Nursing Management Case Study

Assessment 1 Nursing case
study

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
PRIMARY ADMISSION DIAGNOSIS ........................................................................................1
NURSING PROBLEM ...................................................................................................................2
NURSING MANAGEMENT..........................................................................................................3
DISCHARGE PLANNING.............................................................................................................4
CONCLUSION................................................................................................................................5
REFERENCES ...............................................................................................................................6

INTRODUCTION
Interpersonal care model (IPC) is defined as the health care approach in which various
health care professionals works in collaboration with the patient, caregivers, community, and
families. The optimised health outcomes are provided when health services are provided to them
as per their individual needs (Dunphy and et.al., 2015). The partnership and collaboration
through IPC assist in providing high quality experience, safety and improved health results of
communities as well as low cost services to individuals.
The report will provide the diagnosis and nursing management plan for a case study of 68
year old patient named Mr. George Orwell. The patient is suffering from chest pain and has
history of type 2 diabetes, hypertension and other cardiovascular issues. The study will identify
the key nursing problems and suitable interventions. It will also develop a discharge plan for the
patient so that safe and quality care environment can be assured for the patient at home as well.
The purpose of this study is to analyse the various stages of cardiovascular care plan through
nursing management and assessment using interpersonal care model.
PRIMARY ADMISSION DIAGNOSIS
A 68 year old male patient named George Orwell was admitted to hospital for the
problem of chest pain. The patient was conscious and alert but was feeling very anxious. He
complained of central chest pain. The key parameters such as respiratory rate, pulse rate and
saturated oxygen level were found to be normal but he was having very high blood pressure. The
blood pressure of Mr. Orwell was recorded as 170/90. The patient has history of type 2 diabetes
mellitus, hypertension and Hypercholesterolaemia. 5 years ago he had coronary artery bypass
while 6 years ago he had history of Anterior myocardial infarction (MI). For the patients with
history of artery bypass and AI there are higher chances of suffering from angina (Junghans,
2015). It is also observed that last year after the death of his wife he lives alone and thus there is
no one at home to monitor his medication intakes.
The patient is suffering from obesity and is heavy smoker which indicates that there is
lack of self care management which is essential for the diabetic patient. At the time of admission
the pitting oedema was also observed in both the legs. Patient takes GTN spray 4 times in a day
but he complained of breathlessness. The patient was feeling sweaty, anxious and very nauseous.
The pitting oedema and chest pain can be considered as the critical issue as diabetes and medical
history of MI and artery bypass also enhances the risk factor for blood clot or the blockage in
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arteries or veins (Gulanick and Myers, 2016). The leg oedema has association with the
congestive heart failure. The smoking habits and obesity along with the diabetes are the major
risk factor for chest pain or angina. In addition to this since patient did not like to take fluid
medications it is also possible that skipping of such medication can cause the swelling in both
legs (Ulin and et.al., 2016).
NURSING PROBLEM
Along with the psychophysiological changes there are several issues which creates issues
in delivering appropriate nursing care to the patients. The problem becomes more critical and
sensitive with the old age people as they need more assistance and care (Burns, Enomoto and
Momtahan, 2016). The identification of these nursing problems helps to deliver a more improved
nursing management and care plan for the patient. On the basis of primary diagnosis of patient
the two major nursing problems which are identified are as follows:
Inappropriate residential care:
Mr. Orwell is 68 years old and lives does not have any assistance at homes. Due to
diabetes and other medical background he is required to take medications regularly. However
due to age and insufficient monitoring he often does not understand the medications
(Muhammad and et.al., 2016). The patient also take reactive medications such as Aspirin. Thus,
it is very essential that his food habits must be regulated so that there are no adverse implications
of the medications (Smith and et.al., 2015). The breathlessness, anxiety and higher age factors
also enhances the fall risk for the patient.
Ineffective management of diabetes:
The diabetes has been one of the major nursing problem for Mr. Orwell. Despite having
diabetes he does not have any self care management plan. As a result of this his weight is not
managed and smoking habit is also not controlled. The patients with diabetes becomes more
vulnerable to the cardiac issues and heart congestion (Staples, 2015). The regular prevalence of
high blood pressure can also be the result of his loneliness and health condition. The lack of
suitable care and monitoring of eating habits and life style of the patient can impose a continuous
challenge to maintain accurate sugar level and healthy life style (Liu, Gerdtz and Manias, 2016).
Due to this nursing issues the vulnerability of patient towards angina and heart failure may
increase.
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NURSING MANAGEMENT
The nursing management strategies helps to support and develop interventions for the
patient so that their health outcomes can be improved. The management plan for both of the
above issues are as follows:
Management for nursing problem 1:
From the inspection it has been assessed that the lack of care services at home is also one
of the rationale for this nursing problem. The assessment of this issue is essential as it can lead to
complications such as fall risk, medication errors and clinical negligence (Deek and et.al., 2016).
For instance the patient may not notice the dis-integrity in skin or other impacts of type 2
diabetes. Due to breathing issues and diabetes it is necessary for the patient to have a residential
care assistance. The patient is also old and thus he may need assistance in performing various
routine functions as well. The care assistance can help to manage the weight and healthy life
style for the patient.
The registered nurse must analyse the routine habits of the patient so that diabetes as well
as onset of other risks can be identified. The patient has been regularly taking GTN spray and
other medications but despite that breathing issues are continued. Thus, the proposed
intervention will assist in identifying the rationale for the health issues (Chow and et.al., 2015).
For instance it is possible that regular assistance at home will help to assure that patient is
regularly taking his medication and try to control the smoking and other habits which can cause
breathing issues or the other diabetic issues. For this issue also inspection method is used to
assess the condition of patient. The registered nurse must provide guidance to the patient as well
as carer so that routine life of patient can be managed (Ignatavicius and Workman, 2015).
Management for nursing problem 2:
The sugar level and other critical aspects related to diabetes and cardiac parameters must
be monitored regularly. To analyse the adverse impact of diabetes on the other cardiac outcomes
of Mr. Orwell an improved plan for the management of his weight and cardiac output is
developed. For addressing the second nursing issue inspection and palpation assessment
techniques are used to figure out the issues (Gerhard-Herman and et.al., 2017). This assessment
is necessary as it can help to eliminate the risk of heart congestion and other abnormalities
indicating the medical assistance.
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The key intervention which can be used to manage this issue is to regularly monitor the
patients so that symptoms such as swelling, increasing weight and skin impairments can be
identified (Doenges, Moorhouse and Murr, 2016). The swelling and other skin disintegration
issues can also be due to blood clot or other coronary issues. Thus, the intervention will include
monitoring, pain assessment and coronary angiogram so that blood clot and other blood vessel
issues can be identified and treated (Liu, Gerdtz and Manias, 2016). The registered nurse must
also review the medication so that chest pain can be controlled and conditions of blood clot can
be managed.
DISCHARGE PLANNING
It is very important for the patients to follow the suggested interventions even at homes
as well so that even after discharge of the patient from hospital their health and safety can be
maintained (Kennedy-Malone, Martin-Plank and Duffy, 2018). The aim of discharge plan is to
provide a personalised plan for Mr. Orwell so that patient leave health care setting at appropriate
time and post discharge services can assure their safety (Karhula and et.al., 2015). For providing
the sustainable care to the patient multidisciplinary approach is recommended. The
multidisciplinary team will consist of a residential nurse, nutritionist, social worker, physician as
well as counsellor. The registered nurse is well aware of the health condition and requirement of
Mr. Orwell.
Thus, the selection of suitable members for the multidisciplinary team can be best
accomplished by the registered nurse. The patient is suffering from diabetes and thus the
management of weight and eating practices holds utmost importance (Redfield, 2016). The
inclusion of the nutritionist will aid to this as they can provide guidance to the food and sugar
intake of the patient. The nutritionist can also assist in reducing the smoking practices which
increase the breathing issues for the patient.
As patient is also alone at home there is no one at home to regularly assist him at need.
The regular residential nurse can be great at resolving this issue. The nurse will monitor and look
after all the activities of patient (Adam, Osborne and Welch, 2017). It will help to assure that Mr.
Orwell takes all his prescribed medications on time and in correct dosage. At present he forgets
to take his medications. With growing age it is also possible that he may take incorrect dosage of
the pills (Burns, Enomoto and Momtahan, 2016). Thus, the carer are vital for assuring the safety
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of the patient. Due to breathlessness and higher age the fall risk is also significant for the patient
(Lewin and Schaefer, 2017). The 24 hours assistance is also beneficial in eliminating such risk.
In addition to this the physician is also recommended by the registered nurse so that Mr.
Orwell can perform suitable exercise and physical movements at home as well. This intervention
is vital for the obesity management as well as to identify the physiological changes. The timely
identification of the body changes is very important to minimise the risk and to provide more
effective treatment services (Olsen and et.al., 2015). The physician will also be assisted by care
giving nurse as they can inform physician about necessary information about the patient. In the
old age people who live alone are also vulnerable to suffer from psychological diseases such as
dementia or alzheimers (Albert, 2016). Thus, to avoid any such kind of complications social
workers and mental health service providers are also provided so that overall well being of Mr.
Orwell can be assured.
CONCLUSION
From the analysis of given case study in the report it can be concluded that the
management of diabetes and other chronic health care conditions requires implementation of
IPC. The use of medications alone may not prove significant in the management of such
diseases. Thus, it is recommended that multidisciplinary approach must be used by the health
professionals so that personalised needs of the patient can be identified and addressed. It has
been also analysed that among old people medication management also needs integration of
several other aspects. For instance the lack of assistance and support from carers can also cause
anxiety among elder patients. Due to age associated complications medication errors as well as
negligence to critical health conditions can be neglected by the patients.
Thus, it is very important for the older people suffering from chronic diseases that along
with the physical health, psychological health must also be taken into consideration. It has been
evaluated from the report that nursing interventions must not only consider pathophysiology of
the diseases but must also include risk factors which are associated with the social and cultural
perspective of the patient. It can be concluded from the discussion that IPC can help to address
the diversified needs of patient and to assess their individual needs.
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REFERENCES
Books and Journals
Adam, S., Osborne, S. and Welch, J. eds., 2017. Critical care nursing: science and practice.
Oxford University Press.
Albert, N.M., 2016. A systematic review of transitional-care strategies to reduce
rehospitalization in patients with heart failure. Heart & Lung. 45(2). pp.100-113.
Burns, C.M., Enomoto, Y. and Momtahan, K., 2016. A cognitive work analysis of cardiac care
nurses performing teletriage. In Applications of cognitive work analysis (pp. 163-188).
CRC Press.
Chow, C.K. and et.al., 2015. Effect of lifestyle-focused text messaging on risk factor
modification in patients with coronary heart disease: a randomized clinical
trial. Jama. 314(12). pp.1255-1263.
Deek, H. and et.al., 2016. A family‐focused intervention for heart failure self‐care: conceptual
underpinnings of a culturally appropriate intervention. Journal of advanced
nursing. 72(2). pp.434-450.
Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2016. Nursing diagnosis manual: Planning,
individualizing, and documenting client care. FA Davis.
Dunphy, L.M. and et.al., 2015. Primary care: Art and science of advanced practice nursing. FA
Davis.
Gerhard-Herman, M.D., and et.al., 2017. 2016 AHA/ACC guideline on the management of
patients with lower extremity peripheral artery disease: a report of the American College
of Cardiology/American Heart Association Task Force on Clinical Practice
Guidelines. Journal of the American College of Cardiology. 69(11). pp.e71-e126.
Gulanick, M. and Myers, J.L., 2016. Nursing Care Plans-E-Book: Diagnoses, Interventions, and
Outcomes. Elsevier Health Sciences.
Ignatavicius, D.D. and Workman, M.L., 2015. Medical-Surgical Nursing-E-Book: Patient-
Centered Collaborative Care, Single Volume. Elsevier health sciences.
Karhula, T., and et.al., 2015. Telemonitoring and mobile phone-based health coaching among
Finnish diabetic and heart disease patients: randomized controlled trial. Journal of
medical Internet research. 17(6). p.e153.
Kennedy-Malone, L., Martin-Plank, L. and Duffy, E., 2018. Advanced practice nursing in the
care of older adults. FA Davis.
Lewin, W.H. and Schaefer, K.G., 2017. Integrating palliative care into routine care of patients
with heart failure: models for clinical collaboration. Heart failure reviews. 22(5). pp.517-
524.
Liu, W., Gerdtz, M. and Manias, E., 2016. Creating opportunities for interdisciplinary
collaboration and patient‐centred care: how nurses, doctors, pharmacists and patients use
communication strategies when managing medications in an acute hospital
setting. Journal of clinical nursing. 25(19-20). pp.2943-2957.
Muhammad, I., and et.al., 2016. Narrative review of health‐related quality of life and its
predictors among patients with coronary heart disease. International journal of nursing
practice. 22(1). pp.4-14.
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Olsen, B.F., and et.al., 2015. Development of a pain management algorithm for intensive care
units. Heart & Lung. 44(6). pp.521-527.
Redfield, M.M., 2016. Heart failure with preserved ejection fraction. New England Journal of
Medicine. 375(19). pp.1868-1877.
Smith, C.E., and et.al., 2015. Nurse-led Multidisciplinary Heart Failure Group Clinic
appointments: methods, materials and outcomes used in the clinical trial. The Journal of
cardiovascular nursing. 30(4 0 1). p.S25.
Staples, S., 2015. Examining the linguistic needs of internationally educated nurses: A corpus-
based study of lexico-grammatical features in nurse–patient interactions. English for
Specific Purposes. 37. pp.122-136.
Ulin, K., and et.al., 2016. Person-centred care–An approach that improves the discharge
process. European Journal of Cardiovascular Nursing. 15(3). pp.e19-e26.
Online
Junghans, C., 2015. Atypical chest pain in diabetic patients with suspected stable angina: impact
on diagnosis and coronary outcomes. [Online]. Accessed through
<https://academic.oup.com/ehjqcco/article/1/1/37/1860137>
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