NURS8747 Case Study: Analysis of High Acuity Medical Care Management

This case study focuses on a 62-year-old patient with hypothermia, asthma, and impaired skin integrity, assessing their condition, aetiology, and pathophysiology. It critiques the current care against best practices, emphasizing pharmacological interventions like β2‐Adrenoceptor agonists, glucocorticoids, and blood rewarming. The study highlights the importance of a multidisciplinary team in managing the patient's clinical care, including physicians, social workers, and general care providers, to improve patient outcomes and reduce hospital stay rates. The assessment includes comparing the patient's current emergency department treatment for asthma with more proactive and comprehensive care strategies, such as inhaled mepolizumab and reslizumab, along with non-pharmacological interventions like yoga and nutritional diet adjustments. The case study further explores treatments for impaired skin integrity, such as daily skin inspection, proper cleaning, and maintaining a flat bed position, as well as pharmacological options like mineralocorticoids and corticosteroid replacement therapy to address hormonal imbalances and mood improvement.

Nursing

TABLE OF CONTENT
INTRODUCTION...........................................................................................................................3
PART 1............................................................................................................................................3
Comprehensive assessment of patient.........................................................................................3
Aetiology and pathophysiology of condition of patient with pharmacological interventions.....4
Comparison of care provided to patient with the best practice principles to managing high
acuity care....................................................................................................................................6
Role of multidisciplinary team in managing patient’s clinical care............................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Nursing can be defined as collaborative and autonomous care of individuals of all ages,
groups and communities Cassiani & Lira, (2018). This study is based on a patient of 62-years
old, who lives in retirement village with his wife. He is suffering from hypothermia, asthma and
impaired skin integrity problems. This study will compare some treatment that patient is getting
with best practices of hypothermia and asthma. Further, it will discuss Aetiology and
pathophysiology conditions of all disease that patient is suffering from in order to select best
practice.
PART 1
Comprehensive assessment of patient
A 62-year patient who lives in retirement village with his wife, suffering from some
diseases include: Hypothermia, impaired skin integrity and asthma. He is not able to perform his
own daily routine functions. For understanding problems through which he is suffering, it is
important to understand each disease and its impacts on health.
1. Hypothermia patient problem: Hypothermia is a problem in which body temperature of
patients drops and other organs like heart and nervous system cannot work in a normal
manner. If this problem is not being treated in a timely manner, then it can lead to
complete failure of heart as well as respiratory system and death at the end.
Causes and symptoms: This problem is caused by exposure to cold weather or immersion in
cold water Zając & Važanić, (2018). Some symptoms and side effects by which this disease can
be identified include: rapid breathing, heart rate, high blood pressure, fatigue, lack of
coordination and others.
2. Impaired skin integrity: Impaired skin integrity refers damaged to skin and to the
mucous membrane, integumentary, muscular fascia, muscle and others.
Causes and symptoms: Some signs and symptoms of this disease include: affected hot area,
damaged tissues, over sensitivity of skin and tender to touch. On the basis of these symptoms, it
can be said that this 62-year patient may suffer from pain in tissues and over sensitivity
problems. It might affect its overall health like it may increase weakness, might face problems in
performing own daily routine functions due to over sensitivity of skin. Overall, it can be said that
it is important for multidisciplinary team to develop best practice or treatment for protecting this

patient from severity of problem. Pain can be relieved by medication situations. It is also found
that this problem is increasing chill and rigor problem such as shivering and feeling of coldness.
3. Addinsons disease: This disease can be known as adrenal insufficiency that is an
uncommon disorder. This problem occurs when human body does not produce enough of
certain hormones. In this disease, adrenal glands produce too little aldosterone.
Causes and symptoms: This problem occurs in both males, females of all age groups and it is
life threatening disease if it is not treated in a timely manner. It progresses slowly. Some side
effects of this problem include: darkening of skin, fatigue, low blood pressure, weight loss,
abdominal pain, irritability, body hair loss, depression and others.
Asthma: It is the disease or condition in which airways of human gets narrowed and swelled that
produce extra mucus. It makes breathing difficult. It leads whistling sound when affected people
breath out.
Causes and symptoms: Inflections are main causes of asthma. Cold, flu, allergies, smoke,
medicines and emotions like stress Volmer & et.al. (2018). some side effects and symptoms of
this disease includes: chest pain, trouble sleeping because of shortness of breath and wheezing
attacks.
On the basis of above discussed diseases in detailed manner, it can clearly be said that
this 62-year old patient need effective and best treatment otherwise, all these diseases can be life
threatening.
Aetiology and pathophysiology of condition of patient with pharmacological interventions
Hypothermia: It is found that this patient is suffering from hypothermia. For providing
better treatment, it is important to know both aetiology and pathophysiology condition of each
disease. In the context of hypothermia, it can be said that it slows physiologic functions
including mental acuity, respiratory and cardiovascular system. Human body requires external
heat source for rewarming and protecting against severity Mydske & Thomassen, (2020). In
regard to aetiology, it can be said that it is caused by immersion cold water and cold weather that
can lead lower body temperature.
Impaired skin integrity: Aetiology of this disease include: friction, moisture, pressure
and trauma as well. All these factors lead to damaged skin. Some other additional causes of this
problem include: poor nutrition, medical condition and loss of sensation. Some problems that
this cause include: wound, sensitivity of skin and others.

Addinsons: This disease is mainly caused by an autoimmune system when human body’s
immune system assaults its own tissues and organs as well. Tuberculosis is also known as one of
the major common cause as it affects lungs. This problem leads number of problems that are
known as pathophysiology such as: loss of hormone aldosterone, weight loss, salt craving and
nausea.
Asthma: Aetiology and physiology of this condition include: airway inflammation. This
underlying process drive asthmatic inflammatory process Pazderska, Pearce & Mitchell, (2018).
It appears to be an abnormal regulated CD4+ T- cell immune response. Some more
pathophysiology of this problem includes: airway edema, airway hyper responsiveness, airway
remodelling and bronchoconstriction.
On the basis of above discussed both aetiology and pathophysiology of all these problems
that this 62-year old man suffering, it can be said that he requires some effective
pharmacological interventions such as:
β2‐Adrenoceptor agonists and glucocorticoids: These both are known as most effective
drugs that can cure patients from asthmatic problems. There is no doubt that asthma cannot be
cured but its symptoms can be decreased and patient can be protected from severity of this
problem. So, in this context, it can be said that this pharmacological intervention can help this
patient from shortness of breath.
Passive and blood rewarming: In hypothermia, body temperature drops and patient wants
body heating and blood rewarming is one of the effective pharmacology treatment Soysal, Ilce &
Erkol, (2018). In this treatment process, blood is being warmed with haemodialysis machine. It is
an effective machine that can be used to filter blood in people.
Assessing patient’s level of pain: Impaired skin integrity leads excessive pain and
weaknesses in joints and oversensitivity. So, it is important for care providers to assess patient’s
level of pain and taking actions accordingly.

Comparison of care provided to patient with the best practice principles to managing high acuity
care
For providing better treatment, it is important to compare existing and current treatment that
patient is taking for protecting against asthma, hypothermia, impaired skin integrity and other
problems.
ED visit 2/7 for acute exacerbation of asthma RESUS: It is found that this 62-years
old patient visited emergency department for treatment for acute exacerbation. Patients who
represent in emergency department do not have primary care home and primary care physician.
It can slow down their process of healing or protection from severity. In this type of treatment
and in an emergency department, patients are being given an initial asthma-severity rating, peak
flow measurement and oxygen saturation reading. He is also taking thin fluids in diet. But there
are number of effective treatment practice that can be provided to this patient by which he can be
prevented from severity of asthma. Inhaled. Mepolizumab and reslizumab are latest inhalers that
can also be suggested to this patient Agache & et.al. (2020). Yoga, meditation and nutritional
values of diet can also prevent this patient from severity of asthma problem.
Blood and airway rewarming: The main cause of hypothermia is cold weather and
exposure in cold water in which body temperature drops. So, the main treatment of this is to
warm body and blood and it can be done with haemodialysis machine. Heart by-pass machine
can also be used for warming blood and increasing body temperature. In airway rewarming,
professional use humidified oxygen administered with nasal tube. It can warm airways and can
increase body temperature. Patient can be protected from severity of hypothermia and other side
effects Gilardi & et.al. (2020). Along with this, 62-year patient’s wife can be educated and
suggested to cover patient if his body temperature drops suddenly. It is an effective non-
pharmacological treatment that can increase temperature and can warm body.
Daily skin inspection: There are number of best practices that can be used by this patient
from protecting against skin damaged and impaired skin integrity. Daily skin inspection and
noticing as whether skin needs moisturiser because of excessive dryness or not, patient can
protect himself. By keeping head of the bed flat and below 30 degrees, this problem can be
treated Bonifant & Holloway, (2019). Along with this, patient can be asked for drinking plenty
of water, eating balanced diet and keeping their skin clear and hygienic. Proper skin cleaning or

clearing is one of the common non pharmacological intervention that can be used for protecting
this patient against severity of impaired skin integrity.
Mineralocorticoid: It is one of the best and effective pharmacological treatment that is
being used to keep the plasma renin activity in the upper normal range. Dehydro-epiandrosterone
therapy can also help this patient out in improving mood by protecting against depression.
Corticosteroid replacement therapy for replacement the hormones cortisol can also improve
mood. By taking this treatment, this patient can also protect patient from nausea, weight loss and
severe fatigue Pofi, Prete & et.al. (2020).
On the basis of above suggested best practices of all those diseases from which patient is
suffering, it can be said that he can be prevented from severity of diseases. His overall health can
be improved with these suggested treatment practices. As currently he only visited in emergency
department for asthmatic problem. He is not taking other specific treatment so, it is important for
him to take all these treatments in a timely manner otherwise, these may create life threatening
problems.
Role of multidisciplinary team in managing patient’s clinical care
Before discussing roles of multidisciplinary team in care sector, it is important to know what
they are. In regard to this, it can be said that multidisciplinary team refers a group of health care
workers who are members of different discipline. Each member in this team provides specific
service to patients. It includes: physicians, social workers, general care providers and others. All
activities that are brought all together by team members of multidisciplinary by using a care plan
has positive impact on patients’ health Soukup & et.al. (2018). Some effectiveness as well as
roles of multidisciplinary team in managing patients’ clinical care include:
Team members like general professionals, social workers bring skills and expertise together
in order to assess, plan and managing accordingly. It is believed that multidisciplinary team are
expected to work proactively for supporting individuals; care goals. When they all work together
with their experience and skills then they are more likely to bring best practices for treating
patients in clinical care that improves patients’ overall health. By working together,
multidisciplinary team can decrease patients’ hospital stay rate that can also have positive impact
on physically and mentally.
Other main role of focus on multidisciplinary team is on keeping people independent and
well by delivering the right care at home as well as in community to prevent them from

unnecessary clinical care. Overall, it can be said that multidisciplinary team improve health of
patients in a timely manner, makes them feel valued by improving their health and considering
their needs while providing best treatment Mahadevan & et.al. (2019).
Care, provided by multidisciplinary team can make beneficial specially to people who
requires complex needs and long term conditions. Inter professional collaboration of
multidisciplinary team members is flexible and effective for whole range of populations
including children, older people and others with mental health problem.
In regard to 62-year patient who is suffering from hypothermia, risk for falls problem,
impaired skin integrity and asthma, it can be said that he can relief himself from pain and severe
complexity. Multidisciplinary team can provide better treatment practice to this patient and can
ensure that he is able to perform his own daily routine activities in an effective manner without
being dependent on others. It can help him out in protecting against severe oxygen problem that
patients with asthma and hypothermia suffer when these problems are not solved in a timely
manner. There are number of advantages that patients in clinical care and this 62-year patient can
take from multidisciplinary team working such as: improving health, easier access to an entire
team of experts. Along with these, multidisciplinary team members can create new avenues for
service implementation Baron & et.al. (2020). They allow their patients to develop their own
goals as per their needs and they consider patients’ needs by selecting treatment practices.
Overall, it can be said that multidisciplinary team plays a vital role in improving overall health of
patients in clinical care setting.
CONCLUSION
It has been summarised from the above study that multidisciplinary team plays a vital role in
improving health of patients who suffer from critical problems. It has discussed some roles and
effectiveness of multidisciplinary in providing better treatment to patients in clinical care setting,
Further, it has discussed both aetiology and pathophysiology condition of hypothermia and
asthma and some best practices or treatments to protect patients from severity of problem. Blood
rewarming is one of the best treatment that this study has discussed and its effectiveness in
treating patient with hypothermia.

REFERENCES
Books and Journals
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dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma.
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biologicals in severe asthma. Allergy. 75(5). 1023-1042.
Baron, T. H. & et.al. (2020). American gastroenterological association clinical practice update:
management of pancreatic necrosis. Gastroenterology. 158(1). 67-75.
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wound healing. British journal of community nursing. 24(Sup3). S28-S33.
Cassiani, S. H. D. B., & Lira, J. C. G. (2018). Nursing perspectives and the “Nursing Now”
campaign.
Gilardi, E. & et.al. (2020). High-flow nasal cannula for body rewarming in hypothermia. Critical
Care. 24(1). 1-2.
Mahadevan, U. & et.al. (2019). Inflammatory bowel disease in pregnancy clinical care pathway:
a report from the American Gastroenterological Association IBD Parenthood Project
Working Group. Inflammatory bowel diseases. 25(4). 627-641.
Mydske, S., & Thomassen, Ø. (2020). Is prehospital use of active external warming dangerous
for patients with accidental hypothermia: a systematic review. Scandinavian journal of
trauma, resuscitation and emergency medicine. 28(1). 1-8.
Pazderska, A., Pearce, S. H., & Mitchell, A. L. (2018). Autoimmune Addison’s disease: genetic
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replacement dose in patients with primary adrenal insufficiency. The Journal of Clinical
Endocrinology & Metabolism. 105(1). 314-326.
Soukup, T. & et.al. (2018). Successful strategies in implementing a multidisciplinary team
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warming and passive warming on unplanned hypothermia during perioperative period:
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Zając, K., & Važanić, D. (2018). Patient in hypothermia-diagnostic and treatment problems in
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