the abdomen and stays there for some time
thereby dextrose in the dialysate helps in infiltration of waste chemicals from the blood vessels
into the linings of the abnormal cavity while in Hemofiltration dialysis waste products move
across the semi-permeable membrane leaving larger particles.

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Diabetes Type 1 and Type 2. They both occur when the body cannot properly store and use
glucose which is essential for energy. Sugar collects in the blood and does not reach the cell that
needs it.
Cancer and metastases. The spread of malignant tumor cells from a primary neoplasm to
distant parts of the body where they multiply to form new growth which is a major cause of
death from cancer.
Auto-immune disease is a disease in which the body’s immune system attacks healthy cells.
Question 3 answer
The precaution required by nurses to safely administer chemotherapy requires that the nurse
responsible for the administration of the drugs should not be expecting or pregnant since the
drugs might affect the unborn babies.
Question 4 answer
Furosemide is preferred since it contains diuretics which helps the kidney to get rid of unneeded
water and salt thus makes the heart to pump.
Question 5 answer
Fistula is a blood vessel that carries blood back towards the heart, the vein is essentials in
dialysis since when connected with the artery, and it grows larger to enable passage of needles
for dialysis.
Never squeeze access arm with elastic object since fistula can steal much blood from other body
parts.

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Question 6 answer
Diagnosis for kidney failure experienced by Mrs. Romano can be done through urine analysis
which may reveal some of the abnormalities. The blood test is also recommendable to diagnosis.
In the case of Mrs. Romano’s heart failure diagnosis, the electrocardiogram is preferable to
assess the heartbeat rate.
In COPD diagnosis, spirometer will be used to assess the volume of air patient expels from
the lungs after maximal inspiration by Mrs. Romano.
Question 7 answer
Sign and symptoms of the following according to Mrs. Romano’s case study:
Hypertension
• She will be experiencing body fatigue
• She will be experiencing vision problem
• She will be experiencing chest pain
SLE
• She will be experiencing muscle pain
• She will be experiencing ulcers
Asthma, COPD incl bronchitis and emphysema
• She will be coughing
• She will be experiencing breathing problem

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MND, MS, Parkinson’s disease
• She will be experiencing body tremor
• having stiff muscles
• She will be experiencing leaking of urine
Heart failure
• She will be experiencing chest pains
• She will be experiencing shortness of breath
• She will be experiencing bloat
Rh arthritis/osteoarthritis/osteoporosis
• having Joint deformity
• She will be having bumps on fingers
Question 8 answer
Mrs. Romano might explained the following symptoms:
• Excessive hunger
• Frequent urination
• blurred vision

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Question 9 answer
Hypoglycemia is a condition where there is low blood sugar in the body. It is caused by excess
production of insulin by the body after meal causing blood sugar to drop.
Symptoms
• increased thirst
• Weight loss
• Fatigue
• Frequent peeing