Pathophysiology and Nursing Care: Analysis of Multiple Case Studies

This assignment presents a series of case studies focusing on the pathophysiology of various conditions and appropriate nursing interventions. The first case involves Mr. Samuel Jackson, who suffers from urinary tract infections, mild dementia, and hypertension, detailing pharmacological and non-pharmacological treatments along with specific nursing interventions. The second case focuses on Kathy Radcliff, who is experiencing anxiety and depression, outlining treatment options and nursing strategies to manage her condition. The third case examines Steve, a patient with schizophrenia and type 2 diabetes mellitus, discussing pharmacological and non-pharmacological interventions to manage his conditions and the importance of monitoring blood sugar levels. The final case discusses Brenda Brown, who suffers from chronic COPD and leg ulcers, detailing treatments and nursing interventions to improve her respiratory function and overall health. This document is a student contribution to Desklib, a platform offering study tools and resources.

Pathophysiology’s

Contents
Contents...........................................................................................................................................2
CASE STUDY 1..............................................................................................................................1
Pathophysiology..........................................................................................................................1
Nursing intervention (Long term)................................................................................................1
CASE STUDY 2..............................................................................................................................2
Pathophysiology..........................................................................................................................2
Pharmacological treatments.........................................................................................................2
Long term intervention................................................................................................................3
CASE STUDY 3..............................................................................................................................3
Pathophysiology of disease..........................................................................................................3
Pharmacological and non-pharmacological intervention (Long and short term)........................4
CASE STUDY 4..............................................................................................................................4
Pathophysiology of disease..........................................................................................................4
Nursing intervention....................................................................................................................5
REFERENCES................................................................................................................................7

CASE STUDY 1
Pathophysiology
Mr. Samuel Jackson is suffering from urinary tract infections which can be treated by
opting for pharmacological intervention such as administration of simple drugs like trimethoprim
and fosfomycin and nitrofurantoin. It is also extremely crucial to always to stay hydrated and
frequently urinate because it will help in flushing of bacteria. It will be beneficial for Mr.
Jackson to consume enough vitamin C in their diet as vitamin C helps in acidification of the
urine. High fluid intake can help in improving the symptoms of UTI. Nursing intervention of
UTI includes offering a tepid sponge bath (Michael and et. al., 2020). This will facilitate cooling
and give comfort to the body. To reduce the risk of hyperthermic episode or dehydration, the
nurses should encourage the patients to consume 2 litres of fluid on a daily basis. Along with
these, teaching Mr. Jackson to make certain lifestyle modifications related to UTI prevention
including perineal hygiene i.e., wiping the perineal area from front to back to prevent the entry of
pathogens through anus. Avoiding use of tight-fitted garments that lead to moisture formation
which is responsible for growth of bacteria. Apart from urinary tract infections Mr. Jackson is
suffering from mild dementia, pharmacological treatment of which includes cholinergic
neurotransmitters such as acetylcholinesterase inhibitors, neuropeptide modifying agents.
Donepezil, galantamine ans rivastigmine are some of the most commonly prescribed drugs to
treat mild dementia (Long and Koyfman, 2018). Some non-pharmacological treatment methods
that can help Mr. Jackson relax are light massages, aromatherapy, animal assisted therapy and
dance therapy.
Nursing intervention (Long term)
Nursing intervention techniques for a patient with dementia include making the patient
aware about their surroundings along with enforcing positive feedback from Mr. Jackson.
Assessment of patient include techniques such as psychiatric interviews that can help the
caregiver get a better idea about the behaviour and thought process of the patient. Serial
assessment of psychiatric status of Mr. Jackson. Apart from dementia, he is also suffering from
hypertension, pharmacological treatment of which includes administration of diuretics,
angiotensin converting enzyme or angiotensin receptor blockers, beta blockers and calcium
channel blockers. Along with medications, there are various non pharmacological treatments that
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will help Mr. Jackson to treat hypertension such as lifestyle modifications, monitoring sodium
intake, cessation of smoking, consumption of alcohol, consistent physical activity and weight
loss. Nursing interventions for hypertension include controlling Mr. Jackson's blood pressure
along with adherence to his therapeutic regimen, encouraging lifestyle modifications and
prevention of severity of complications (Dubbs and Sommerkamp, 2019). The first and foremost
nursing diagnosis for hypertension includes decreased risk for cardiac output. Mr. Jackson
should be given heart healthy diet with less sodium. Alcohol consumption should be reduced and
regular physical activity should be incorporated.
CASE STUDY 2
Pathophysiology
Kathy Radcliff's medication history shows that she had depression at the age of 24 and
has received Cognitive behavioural Therapy from which she recovered without anti depressants.
Kathy has been working full time and also have to deal all her family members. Out of which her
husband is not supportive and demanding. After the death of her father three months ago, she is
having a hard time as she was very close to her father. In relation to that her mother seemed to be
more dependent on her and wants her to visit her daily. Her mother is trying to fill avoid that
Kathy's father left. However, it is nearly impossible to visit her mother daily as she has a full-
time job and has her own family to manage. Her daughters, Lucy and Beth are an important part
of her life but recently she noticed that one of her daughters, Beth is getting bullied at school and
Lucy has been getting into trouble a lot since the death of her grandfather. Kathy seems to be
extremely concerned about her daughter. In addition to all these factors, she has also been trying
to complete her master’s programme, to which she needs to give her time. It is a lot that has been
going on in her life and she is feeling stuck at this stage of her life. Therefore, considering all
these factors it can be concluded that she has been suffering from anxiety and depression all her
life and these factors have worsened the situation. This has lead her to report that she is going to
die because of shortness of breath and chest tightness (Rao and et. al.,2020).
Pharmacological treatments
Depression and anxiety go hand in hand. Chest tightness can be easily associated as an
indicator for diagnosis of depression. After analysing all the factors, it can be derived that Kathy
is suffering from anxiety and depression. Shortness of breath and chest stiffness are symptoms of
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her having a panic attack. Pharmacological treatment for depression includes prescription of
SSRI that citalopram, fluoxetine, proxetine and sertraline. Other medication intervention
methods include consumption of tricyclic antidepressants, mirtazapine and bupropion. Some
non-pharmacological treatment for depression includes
Long term intervention
Cognitive behaviour therapy (CBT) and interpersonal therapy (IPT). There are other
supportive strategies such as primary care, mindfulness-based therapy and self-help strategies
(van de Loo and et. al.,2018). Nurses ensure safety of patients at all times and reduce the risk
contracting a chronic health condition for patients during their hospital stays. Nursing strategies
will encourage Kathy to express her feelings in a way that is appropriate and also help her figure
out alternative ways to control her overwhelming emotions instead of consuming wine on a daily
basis. Implementation of different strategies such as stress management for Kathy, self-coping
skills, relapse prevention along with psycho education are methods for nursing interventions
(Samuels, Rosenthal, Lin, Chaudhari and Natsuaki, 2020). However, the most effective
intervention technique is combination of antidepressant medications along with psychotherapy.
CASE STUDY 3
Pathophysiology of disease
Steve is suffering from schizophrenia and also been diagnosed with type 2 Diabetes
Mellitus. Therefore, he was administered with metformin to control poor glycaemic index in his
body. Later on, he was commenced with gliclazide which was followed by olanzapine,
metformin and gliclazide all in combination. Because of administration of gliclazide, Steve
gained a lot of weight for which he started running each day for about 3 miles. Due to this
reason, he had to progressively cut down his food intake. A week ago, it was reported that Steve
started showing symptoms of schizophrenia, which were characterized by him acting funny and
having a conversation with himself. These episodes were followed severe headache as reported
by him and utter state of confusion (Magliano and et. al., 2020). Due to these reasons, the 49
year old patient was brought to the accident and emergency department where different tests
were performed. These tests reported his respiratory rate to be 22 breathes per min, which is a
little higher than the normal range leading to a higher rate of psychological conditions such as a
panic attack. Furthermore, his heart rate was racing to 100 heart rates per minute and a condition
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of very low blood pressure i.e., 100/60 mm Hg. It can also be derived from his test results that
his blood sugar level is extremely low causing hypoglycaemia.
Pharmacological and non-pharmacological intervention (Long and short term)
Blood sugar level below 3.9 mmol/L can be harmful as there is a high chance of patient
falling into coma. Some of the commonly used drugs in the pharmacological treatment of
diabetes is are metformin, insulin, sensitizers, alpha-glucose inhibitors and insulin therapies.
Administration of metformin helps by reducing the production of glucose in the body and
improving the ability of the body to take insulin more effectively. Following a low-calorie diet,
weight loss and regular physical activity are some non-pharmacological treatment methods for
the regulation of Type 2 diabetes (Scheen, 2020). These factors along with microbiota-based
therapy are some of the other cornerstones of diabetes treatment. However, for effective
management of diabetes pharmacological approaches are important to incorporate as lifestyle
modifications alone are insufficient in achieving the desired outcome. Nursing interventions for
diabetes include educating patients about home glucose monitoring and reviewing the factors
that determine instability glucose. Educating patients about the working of antidiabetic
medications. It should also be ensured that nurses check the injection sites periodically and
encouraging Steve to incorporate physical activity in his workout specially aerobic exercises.
Anti-psychotic medication increases the risk of type 2 diabetes as they affect insulin sensitivity
and cause weight gain (Arora and et. al., 2021). This is what exactly happened with Steve was
suffering from schizophrenia already and later he developed diabetes due to consumption of
antipsychotic medications.
CASE STUDY 4
Pathophysiology of disease
Brenda brown is suffering from chronic COPD and leg ulcers which have become smelly
and wet with time as they were left untreated. Brenda is a chain smoker which can be derived
from the cigarette burns on her cardigans. A district nurse is appointed to carry out her dressing
three times a week. Her past medical history stated that she has been treated for chest infection
around 2 weeks ago. She also has been coughing and producing sputum on a daily basis. Upon
observation it was observed that her respiratory rate has been abnormally high. Her respiratory
rate was found to be 30 breaths per minute. Her heart rate short up to 100 bpm which is not
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normal. Her blood pressure was also found to be very less, giving rise to condition of
hypotension. COPD is a chronic inflammatory lung disease where the airflow from the lungs is
restricted and some of the symptoms include difficulty in breathing, production of mucus and
wheezing. COPD can occur as a result of second-hand smoke and dust. Brenda has been
smoking for a very long time which led to development of COPD (Song and et. al.,2021). Some
of the early signs of COPD are shortness of breath and chest tightness as reported by Mrs.
Brown. Production of chronic cough with yellow sputum along with frequent infections of the
respiratory tracts.
Nursing intervention
Some of pharmacological treatments available for the treatment of COPD are administration of
bronchodilators, such as beta-2 adrenergic agonists, anticholinergics and theophylline.
Bronchodilators inhalers are used as first line of treatments for COPD. There are two types of
short acting bronchodilators such as salbutamol and terbutaline. Non pharmacological methods
of treatment for Mrs. Brown include cessation of smoking, pulmonary rehabilitation and
administering of influenza vaccines that will help her in regaining back her strength (Hendryx,
Luo, Chojenta and Byles, 2019). In acute exacerbation, the introduction of new pharmacologic
agents that involve novel mechanisms for treatment for COPD in early stages of development of
the infection. Furthermore, some nursing interventions for COPD include inspiratory muscle
training which will help the patient in improving their breathing patterns, diaphragmatic training
which helps in reduces the respiratory rate and increase alveolar ventilation. It is crucial to
ensure the selection of appropriate equipment and methods of delivery for effect supply of
oxygen in to the body. Breathing training and breathing control exercises help in supporting
adequate respiratory function for Mrs. Brenda (Mirza, Clay, Koslow and Scanlon, 2018). These
exercises include lip breathing, body position exercises and respiratory muscle training. Chest
infections are extremely common if a person is suffering from COPD. Sudden worsening of the
symptoms of COPD can be termed as exacerbation. This makes you cough more sputum. It is
extremely common for COPD patients to have difficulty clearing the bacteria out of their lungs
along with other pollutants. In this case, Mrs. Brenda smoked regularly which lead can possibly
worsen her condition.
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REFERENCES
Books and Journals:
Michael and et. al., 2020. A fidget spinner for the point-of-care diagnosis of urinary tract
infection. Nature Biomedical Engineering, 4(6), pp.591-600.
Long, B. and Koyfman, A., 2018. The emergency department diagnosis and management of
urinary tract infection. Emergency Medicine Clinics, 36(4), pp.685-710.
Dubbs, S.B. and Sommerkamp, S.K., 2019. Evaluation and management of urinary tract
infection in the emergency department. Emergency Medicine Clinics, 37(4), pp.707-723.
Rao and et. al.,2020. The prevalence and impact of depression and anxiety in cardiac
rehabilitation: A longitudinal cohort study. European Journal of Preventive
Cardiology, 27(5), pp.478-489.
van de Loo and et. al.,2018. Depression and anxiety during pregnancy: the influence of maternal
characteristics. Birth, 45(4), pp.478-489.
Samuels, D.V., Rosenthal, R., Lin, R., Chaudhari, S. and Natsuaki, M.N., 2020. Acne vulgaris
and risk of depression and anxiety: a meta-analytic review. Journal of the American
Academy of Dermatology, 83(2), pp.532-541.
Magliano and et. al., 2020. Young-onset type 2 diabetes mellitus—Implications for morbidity
and mortality. Nature Reviews Endocrinology, 16(6), pp.321-331.
Scheen, A.J., 2020. Sodium–glucose cotransporter type 2 inhibitors for the treatment of type 2
diabetes mellitus. Nature reviews endocrinology, 16(10), pp.556-577.
Arora and et. al., 2021. Unravelling the involvement of gut microbiota in type 2 diabetes
mellitus. Life sciences, 273, p.119311.
Song and et. al.,2021. Distinct effects of asthma and COPD comorbidity on disease expression
and outcome in patients with COVID‐19. Allergy, 76(2), pp.483-496.
Mirza, S., Clay, R.D., Koslow, M.A. and Scanlon, P.D., 2018, October. COPD guidelines: a
review of the 2018 GOLD report. In Mayo Clinic Proceedings (Vol. 93, No. 10, pp. 1488-
1502). Elsevier.
Hendryx, M., Luo, J., Chojenta, C. and Byles, J.E., 2019. Air pollution exposures from multiple
point sources and risk of incident chronic obstructive pulmonary disease (COPD) and
asthma. Environmental research, 179, p.108783.
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